Addressing the emerging risks of multi-drug resistant TB and TB HIV co-infection in the Pacific

The Secretariat of the Pacific Community’s TB Section, in conjunction with the WHO Western Pacific Region Office, held a meeting for managers of Pacific TB and HIV programmes in Nadi, Fiji Islands, from 23–26 May.  On the first day of the meeting, TB and HIV managers were brought together to discuss and plan collaborative activities. This is the second time that this type of discussion has been held in the Pacific. During the remaining two days of the meeting, National TB Programme managers focused on the prevention and management of multi-drug resistant TB (MDR-TB), ensuring a reliable drug supply, and monitoring and evaluation of National TB Programmes.

Representatives from 18 countries and territories took part in the meeting and agreed on a number of recommendations that will serve to strengthen TB and HIV services and the prevention and control of MDR-TB in the region. These recommendations will be actioned by country programmes in the coming months with support from SPC, WHO WPRO and other partners in the region.


TB remains an issue of public health significance in the Pacific. In 2007, a total of 1441 cases were notified in the Pacific (excluding PNG) and just over one-third (34%) of these patients were infectious. Rates of TB in some Pacific Island countries and territories are among the highest in the Western Pacific region and are higher than in China and Cambodia, two countries with a high burden of TB. Since 2000, the TB rate in the Pacific has increased to its current rate of 52/100,000 population.  Rates have increased more rapidly in the sub-region of Micronesia but have remained relatively stable in Polynesia and Melanesia.  The proportion of TB cases successfully treated in the Pacific is relatively high. In 2006, 89% of infectious TB cases successfully completed their treatment. This exceeds the international target of 85%. However, this high success rate may be threatened by the emergence of MDR-TB and TB/HIV co-infection. In the Pacific, these emerging threats require an effective, co-ordinated response.

As of May 2009, MDR-TB, which is resistant to the two most powerful TB drugs available, has been recorded in seven Pacific Island countries and territories. In 2008, an outbreak of MDR-TB occurred in Federated States of Micronesia with 23 cases identified in Chuuk State. The treatment of MDR-TB is lengthy, expensive and resource-intensive. Its prevention and management is therefore a priority for National TB Programmes throughout the Pacific.
At the Joint meeting of TB/HIV managers, countries were urged to ensure that their TB programmes are prepared for MDR-TB. Participants affirmed that prevention of MDR-TB is the ultimate goal and agreed that National TB Programmes must be strengthened to achieve it.

TB/HIV co-infection is also an emerging threat in the region.  To date, a cumulative total of 1335 people have been diagnosed with HIV in the Pacific region (excluding Papua New Guinea), with 80 people newly diagnosed in 2008. It is well known that HIV has the potential to fuel the TB epidemic as HIV weakens the immune system, making people more vulnerable to infections such as TB. In the Pacific, collaborative activities on TB/HIV are being encouraged so that an evidence-based assessment can be made of the interaction between the two diseases. At the meeting, countries were urged to ensure that TB patients are tested for HIV and people living with HIV/ AIDS are screened for TB.
By the end of the meeting, good progress had been made towards developing plans for collaborative TB/HIV activities and identifying needs to support the strengthening of national TB and HIV programmes.

Over the coming months, SPC and WHO WPRO will continue to work with staff from national TB and HIV programmes to strengthen their respective programmes and to prepare to deal with emerging risks in the region.