Myanmar: Pioneering TB Testing and Treatment

WASHINGTON, DC, October 26, 2004 — PSI/Myanmar has significantly improved detection, diagnosis and treatment of tuberculosis (TB) in pilot regions since launching PSI's first such program in March 2004. By adding TB screening and branded Directly Observed Treatment (DOTS) to the services and products offered through PSI/Myanmar's Sun Quality Health (SQH) network of private clinics, and motivating those at risk to get tested and treated, Myanmar is blazing a path not only for PSI but for other TB implementers and donors.

One-third of the world's population is infected with TB. Surrounded by a waxy coating, the bacterium can survive in the body for years in a latent state, waiting for the immune system to weaken - then it strikes, causing death if left untreated. The HIV epidemic has resulted in a global explosion of active TB cases. TB is the single largest killer of people with HIV. With their compromised immune systems inviting TB to shift from latent to active, people living with HIV have a 50-70% lifetime chance of developing active TB.

DOTS is recommended by WHO as the most effective strategy for combating TB, and has gained significant international acceptance and practice. The DOTS strategy is:

• Political commitment for sustainability;

• Simplified diagnosis by smear microscopy;

• Standardized six-month treatment regimen, in which the treatment is directly observed for at least the first two months;

• Uninterrupted supply of appropriate and affordable drugs; and

• Monitoring of outcomes for every patient through a systematic and uniform reporting system.

DOTS has proven highly effective in curing TB, preventing the emergence of drug-resistant TB and preventing new infections. Successful treatment rates of 85-95% are possible through effective DOTS programs, regardless of HIV status. A full course of drugs can cost as little as $10 per patient. TB control is among the most cost-effective public health interventions, costing an estimated $5-7 per disability adjusted life year (DALY) saved.

Improving the private sector's ability to manage TB effectively, PSI/Myanmar's integrated approach includes training SQH franchise members in TB diagnosis and treatment, and branding DOTS services, drugs and communications and motivating those at risk to get tested and complete treatment. Along the way, the program has taken numerous essential steps, including defining protocols, training and accrediting labs, conducting quality assurance, aggregating and sharing data and enlisting the help of Myanmar's biggest star - actor, singer and dancer Yazar Ne Win - in the production of a television spot.

Off to a solid start, SQH providers had registered and begun DOTS treatment for 1,311 confirmed TB cases by early October. Only ten clients have defaulted. PSI/Myanmar has trained over 100 SQH general practitioners in TB/DOTS, and seven private labs have been trained and accredited.

Mass communications are designed to increase care-seeking behavior and reduce stigma. Robust training for providers covers disease basics, high-risk groups, diagnosis, treatment, monitoring and patient education, with an emphasis on the quality of client interaction. Providers are given printed materials for counseling and client information. PSI also maintains a telephone hotline for providers; the questions and responses are summarized in a monthly bulletin distributed to all providers.

— Cheryl Barnds, PSI/Washington

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PSI-trained technicians at PSI/Myanmar Sun Quality Health clinics use sputum smear microscopy to diagnose tuberculosis. PSI/Myanmar's tuberculosis screening and branded Directly Observed Treatment products and services are motivating those at risk to get tested and treated.