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National Tuberculosis Programme Myanmar Annual Report 2016 June

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National Tuberculosis Program Annual Report 2016 NATIONAL TUBERCULOSIS PROGRAMME MYANMAR ANNUAL REPORT 2016 JUNE 2018 National Tuberculosis Program Annual Report 2016 National Tuberculosis Program Annual Report 2016 CONTENTS Page List of Abbreviations 1 Introduction 1 2 Objectives of NTP 2 3 Human resource of NTP in Myanmar 4 4 Progress of end TB strategy 5 5 External Technical Support 77 6 BCG Immunization 84 7 Budget and External Technical Support 85 8 Progress Towards NTP Goals in 2016 87 9 Evaluation of Regional and State level TB control achievement 96 10 Possble actions to be taken for solving the problems 122 11 Recommendations 124 12 Conclusions 125 13 Annexs 126 National Tuberculosis Program Annual Report 2016 National Tuberculosis Program Annual Report 2016 Abbreviations ACSM Advocacy, Communication and Social Mobilization AD Assistant Director AFB Acid-Fast Bacilli AIDS Acquired Immunodeficiency Syndrome ARTI Annual Risk of Tuberculosis Infection BCG Bacille Calmette Guerin BHS Basic Health Staff CBTC Community Basd TB Care CNR Case Notification Rate DD Deputy Director DOH Department of Health DOT Directly Observed Treatment DOTS Directly Observed Treatment Short Course DST Drug Sensitivity Testing ELISA Enzyme-Linked Immuno-Solvent Assay EPI Expanded Programmen fo Immunization ETB Ethambutol EQA External Quality Assessment FDC Fixed-dose combination FLD First Line Anti-TB drugs FHI 360 Family Health Internaitonal 360 FM Fluorescence Microscope GF Global Fund GLC Green Light Committee GPs General Practitioners HIV Human Immunodeficiency Virus HA Health Assistant HSS HIV Sentinel Surveillance HFN High False Positive IEC Information, Education, Communication INH Isoniazid IOM International Organization for Migration IPT Isoniazid Preventive Therapy JICA Japan International Cooperation Agency LHV Lady Health Visitor LFN Low false negative i National Tuberculosis Program Annual Report 2016 LFP Low falise positive LPA Line Probe Assay MDR-TB Multidrug-resistant tuberculosis MGIT Mycobacterium Growth Indicator Tube MMA Myanmar Medical Association MMCWA Myanmar Maternal and Child Welfare Association MO Medical Officer MOHS Ministry of Health and Sports MHSCC Myanmar Health Sector Coordinating Committee MWAF Myanmar Women’s Affair Federation MRCS Myanmar Red Cross Society MSF Medecins Sans Frontieres MWs Midwives NGOs Non Governmental Organizations NAP National AIDS Programme NHL National Health Laboratory NTM Non-tuberculosis Mycobacteria NTP National Tuberculosis Programme NTRL National Tuberculosis Reference Laboratory PHSII Public Health Supervisor II PSI Population Services Internation QC Quality Control RHC Rural Health Center SCC Sputum Collection Center SOP Standard Operational Procedure STLS Senior Tuberculosis Laboratory Supervisor SDGs Sustainable Development Goals TL Team Leader TOT Training of Trainers TSG Technical Strategic Group TMO Township Medical Officer UTI Union Tuberculosis Institute USAID United States Agency for International Development XDR-TB Extensively Drug resistant Tuberculosis 3MDG Three Millenium Development Goal Fund ii National Tuberculosis Program Annual Report 2016 NATIONAL TUBERCULOSIS PROGRAMME ANNUAL REPORT (2016) 1. INTRODUCTION Tuberculosis (TB) is one of the major public health problems in Myanmar. The country is listed among 30 high TB/TB-HIV/MDR-TB burden countries. According to Global TB Report 2017, WHO estimated that TB incidence in 2016 was 361/100,000 population and TB mortality was 47/100,000 population. It is estimated that 191,000 new TB patients develop. Prevalence of HIV sero-positive among new TB patients was 8.5% according to the sentinel surveillance conducted at 34 sites in 2016. Prevalence of multi-drug resistant TB (MDR-TB) was reported as 5% among new TB patients in third nationwide drug-resistant TB survey conducted in 2012-2013. In 2016, totally 139,625 TB patients (all forms) were notified in Myanmar (Case Notification Rate of 277/100,000 population) in which 46,037 patients were bacteriologically confirmed TB cases. NTP achieved treatment success rate (TSR) of 87% among all form TB cases in 2016. The National Tuberculosis Programme (NTP) is functioning with 17 Regional and State TB Centers with (404) TB teams at district and township levels. TB control activities are being implemented at township level by the Township Medical Officer, through integration with primary health care. NTP covered all 330 townships with DOTS strategy in November 2003 and all 330 townships including five new townships established in the Nay Pyi Taw Council area in 2011. The diagnosis of TB is primarily based on direct sputum smear microscopy. The External Quality Assurance System (EQAS) for sputum microscopy has been introduced in Myanmar since 2006 and at the end of 2016, 520 public and private laboratories were under it. The NTP has introduced Fixed Dose Combinations (FDC) of first- line anti-TB drugs since 2004 and started using patient kits in 2010, as per WHO recommended treatment guidelines. The Basic Health Staffs (BHS) closely supervise TB patients to take anti-TB drugs. The National Drug-resistant Tuberculosis (DR-TB) Expert Committee was established in September 2006 and a pilot project for the management of MDR-TB was begun in July 2009, embedded within the existing TB control programme. The project has experienced great success. In order to address the high burden of MDR-TB in the country, the pilot project was expanded with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). By the end of 2016, MDR-TB diagnosis, treatment and care services were scaled up to all 330 townships. The rapid diagnostic test known as 1 National Tuberculosis Program Annual Report 2016 Gene-Xpert, was introduced in 2011 and by the end of 2016 operational in 65 sites, mainly at Region/State and District TB centres. Regarding TB/HIV collaborative activities, the National TB/HIV coordinating body, organized in 2005, was reformed in 2012. TB/HIV collaborative activities were initiated in seven townships in 2005, scaled up to 236 townships in 2015, covering to all 330 townships in 2016. HIV sentinel surveillance (HSS) among new TB patients has been initiated in 5 townships since 2005 under the surveillance system of National AIDS Programme (NAP). The HSS townships are gradually expanded and numbered 34 in 2016. According to 2016, HSS, HIV prevalence among new TB patients was 8.5%. The HSS has been planned to carry out once every two year since 2016 term. The Public-Public Mix DOTS activities have been implemented in four public general hospitals since 2007 with the support of Three Diseases Fund (3DF). The NTP gradually scaled up to 25 public hospitals in 2016 with the support of the Global Fund (GF). The Public-Private Mix DOTS activities have also been initiated since 2004-2005 in collaboration with NTP, Myanmar Medical Association (MMA) and Population Services International (PSI). Till the end of 2016, PSI implemented PPM DOTS activities with scheme III in 199 townships and MMA in 135 townships across the country. Community-based TB care (CBTC) activities have been implemented by four local non-governmental organizations (NGOs) and six international NGOs (INGOs) since 2011 with the support of the GF. The Three Millennium Development Goals Fund (3MDG) also funded CBTC activities through 4 INGOs and 2 local NGOs since 2014. In 2016, 4 local NGOs and 9 INGOs implemented CBTC activities. 2. OBJECTIVES OF NTP The overall goal of the NTP is to reduce morbidity, mortality and transmission of TB until it is no longer a public health problem, to prevent the development of drug resistant TB. Specific objectives are set towards achieving the Sustainable Development Goals (SDGs) target 3.3 aiming to end the epidemic of TB by 2030; a 90% reduction in TB deaths a 80% reduction in the TB incidence rate (to less than 10 per 100 000 population) compared with 2015. an earlier target, linked to progress towards UHC, is that zero TB-affected families should face catastrophic costs due to TB by 2020. 2 National Tuberculosis Program Annual Report 2016 National TB Strategic Plan (2016-2020) On the other hand, NTP is implementing TB control activities in conjunction with the National Strategic Plan for TB (2016-2020). The NSP (2016-2020) is based on WHO End TB Strategy, in line with Universal Health Coverage plan, and Vision, Goal, Objectives and Strategies of the National Strategic Plan for TB Control in Myanmar have been set up as the followings: Vision: A World Free of TB: less than 1 TB case/1 million population by 2050 (zero deaths, Zero disease and Zero suffering due to TB) Goal: End of the Global TB Epidemic: less than 10 TB cases/100,000 population by 2035 General objective: To reduce mortality, morbidity and catastrophic cost due to TB Specific objectives: 1. Reduce the prevalence of all forms of TB by 25% by 2020, compared to the 2015 baseline (5% reduction per year during 2016-2020) 2. Reduce the prevalence of MDR among new TB cases by 20% by 2020, compared to 2015 (4% reduction per year) 3. Reduce the mortality due to TB by 35% by 2020, compared to the 2015 baseline (7% reduction per year) 4. Reduce the incidence of all form of TB by 15% by 2020, compared to 2015 (3% per year) 5. Reduce the affected families face catastrophic costs due to TB by 2020 (target to be determined after baseline TB catastrophic costs survey [2015-2016]) NSP is also strategized according to three Strategic Directions; Strategic Direction I: Integrated, Patient-centered Care and Prevention Strategic Direction II: Bold Policies and Supportive Systems Strategic Direction III: Intensified Research and Innovation. The government increases the budget for TB control gradually, especially for anti-TB drug procurement. TB patients have been treated with WHO recommended regimens using Fixed Dose Combination of first line anti-TB drugs (FDC) since 2004. NTP started to use patient kits in April, 2010. Treatment for drug resistant TB started in 2009 and the second line drugs procurement using government budget started in 2014-2015 budget year.
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