Journey of TB preventive treatment (TPT) provision in Myanmar

In Myanmar, TPT started after the development of isoniazid preventive therapy (IPT) protocol through collaborative activity of National TB Programme (NTP) and National AIDS Programme (NAP) in 2008. A pilot project was held from August 2009 to June, 2012 in 9 pilot sites of Mandalay and Shan (Lashio and Tachilaik). The country adopted six-month long INH prophylaxis regimen for under 5-year-contacts of bacteriologically confirmed TB patients and PLHIV. Referencing IPT protocol, orientation to initiate “Myanmar IPT Pilot Project” was held. 

Doctor in Yangon providing TPT Photo credit: MATA

A total of 3,134 people living with HIV/AIDS (PLWHA) received IPT in the pilot project. 65 percent completed IPT, 29.5 percent were lost to follow up, 2.5 percent participants discontinued the treatment due to side effects, 1 percent died, and 2 percent developed TB during IPT. As a result of positive findings of the pilot project and lessons learnt, expansion of IPT was re-strategized. IPT was then expanded to all townships throughout the country in 2014.

The national TB programme provided TPT to 1741 eligible children during 2015-2018. During quarter 3 and 4 of 2019, 17 State and Regional level “advocacy meetings and trainings for TPT” was conducted by NTP with the technical support of WHO and resources of the Global Fund. As a result, the total numbers of IPT given to the under 5-year contacts of TB patients significantly increased from 534 in 2018 to 1226 in 2019 and 2139 in 2020. 

In 2020 October, the new Myanmar guideline of programmatic management of latent TB infection (in local Myanmar language) was developed and disseminated as a recommendation of the national level “workshop on latent TB infection treatment”. Pilot study using 3HP for 2 to 5-year-old children by NTP (Mandalay) has been conducted in 2020-2021, showing good results. In the near future, TPT with shorter regimen 3HP (Isoniazid and Rifapentine weekly for 3 months) will be rolled out. 

Due to the challenging political situation of Myanmar in 2021, TPT provision may have been reduced than the previous years (data awaited). WHO-Myanmar (TB team) has been facilitating capacity building trainings to implementing partners focusing on the importance of TPT, eligibility criteria for TPT, strengthening contact investigation and scaling up of TPT provision in an attempt to achieve the targets of the End TB and National TB Programme.