Search

 

Cablegate: Burma: Combating Mdr-Tb in Rangoon and Mandalay

VZCZCXRO3484
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB RUEHPOD
DE RUEHGO #0282/01 1141022
ZNR UUUUU ZZH
R 231022Z APR 08 ZDK TO ALL CTG NUM SVCS
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC 7421
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 1821
RUEHBY/AMEMBASSY CANBERRA 1072
RUEHKA/AMEMBASSY DHAKA 4830
RUEHLO/AMEMBASSY LONDON 2019
RUEHNE/AMEMBASSY NEW DELHI 4620
RUEHUL/AMEMBASSY SEOUL 8160
RUEHTC/AMEMBASSY THE HAGUE 0673
RUEHKO/AMEMBASSY TOKYO 5721
RUEHRO/AMEMBASSY ROME 0157
RUEHFR/AMEMBASSY PARIS 0576
RUEHCN/AMCONSUL CHENGDU 1424
RUEHCHI/AMCONSUL CHIANG MAI 1514
RUEHCI/AMCONSUL KOLKATA 0282
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHPH/CDC ATLANTA GA
RUCLRFA/USDA WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUCNDT/USMISSION USUN NEW YORK 1475
RUEKJCS/SECDEF WASHDC
RUEHBS/USEU BRUSSELS
RUEKJCS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 03 RANGOON 000282

SENSITIVE
SIPDIS

DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD
DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART;
OES/IHA/DSINGER AND NCOMELLA
DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL
CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN
USDA FOR OSEC AND APHIS
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM
DOD FOR OSD/ISA/AP FOR LEW STERN
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE
ROME FOR FAO
BANGKOK FOR REO OFFICE, USAID/RDMA HEALTH OFFICE - JMACARTHUR,
CBOWES
TOKYO FOR HEALTH OFFICER
PACOM FOR FPA

E.O. 12958:N/A
TAGS: ECON TBIO EAID SOCI PGOV AMED BM
SUBJECT: BURMA: COMBATING MDR-TB IN RANGOON AND MANDALAY

REF: A ) RANGOON 278 B) 07 RANGOON 1120 C) 07 RANGOON 1027

RANGOON 00000282 001.14 OF 003


1. (SBU) Summary. Tuberculosis is a growing concern in Burma, with
the Ministry of Health ranking it as the second priority disease
after HIV/AIDS. As the TB prevalence rate increases throughout the
country, the risk of multi drug resistant (MDR) and extensively drug
resistant (XDR) TB also increases. Recognizing that MDR-TB rates
are likely three times higher than previous estimates - 4.2 percent
and 15.5 percent MDR among new and previously treated cases in 2003
- the GOB plans to launch a three-year MDR-TB treatment pilot
program in 2008. Using second-line TB drugs procured from the Green
Light Committee, the National TB Program (NTP) will collaborate with
the WHO and MSF-Holland to provide treatment to 100 patients in
Rangoon and Mandalay in 2008 and extend the program to an additional
175 patients in mid-2009. Additionally, in the next few weeks the
GOB plans to establish a second-line treatment protocol based on the
results of 100 Category II TB failures analyzed in Belgium. If the
pilot program is successful, the GOB and WHO plan to expand the
program to the national level in the next five years. End Summary.

Growing Concern About MDR-TB
----------------------------

2. (SBU) Burma is one of 22 TB high burden countries in the world.
As the rate of TB prevalence increases throughout Burma, so does
the rate of MDR-TB. A 2003 WHO study on National Drug Resistance
showed that 4 percent of new TB cases and 15.5 percent of previously
treated TB cases were multi drug resistant - these figures are the
highest in Southeast Asia (Ref B). A 2006 MDR study in Rangoon
showed higher MDR-TB prevalence rates - 4.2 percent among new cases
and 18.8 percent among previously treated cases, which indicate
higher rates at the national level. WHO TB officer Dr. Hans Kluge
acknowledged that the true TB burden in Burma remains unknown but
that the TB prevalence rate, and thus the rate of MDR-TB rate, are
likely to be three times higher than previous estimates (Ref C).
While health officials cannot pinpoint exactly why the rate of
MDR-TB in Burma is so high, they note that both the availability of
inferior TB drugs on the local market, as well as higher default
treatment rates, play a role in creating new MDR-TB cases. The NTP
Reference Lab, under the guidance of Lab Director Dr. Ti Ti, is
currently conducting the Second National Drug Resistance survey.
Results are expected by late 2008.

3. (SBU) In addition to the National Drug Resistance Survey, the
Burmese Government, working with the WHO, sent samples from 100
Category II TB failures to the National Reference Lab in Antwerp for
analysis in 2007. While the results of the survey are not yet
finalized, Dr. Kluge and Dr. Win Maung from the NTP informed us that
almost all of the 100 cases were resistant to first-line TB drugs.

RANGOON 00000282 002.13 OF 003


Additionally, the Antwerp lab confirmed that one of the cases was
XDR-TB, which proves that XDR-TB does exist in Burma, albeit at an
unknown magnitude. The GOB and WHO will use the results of the
Antwerp study to establish a protocol of second-line drugs to treat
MDR-TB cases. According to Kluge, the Ministry of Health should
approve the protocol by the end of April.

GOB Efforts to Combat MDR-TB
----------------------------

4. (SBU) WHO and NTP officials agree that MDR and XDR-TB are
serious threats not just to Burma, but also the region, as Burmese
migrants with TB travel to neighboring countries to find work.
Indeed, a MSF-France clinic in Mae Sot, Thailand diagnosed several
cases of MDR and XDR-TB among Burmese migrants working in Thailand
in 2007 (Ref B). Thus, MDR and XDR-TB cases in Burma potentially
pose serious threats to the health of the region, Dr. Kluge
declared. The GOB recognizes the seriousness of TB, Dr. Kluge
stated. Although healthcare for Burmese citizens remains woefully
under funded, the GOB has increased its TB budget significantly -
from $14,500 in 1995 to $400,000 in FY08 - but the budget is still
far short of what is needed. In 2006, the GOB established the
National Drug Resistant TB Committee, comprised of officials the
NTP, Food and Drug Administration, National Health Lab, WHO, PSI,
and MSF-Holland. This committee created the National Response to
MDR-TB in Burma and helped establish a pilot protect to treat
MDR-TB, which will begin in late 2008. The GOB has also taken steps
to improve the NTP in recent years, recognizing that a strong DOTS
program is key to preventing MDR and XDR-TB. In the past two years,
the Ministry of Health created 13 additional posts to strengthen the
TB control activities at the State and Division level. It also
created a new MDR-TB consultant position to work with the WHO and
coordinate activities and draft the MDR-TB operational plan.

DOTS Plus Pilot Project
-----------------------

5. (SBU) The GOB has done more than just establish MDR-TB
treatment protocols, Dr. Kluge emphasized. In 2007, the NTP and the
WHO jointly applied for a grant from the Greenlight Committee to
fund a pilot project to treat MDR-TB. The Greenlight Committee
approved the grant in late 2007 and will provide second-line drugs
for 275 MDR-TB patients over three years. Second-line TB drugs are
much costlier than the drugs for first-line treatment and cost an
average of $3,000 per patient. To prepare for the pilot, the NTP
and WHO have established a national second-line drug treatment
protocol based on the results of the 100 Category II TB failures;
the National TB Committee should approve the protocol by the end of
April. Once the protocol is approved, the NTP and WHO will order

RANGOON 00000282 003.6 OF 003


the drugs, which should arrive within six months.

6. (SBU) NTP, in collaboration with the WHO and MSF-Holland, plan
to launch the MDR-TB pilot program by October 2008. Under the
program, the NTP will provide second-line drugs to 100 MDR patients
in five townships in Rangoon and Mandalay during the first year and
expand the program to an additional 175 patients by mid-2009.
During the first year, the National TB Committee will select 25
MDR-TB patients from Mandalay and 50 patients from Rangoon to
receive the drug protocol at either the Pathengyi TB Hospital or
Aung San TB Hospital. MSF-Holland will also select 25 of its
patients from Rangoon, who will be treated at Aung San Hospital.
MDR-TB treatment takes substantially longer than normal TB treatment
- 18 to 24 months compared to six to nine months. During the year,
patients will spend the first four months at either of the two TB
hospitals, where they will be monitored daily. For the remaining
months, patients will receive daily outpatient care. Because the
MDR-TB treatment is so time consuming, the NTP will rely on
community volunteers and health workers from Population Services
International (PSI), MSF-Holland, and World Vision to monitor
patients' treatment. NTP officials will be responsible for the
monitoring and evaluation of the program. It will be challenging,
Kluge declared, but he believes the NTP is committed to treating
MDR-TB and containing the problem within Burma.

Comment
-------

7. (SBU) The Ministry of Health is not the obstacle to tackling
Burma's TB problem. It is staffed with low-paid but dedicated civil
servants who comprehend the growing problem and are trying their
best to treat it with the minimal resources the senior generals
allocate to them. While the national program and private sector
appear to be handling the current TB case load, an increasing number
of MDR-TB cases will overburden the program's capacity. This pilot
program will enable the NTP and Ministry of Health to show that they
can handle more difficult TB cases. However, Burma also needs to
focus on preventing MDR-TB as well as treating it. The best way to
prevent MDR-TB and XDR-TB outbreaks is to strengthen the exiting NTP
and DOTS program and promote educational outreach to ensure that new
cases are treated properly. Burma's growing TB problem is a danger
to the region, and eventually to the world, if it cannot be
contained soon.

VILLAROSA

© Scoop Media

 
 
 
 
 
World Headlines

 

Werewolf: Gordon Campbell On North Korea, Neo-Nazism, And Milo

With a bit of luck the planet won’t be devastated by nuclear war in the next few days. US President Donald Trump will have begun to fixate on some other way to gratify his self-esteem – maybe by invading Venezuela or starting a war with Iran. More>>

Victory Declared: New Stabilisation Funding From NZ As Mosul Is Retaken

New Zealand has congratulated the Iraqi government on the successful liberation of Mosul from ISIS after a long and hard-fought campaign. More>>

Gordon Campbell: On The Current US Moves Against North Korea

If Martians visited early last week, they’d probably be scratching their heads as to why North Korea was being treated as a potential trigger for global conflict... More>>

ALSO:

Gordon Campbell: On The Lessons From Corbyn’s Campaign

Leaving partisan politics aside – and ignoring Jeremy Corbyn’s sensational election campaign for a moment – it has to be said that Britain is now really up shit creek... More>>

ALSO:

Another US Court: Fourth Circuit Rules Muslim Ban Discriminatory

ACLU: Step by step, point by point, the court laid out what has been clear from the start: The president promised to ban Muslims from the United States, and his executive orders are an attempt to do just that. More>>

ALSO:

 
 
 
 
 
 
  • Pacific.Scoop
  • Cafe Pacific
  • PMC