BURMA: GOVERNMENT LAUNCHES PILOT MDR-TB PROGRAM;

C O N F I D E N T I A L SECTION 01 OF 03 RANGOON 000428

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E.O. 12958: DECL: 07/10/2019
TAGS: ECON TBIO EAID SOCI PGOV AMED BM
SUBJECT: BURMA: GOVERNMENT LAUNCHES PILOT MDR-TB PROGRAM;
PLANS TO FILL TB-DRUG GAP

REF: A. RANGOON 156

B. RANGOON 200

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Classified By: Economic Officer Samantha A. Carl-Yoder for Reasons 1.4
(b and d).

Summary
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1. (C) The Burmese Ministry of Health (MOH),in coordination
with the World Health Organization (WHO) and Medecins sans
Frontieres-Holland (MSF-Holland),launched a three-year
multi-drug and extensively-drug resistant tuberculosis (MDR-
and XDR-TB) pilot program in Rangoon on July 9; the MOH plans
to begin the pilot program in Mandalay on July 15. The USG,
through USAID, provides technical support for the program,
which will provide DOTS Plus treatment to 275 MDR-TB
patients. MOH continues to try to prevent MDR-TB by
strengthening first-line TB treatment; however, the GOB still
lacks funding to fill an expected one-year gap in the TB drug
supply, starting mid-2010 and continuing until the hoped for
start of a renewed Global Fund program. While donors have
not officially pledged funding, the Three Diseases Fund will
likely provide USD 3 million to cover the initial gap and the
Japanese Government could provide as much as USD 4 million
for TB drugs in 2011. End Summary.

Combating MDR-TB
--------------


2. (SBU) According to the WHO, Burma is one of 27 MDR- and
XDR-TB high-burden countries. The MOH's 2007 National Drug
Resistance Survey indicates that MDR-TB accounts for 4.2
percent of new TB cases and 10 percent of previously treated
cases (Ref A). Dr. Zaw Win, Deputy Director General of
Disease Control, confirmed Burma has an estimated 2,400
MDR-TB patients, although the number may be much higher. The
National TB Program (NTP) currently has no protocol for MDR-
and XDR-TB treatment, WHO TB Officer Dr. Hans Kluge told us.
In the past, NTP officials treated MDR-TB patients with
first-line TB drugs and holistic medicines. Consequently,
Burma has a high rate of MDR-TB mortality, he noted.


3. (SBU) Since 2007, the MOH has worked closely with public
and private partners to address MDR-TB, including increasing
public awareness of the disease, strengthening basic DOTS
treatment, improving diagnostic capacity, and developing a
DOTS Plus MDR-TB pilot program. The NTP, in collaboration
with WHO and MSF-Holland, launched its MDR-TB treatment pilot
program in Rangoon on July 9. The Charge, EconOff, and a
USAID rep from Bangkok participated. The Mandalay launch is
scheduled for July 15. According to Dr. Zaw Win, the NTP

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will provide second-line DOTS treatment to 100 MDR-TB
patients in five townships in Rangoon and Mandalay during the
first year and expand the program to an additional 175
patients by mid-2010. MDR-TB treatment lasts up to two
years, compared with a normal TB treatment course of six to
nine months. Patients will receive initial treatment at
either the Aung San TB Hospital in Rangoon or the Pathengyi
TB Hospital in Mandalay for between four and six months;
followed by daily outpatient care.

Addressing the Looming Gap in TB Drug Supply
--------------


4. (SBU) During the launch ceremony, Dr. Kluge emphasized
that strengthening first-line TB treatment is vital for
reducing the spread of MDR-TB. Burma currently receives TB
drugs, which it provides free of charge to TB patients, from
the Global Drug Facility (GDF). However, GDF funding for
DOTS treatment will end in December 2009, and the MOH faces a
potential gap of at least one year in the first-line TB drug
supply by mid-2010. The GOB applied for a Round Nine Global
Fund grant, which includes funding for TB drugs. That
funding, if approved, would not likely flow until mid-2011
(Ref B). While the MOH has pledged to increase funding for
TB medicines, it lacks the resources to cover the entire gap,
estimated to cost more than USD 4 million.


5. (C) Julia Kemp, DFID Health Officer, told us DFID,
through the Three Diseases Fund (3DF),will make available up
to USD 3 million for TB drugs to cover the initial gap. 3DF
expects to announce this funding in the next month. Matsui
Suzuka, Japanese Embassy Economic Counselor, confirmed the
Japanese Government, in response to a MOH proposal for
funding, will conduct a fact-finding mission in the next
three months to determine Burma's drug need. He intimated
that the Japanese Government would likely provide up to USD 4
million, starting in 2011, to bridge the remaining gap.
However, he observed that any Japanese Government funding
will likely depend heavily on whether the GOB receives a
Global Fund grant, as the GOJ does not want to commit to
long-term funding.

Comment
--------------


6. (SBU) WHO, using USAID assistance, is strengthening
Burma's first-line and second-line TB programs through health
worker education, creation and adoption of international
protocols on TB treatment, and expansion of surveillance.
During the launching ceremony, officials from both the WHO
and the Ministry of Health, thanked the Charge and USAID for
the USG's generous contribution and support for the program.

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