Epidemiological profile of DR-TB and TB/HIV co-infection in Myanmar

Epidemiological profile of DR-TB and TB/HIV co-infection in Myanmar Dr Thar Tun Kyaw Director, Disease Control

The time is now!

Turning the tide on drug-resistant TB and TB/HIV co-infection in Myanmar 22-23 August 2013

Presentation overview Global TB, MDR-TB and HIV situation Myanmar TB, MDR-TB and HIV situation Country profile and situation analysis Management of MDR-TB Management of TB/HIV

The Global Burden of TB -2011 Estimated number of cases

All forms of TB

8.7 million (8.3–9.0 million)

HIV-associated TB

Multidrug-resistant TB

Estimated number of deaths

1.4 million* (1.3–1.6 million)

1.1 million (13%)

430,000

(1.0–1.2 million)

(400,000–460,000)

630,000

Unknown, but probably > 150,000

(460,000-790,000) out of ~12 million prevalent TB cases Source: WHO Global Tuberculosis Report 2012

* Including deaths attributed to HIV/TB

TB incidence rates, 2011

0–24 25–49 50–149 150–299 ≥300

Per 100 000 population

Highest rates in Africa linked to high rates of HIV infection, ~80% of HIV+ TB cases Highest rates also in Myanmar and Cambodia

Drug resistant TB: Major challenge

o Multi-drug resistant TB (MDR-TB) •

Second-line drugs, toxic, costly, lengthy

o Extensively drug resistant TB (XDR-TB) •

Almost incurable, fatal

o Drug resistant TB results from inadequate TB care and irrational use of drugs o New York epidemic in early 90’s – Cost of response: US$ 1 billion

Estimated number of MDR-TB Cases, 2011

Adult HIV prevalence (15-49 years),

by WHO region - 34 million people living with HIV/AIDS worldwide in 2011

TB situation in Myanmar, 2011 240,000 prevalent cases

600

180,000 incident cases 10% HIV co-infected 9,000 with MDR-TB

Rate per 100,000 population

500

400

300

200

100

0 Mortality Myanmar

Prevalence

Incidence

WHO Southeast Asian Region

Global

TB epidemiology in Myanmar, 2011 Mortality

Prevalence

Incidence and notifications

MDR-TB situation in Myanmar • WHO estimates that there were 5,500 MDR-TB cases among notified pulmonary TB cases in 2011 • Among the total annual TB cases 9,000 are estimated to have MDR-TB • Two nationwide drug resistance surveys completed and a third being finalized • A total of 5 XDR-TB cases have been confirmed New cases Cases with DST results (H+R)

Previously treated cases

Multidrug-resistant

No.

%

Multidrug-resistant Cases with DST results (H+R)

No.

%

20022003

3.90%

15.50%

20072008

4.2% (3.1-5.6)

10.0% (6.9-14.0)

2013

1,071

45

299

30

Third survey to be completed in 2013

HIV situation in Myanmar • HIV seroprevalence – adult population – 0.53% • HIV Prevalence among sentinel population – HSS 2011 Sentinel Group Male STI

Sero positive (%) 4.6%

95% CI 4 - 5.2

FSW Injecting drug users MSM

9.4% 21.9% 7.8%

7.6 - 11.2 19.5 - 24.4 5.1 - 10.4

Pregnant Women Military recruits

0.9% 1.5%

0.7 - 1 0.7 - 2.3

New TB patients Blood donors

9.9% 0.22%

8.8 - 11 0.1 - 0.3

HIV/AIDS situation in Myanmar • First HIV positive case reported : 1988 • First AIDS case reported : 1991 • Main mode of transmission: Sexual Transmission Regional and in-country workshop on Estimation and Projection of HIV/AIDS in Myanmar has been conducted biannually since 2005 According to the results of 2010 Estimation and Projection of HIV/AIDS in Myanmar:

Estimated number of people living with HIV/AIDS (Adults + Children) 213,668

Estimated number of AIDS Deaths (Adults + Children) 15,741

20000

16000

12000

8000

4000

0 1985

1990

Estimated number of New HIV Infections

1995

2000

2005

2010

2015

Estimated number of ART Needed 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 2011

2012 15+

2013 <15

needing PMCT

2014

2015

Country profile and situational analysis • Population: 60 million • 7 Regions + 7 States + Nay Pyi Taw • 330 Townships • 69 Districts • District TB Teams - 43 • Township TB Teams - 58 • AIDS/STD Teams - 45 • Both TB and AIDS/STD teams – 34

• DOTS coverage: all townships since 2003 • ART treatment and care: 47 sites • MDR-TB coverage: 38 townships • TB/HIV collaborative activities: 18 townships

TB and HIV national strategic plans including plans on TB/HIV and MDR-TB plus new MDR-TB guidelines

Number of MDR-TB patients enrolled on treatment 2009-2013 (first quarter) 1000

800

Cumulative number

861

First cohort evaluated show 71% cure rate (n=185)

900

796

700 600

523

500

426 354

400

376

304 287 247

300 192 158 125

200 64 100

43

92

End DOTS-Plus pilot project

0 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1

MDR-TB training for Medical Officers & Hospital staff

MDR-TB counseling training

Developed SOPs in 2007, finalized in 2009 and revised in 2013

A Guide for MDR-TB Treatment Supporter

Infection control training

Training module for Basic Health Staff

MDR-TB patients at Aung San TB Hospital, Yangon, and in Meiktila Township, Mandalay Region

Laboratories, drugs, staff, social support and information systems

TB/HIV collaborative activities in 2011 to 2012 (VCCT) - VCCT (2011-2012) TB/HIV collaborative townships 12000 10000

9683

Registered TB patient

8000 6000

51%

HIV Tested

6394

65%

5626

4937

48%

4000

4137

61%

3530

2700

2134

2000

0 M

F

2011

M

F

2012

ď&#x192;ź Calculation based on 15 TB/HIV sites in 2011 and 18 TB/HIV sites in 2012

TB/HIV collaborative activities in 2011 to 2012 (VCCT) – MOH and partners NTP only

NTP + Partners

No. of registered TB patients (≥15 years)

9,924

34,535

No. of VCCT accepted & HIV tested

6,271

18,683

% of VCCT tested

63.2%

54%

No. of HIV sero (+)ve among tested

1,088

3,100

% of HIV (+)ve among TB patients tested

17.3%

16.6%

Indicators

Thank you very much for your attention