“There are substantial barriers to accessing TB services for those who live in the townships and villages of Yunnan Province,” says Dr Chiang Chen-Yuan, The Union’s Asia Pacific expert in both TB and MDR-TB. “This results in long delays in the diagnosis and treatment of TB and opens the door for drug resistance to develop.”
Chiang has been working in Yunnan since 2012 as part of a CAP-TB project led by FHI360 that aims to develop a model for the planned management of MDR-TB in three countries in the Greater Mekong Subregion – Myanmar, Thailand and China. In addition to The Union, project partners include the World Health Organization, TB programmes at the national/local levels and nongovernmental organisations.
While there are TB patients in Yunnan being detected and treated successfully, the delay in diagnosis is only one of the issues the project seeks to address. Chiang has also found that treatment of previously treated TB cases was not standardised, and fluroquinolones were frequently used inappropriately.
“Keeping patients alive by ineffective treatment without curing them means you are still leaving the door open for transmission of the disease,” he says. “Add to that the improper use of antibiotics, irregular drug administration, inadequate treatment regimens and failure to complete the whole course of treatment – all contribute to the development of drug-resistant TB.”
One of the primary challenges faced in Yunnan is insufficient local-level resources and capacity, both of which hinder early detection and effective treatment. When local clinics are unable to effectively detect presumptive TB, patients are referred to the Xenzhiong County CDC – a service whose usefulness is limited by distance and transportation issues.
Chiang’s technical support to existing and new clinical sites includes both on-site mentoring and training. “What we try to focus on are the priorities for MDR-TB: prevention, early detection and effective treatment,” he says. “This calls for frequent contact between the healthcare workers and patients with strong treatment support and the rational use of drugs to ensure success.”
“The strategy is to provide patient-centred, community-driven support for MDR-TB elimination,” says Chiang, who has worked for The Union since 2003 conducting research, providing technical assistance and leading international and national courses.
“While we’ve made progress, healthcare and community workers still need further training in the risks and symptoms of the disease for faster identification and early referral, laboratory testing and treatment services.”
“The encouraging part in Yunnan is that there is a high level of commitment from the local authorities in the fight against TB,” he says. “Also local healthcare workers are keen to improve their skills and pass on their knowledge as trainers for TB control.”
In addition to his work for the region, Chiang represents The Union on the Core Group of the Global Drug-Resistant Tuberculosis Initiative (GDI); and, in November, he will lead a five-day international course on the clinical management of drug-resistant TB in Bangkok.