Dr Lin Htoo Lwin is a private practitioner at the Kaung Su Aung private clinic in Shwe Pyi Thar Township, Yangon.

As a health care provider, his priority is the health of his patients, and so when he refers a presumptive TB case to the National Tuberculosis Programme, he wants to be sure that the patient actually goes there to get the necessary diagnosis and treatment.

Since becoming involved in the Myanmar Medical Association (MMA) Public–Private Mix (PPM) Tuberculosis project in 2013, he has become more engaged in TB care and control. He is now more confident with the overall management of TB patients as he can provide proper diagnosis and treatment, and better support to ensure their adherence to treatment.

“I am always ready to utilize the available local public health services to the best interest of my patients and I can count on the MMA PPM project staff to visit the patient’s home to assess clinical status and monitor the progress and treatment adherence,” he said.

Myanmar Medical Association (MMA) has been implementing the ‘Public-Private Mix TB Project’ with support from the Global Fund since 2011 in Myanmar.

The training organized by MMA for private practitioners made Dr Lin Htoo Lwin aware of the proper referral and feedback system for TB and of prescribing an appropriate anti-TB treatment regimen.

He never misses a chance to provide counselling and education to his patients so that they follow and complete the recommended course of treatment in a timely manner in order to cure TB and prevent drug resistance—and to stress that nonadherence can have serious consequences.

Under the MMA PPM TB project, with support from the Global Fund, all TB patients are provided nutritional support. Poor TB patients receive additional support for transportation and chest X-rays as necessary.

“This has led to more case detection and better treatment outcome [eg. cure rate and treatment success rate] of TB patients treated at my clinic,” he added.

Saw Lay Doo is a 32-year-old patient who visited the Kaung Su Aung private clinic. As this patient had signs and symptoms of TB, Dr Lin Htoo Lwin did sputum examination, and the result was confirmed to be positive. 

After education and counselling, Dr Lin Htoo Lwin started him on anti-TB initial regimen for six months. On follow-up sputum examination for month-2, his sputum result was still positive and Dr Lin Htoo Lwin prescribed him an extra one month of initial regimen before switching his treatment to the continuation phase for four months.

His month-5 sputum result was negative but on completion of anti-TB treatment at seven months it was again positive. Dr Lin Htoo Lwin suspected drug-resistant TB and sent the patient for GeneXpert sputum testing, which was negative. To assess HIV serostatus, Dr Lin Htoo Lwin asked him to go for HIV counselling and testing, and the result was also non-reactive. The doctor decided to prescribe Saw Lay Doo retreatment regimen.

“As a doctor, care of patients is my first concern so I was very worried when Saw Lay Doo refused to take the retreatment regimen, arguing that he had already taken a seven-month course. He seemed to be depressed and discouraged at the idea of an eight-month retreatment regimen which included two months of injections. There was not a moment to spare, and I had several counselling and education sessions with him on the lifesaving importance of good adherence and the life-threatening risk of poor adherence.”

Dr Lin Htoo Lwin managed to overcome this challenge with the support of MMA staff – the Field Coordinator in charge of Shwe Pyi Thar, Dr Ei Mon Mon Kyaw, and the Field Assistant, U Khin Zaw – who promptly visited the patient's home to provide psychosocial support, health education and counselling. 

“Your sputum test result confirms that you are not yet cured of TB. If the treatment is interrupted, your condition will get worse and there are the risks that your family members could be infected and of development of drug-resistant TB,” explained by U Khin Zaw to Saw Lay Doo and his family members. After several intensive counselling sessions, Saw Lay Doo finally understood the need to continue treatment.

“Saw Lay Doo’s recovery from TB is the result of our successful partnership, the Private–Public Mix approach, and it brought us a great moment of joy when Saw Lay Doo finally agreed to continue lifesaving anti-TB treatment. I would like to thank the 

Field Coordinator Dr Ei Mon Mon Kyaw and Field Assistant U Khin Zaw from MMA who promptly responded to my request and are always on hand for care and treatment of TB patients,” continued Dr Lin Htoo Lwin.

“As a private practitioner treating patients for TB, I am fulfilling an important public health responsibility. I will continue to contribute my service to the best of my ability for the success of TB care and control in Myanmar,” Dr Lin Htoo Lwin concluded confidently with a smile.