A young TB patient in the Baro Pite Clinic in Dili, Timor-Leste.
The Burnet Institute recently hosted a meeting to identify areas of need for the prevention and treatment of tuberculosis (TB) in Timor-Leste, which has the second highest rates of TB in the Asia and Pacific regions.
A delegation from Timor-Leste attended the meeting including the Manager of the National TB Program, Mr Constantino Lopes, the former Minister of Health, Dr Nelson Martins, the Director-General of the National Health Laboratory, Dr Santina de Jesus Gomes, and a clinician from the Baro Pite Clinic in Dili, Dr Dan Murphy.
Burnet infectious diseases physician, Dr Jack Richards says TB is one of the most challenging health issues facing the people of Timor-Leste.
“The number of detected cases is increasing but likely reflects the tip of the iceberg, with a desperate need for strengthened diagnostic services,” he said.
“Cases of multidrug-resistant TB have been detected, but the true burden remains unknown, and many more people are likely to be infected but undiagnosed.”
One of the key areas of discussion at the meeting was the devastating impact TB is having on children in Timor-Leste.
Dr Richards explained that children are extremely susceptible to TB because of the time and space they share with parents and grandparents who may be infected, and their vulnerable immune systems.
“TB can have a devastating impact on children. They are at risk of developing disseminated disease where every organ is infected, and can also develop TB meningitis, resulting in long-term neurological deficits or death,” he said.
Delegates also discussed the challenge of accurate and timely diagnosis of TB. The Adelaide Supranational TB Reference Laboratory at SA Pathology has been assisting the National TB Program in Timor-Leste to build local capacity for more than 10 years, but these programs require further strengthening.
Once diagnosed, TB treatment is effective, but usually takes at least six months of antibiotic treatment, posing significant challenges to ensure adequate follow up of patients undergoing treatment, especially in remote and rural communities.
In cases of multidrug resistant TB, treatment can continue for more than two years, becoming much more costly and often with significant side effects.
The Timor-Leste TB Interest Group is now developing strategies to support the National TB Program to improve the prevention and management of TB in the country.
One project likely to emerge from the meeting is the strengthening of the use of prophylactic treatment for children exposed to known sputum-positive TB cases.
Implementing such treatment is well tolerated in children and can lead to reduced numbers infected with TB in the country.
The Timor-Leste TB Interest Group at their recent meeting in Melbourne.