The USAID-funded CAP-TB Project provides technical assistance and support to the Myanmar National Tuberculosis Program (NTP) to reduce the incidence of and mortality-related to multidrug resistant tuberculosis (MDR-TB) in Myanmar. The Project has four intermediate results (IRs) that contribute to USAID’s overall goal for the control and prevention of MDR-TB: (1) Strengthened TB Prevention, (2) Strengthened MDR-TB management,( 3) Improved strategic information for MDR-TB, and ( 4) Strengthened enabling environment for MDR-TB. The Myanmar Health Assistant Association (MHAA) is a partner on the CAP-TB Project and will contribute to all IRs. MHAA is working in the following townships in Mandalay Region; AungMyaeTharzan, Chan Aye ThaZan,MaharAungMyay, and Patheingyiby basing atPatheingyi Township.

Snap Shot

cap-tb-1

The challenge of TB infection control becomes a clearer picture when viewed through the story of one patient. This is “M”, who is a 17 year old MDR-TB patient who has almost completed her treatment of 24 months. M contracted MDR-TB when she was living in Myitkyina, Myanmar, in a house with her father, two sisters, and 14 other relatives. Her father fell ill with TB in 2005, and even after 2 years of inpatient treatment for TB, he is still confined to his bed today.

When M came down with MDR-TB, she moved into her aunt’s home in Mandalay, where she could get treatment from Myanmar's National TB Program. But the aunt also came from a family that had been struck by TB -- seven out of 20 family members had all successfully received Category I TB Treatment -- and her house was small and, something even worse for TB: poorly ventilated.

Three months ago, M and her aunt moved to a larger, better-ventilated house, and she is feeling better and glad that she will soon be off her treatment. But her story clearly illustrates the conditions facing those who aim to beat TB in Myanmar. Infection is worse in close quarters, and large, cramped households like M's lead to the spread of TB and MDR-TB. M was in tears when she told us about her ill father and the worries that her sisters might become infected.

These are the stories that give rise to the strategies and concrete methods that CAP-TB supports: methodical infection control to prevent infection before it happens, and treatment through Directly Observed Therapy (DOTS) when it does. Remembering the families and homes that are helped by this work makes us more effective.

Infection Control

For U Ba Maung, infection control is not just an academic phrase. For the 63-year-old U Ba, it means riding his motorcycle through dense city streets and village roads, finding the hard-to-locate homes of TB patients, and tracing their close personal contacts to help detect spread of infection and halt it by means of early screening, medical treatment, and education in health practice. U Ba Maung is one of the newest Community Health Facilitators for CAP-TB partner, MHAA. For more than 40 years, U Ba has worked in public health. Now, he lends his expertise by riding his motorcycle throughout two townships in the Mandalay area, giving health education to the general population and direct facilitation to TB patients in their homes. Much about defeating MDR-TB comes down to a simple challenge: Bring the work all the way into the community. While it is critical for doctors and public health officials to have a great plan, the real victory comes when the people in the streets know about TB and how to prevent and treat it.

cap-tb-2

Innovative community work in Mandalay

Innovative community work in Mandalay, Myanmar: Mr. Win Toe, MHAA Community Facilitator, delivers our package of nutritional support to an MDR-TB patient in Mandalay. Included in the package are rice, fish, peas, and oil. Mr. Win Toe also led a TB health education session in Mandalay.

cap-tb-3

TB health education session led by Mr. Win Toe, MHAA Community Facilitator, in Mandalay

World TB Day

Myanmar Health Assistant Association led World TB Day activities in Mandalay. Meetings in four Mandalay townships to advocate for TB control were also held to capitalize on momentum and interest in TB around March 24. Stay posted!

cap-tb-4 cap-tb-5

Innovative Idea of Peer Supporter

Volunteers who counsel the MDR-TB patients as peer supporters for peer education, experience sharing and adherence counseling in group sessions as well as in home visits.