VZCZCXRO6184
RR RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHGO #0156/01 0700633
ZNR UUUUU ZZH
R 110633Z MAR 09
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC 8762
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 2215
RUEHBY/AMEMBASSY CANBERRA 1841
RUEHKA/AMEMBASSY DHAKA 5141
RUEHLO/AMEMBASSY LONDON 2077
RUEHNE/AMEMBASSY NEW DELHI 5315
RUEHUL/AMEMBASSY SEOUL 8915
RUEHTC/AMEMBASSY THE HAGUE 0711
RUEHKO/AMEMBASSY TOKYO 6488
RUEHRO/AMEMBASSY ROME 0185
RUEHFR/AMEMBASSY PARIS 0606
RUEHCN/AMCONSUL CHENGDU 1731
RUEHCHI/AMCONSUL CHIANG MAI 2096
RUEHCI/AMCONSUL KOLKATA 0579
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHPH/CDC ATLANTA GA
RUCLRFA/USDA WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUQ/USMISSION USUN NEW YORK 2309
RUEKJCS/SECDEF WASHDC
RUEHBS/USEU BRUSSELS
RUEKJCS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 04 RANGOON 000156 
 
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: LAUNCHING PILOT PROJECT TO COMBAT MULTI-DRUG 
RESISTANT TB 
 
RANGOON 00000156  001.2 OF 004 
 
 
Summary 
------- 
 
¶1. (SBU)  The Burmese Ministry of Health, working with the World 
Health Organization (WHO) and Medecins sans Frontieres-Holland, will 
launch a three-year multi-drug and extensively-drug resistant 
tuberculosis (MDR- and XDR-TB) pilot program in Rangoon on March 23 
and Mandalay on April 2.  The National TB Program will provide 
treatment to 100 patients in Rangoon and Mandalay in 2009 and an 
additional 175 patients in 2010.  If the pilot program is 
successful, the GOB and WHO will expand it to the national level in 
the next five years, pending funding.  In celebration of World TB 
Day on March 24, the MOH will adopt the International Standards for 
TB Care (ISTC), which will help unify public and private sector 
approaches to diagnosis and treatment of TB and improve Burma's 
capacity to identify and treat the disease.  End Summary. 
 
Determining TB Prevalence Rates 
------------------------------- 
 
¶2.  (SBU)  According to the WHO, Burma is one of 22 TB high-burden 
countries in the world, with a GOB-estimated TB prevalence rate of 
1.5 percent.  The true burden of TB in Burma remains unknown; WHO TB 
Officer Dr. Hans Kluge estimates that the rate could be at least 
three times higher than Ministry of Health figures.  In 2007 the 
National TB Program (NTP) diagnosed 133,547 TB cases, up from 
107,991 in 2006.  Eighty percent of all TB cases in Burma are among 
those between 15 and 54, and one out of every six children has TB. 
The mortality rate for TB infected patients in 2007 was 23 deaths 
per 100,000 people, or more than 11,000 deaths annually -- a rate 
the WHO believes will increase in future years. 
 
¶3.  (SBU)  Contacts at Population Services International (PSI) and 
Medecins sans Frontieres (MSF)-Holland believe that more than 40 
percent of Burma's population contract TB annually.  While the MOH 
publicly rejects this figure, MOH officials privately admit that the 
prevalence rate is likely far higher than GOB estimates.  The MOH, 
working with WHO, PSI, and the Three Diseases Fund (3DF), is 
currently conducting a new National TB Prevalence Survey.  MOH 
Deputy Director of Infectious Disease Dr. Kyaw Nyunt Sein told us 
that the MOH will finish data Qection by the end of 2009 and 
publish the results by mid-2010. 
 
MOH Efforts to Combat MDR-TB 
---------------------------- 
 
¶4.  (SBU)  According to the MOH's most recent National Drug 
Resistance Survey in 2007, MDR-TB accounts for 4.2 percent of new TB 
cases and 10 percent of  previously treated cases.  (Note:  the 
 
RANGOON 00000156  002.2 OF 004 
 
 
percent of MDR-TB among previously treated cases was last estimated 
at 15.5 percent during the 2002 MDR-TB Prevalence Survey.  WHO and 
MOH have yet to analyze the reasons for the apparent decrease.  End 
Note.)  WHO recently concluded a study of 100 Burmese TB patients 
whom the NTP categorized as Category II TB failures (they defaulted 
on several TB treatments), and determined that all 100 patients had 
MDR-TB and one had XDR-TB.  Kluge commented that these results, just 
a small sample of Burma's TB patients, prove that MDR-TB could be 
far more widespread that previously thought.  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. 
 
¶5.  (SBU)  WHO and NTP officials note that MDR and XDR-TB are 
serious regional threats because Burmese migrants with TB travel to 
neighboring countries to find work.  Although healthcare for Burmese 
citizens remains woefully under funded, the GOB has increased its 
NTP budget significantly -- from $14,500 in 1995 to $400,000 in FY08 
-- but the budget is still far short of what is needed.  (Note:  The 
NTP budget is used to pay for TB drugs and other medical treatment. 
Medical infrastructure, salaries, and other administrative costs are 
paid for out of the general MOH budget.  End Note.)  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 the pilot project 
to treat MDR-TB to be launched in March.  The GOB has also taken 
steps to improve the NTP in recent years, recognizing that a strong 
DOTS (directly observed treatment, short course) 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. 
 
New MDR-TB Pilot Project 
------------------------ 
 
¶6.  (SBU)  NTP, in collaboration with WHO and MSF-Holland, will 
launch its MDR-TB treatment pilot program in Rangoon on March 23 and 
in Mandalay on April 2.  Through the program, the NTP will provide 
second-line DOTS treatment 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-2010.  The National TB Committee 
has already selected 25 MDR-TB patients from Mandalay and 75 
patients from Rangoon to receive the drug protocol at either the 
Pathengyi TB Hospital or Aung San TB Hospital, Dr. Kyaw Nyunt Sein 
told us.  MSF-Holland will also select 25 of its patients from 
 
RANGOON 00000156  003.2 OF 004 
 
 
Rangoon, who will be treated at Aung San Hospital during the first 
year.  Funding for the program (USD 1 million) will be provided by 
the WHO's Greenlight Committee Initiative, which helps countries 
gain access to high-quality second-line TB drugs. 
 
¶7.  (SBU)  MDR-TB treatment takes substantially longer than normal 
TB treatment -- 18 to 24 months compared to six to nine months, 
Kluge explained.  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 PSI, MSF-Holland, and World Vision to monitor patients' 
treatment.  NTP officials will be responsible for the monitoring and 
evaluation of the program.  Kluge said that he believes the NTP is 
committed to treating MDR-TB and containing the problem within 
Burma. 
 
Celebrating World TB Day March 24 
--------------------------------- 
 
¶8.  (SBU)  During a planned March 24 ceremony in Nay Pyi Taw 
commemorating World TB Day, the Minister of Health  will announce 
the GOB's adoption of the International Standards for TB Care (ISTC) 
-- 17 standards that will govern public and private sector 
approaches to diagnosis and treatment of TB in Burma.  During the 
past two months, WHO, with USAID FY08 funding for TB, has held 
several technical assistance and training sessions for high-level 
MOH officials, TB treatment providers, medical school professors, 
and doctors to discuss implementation of the ISTC.  According to Dr. 
Philip Hopewell, Professor of Medicine at the University of 
California, San Francisco and visiting technical advisor, the MOH 
appears committed not only to implement the ISTC, but also to find 
ways to monitor and evaluate the treatment standards.  By July 2009, 
the MOH plans to translate the ISTC into Burmese and expects to 
begin working with the Myanmar School of Medicine to incorporate the 
ISTC into the curriculum. 
 
Comment 
------- 
 
¶9.  (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 TB 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 requiring significant additional resources will soon 
overburden the program's capacity.  The upcoming pilot program will 
 
RANGOON 00000156  004.2 OF 004 
 
 
provide the NTP and Ministry of Health with a better sense of 
treatment requirements for difficult TB cases.  However, Burma 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 existing 
NTP and DOTS program and promote educational outreach to ensure that 
new cases are treated properly.  Burma's growing TB problem could be 
a danger to the region, and eventually to the world, if it cannot be 
contained. 
 
VAJDA