Timor-Leste has a high incidence of tuberculosis (TB) with 498 cases per 100,000 population. There is limited availability of diagnosis and treatment services for drug-resistant TB. The TB treatment coverage is relatively low and mortality is high. There have only been a limited number of patients diagnosed and started on treatment for rifampicin resistant/multidrug resistant (RR/MDR-TB) in the last decade. The estimated number of patients with RR/MDR-TB is much higher, potentially indicating a large gap in diagnosis.
There is a lack of understanding surrounding MDR-TB in Timor-Leste, not just for patients and communities but also among healthcare workers. The treatment of MDR-TB is an arduous process for patients. Alongside treatment, the WHO recommends the use of counselling to support patients undergoing treatment for MDR-TB, which may involve engaging previous patients (peer counsellors) as TB Champions to educate, counsel and support MDR-TB patients throughout their whole treatment.
Unfortunately, due to a wide range of barriers including poor access and lack of knowledge, contact tracing for MDR-TB patients is only infrequently occurring. Contact tracing is a high-yield method for case finding, and early diagnosis and treatment is the mainstay of MDR-TB infection.
The Burnet Institute and Maluk Timor is collaborating on two activities which aim to improve the TB services provided in Timor-Leste:
Piloting a peer counsellor model of care for drug-resistant and drug-sensitive TB treatment in Timor-Leste. This includes recruiting counsellors who have a lived experience of TB, adapting patient support tools, conducting training, establishing monitoring tools, and providing supervision and management. Peer counsellors work out of the specialist TB clinic at Klibur Domin, close to the capital of Dili, where they provide counselling and support to each TB patient.
Conducting contact tracing for household contacts of patients with drug-resistant TB. This will include screening contacts for TB, raising awareness of drug-resistant TB for families and communities, and upskilling of healthcare workers at local health centres.
2018 – 2021