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