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MSF Experience on Use of HIV Viral Load testing in Myanmar Slide 2 MSF HIV/ART program started since 2003 17 TB/HIV clinics Yangon Region Taninthayi Region Kachin State Shan State Rakhine State >30,000 patients are on HAART Waing Maw Moe Gaung Slide 3 3 HIV Prevention focusing on SW, MSM, DU HIV Care and Support including HTC, PMTCT, OI management, HAART Laboratory services Network of CD4 facility, 1 Cavidi Viral Load system, GeneXpert, Biochemistry, etc. Slide 4 4 MSF installed one Cavidi VL system in Yangon Mid 2009 Slide 5 Manual Extraction of RT enzyme and amplification Takes 2 days for one lab tech Leave overnight for final reading 5 Slide 6 Final Reading on the next morning Takes 5 Minutes only Results obtained through a computer software 29 samples per each run 6 Slide 7 7 Very feasible for resource limited settings.. Does not require sterile environment/molecular laboratory Allows for decentralised testing Subtype independent technology Affordable cost However, Technician dependent Capacity per lab tech: Collection and Transportation of specimen Slide 8 Max. Capacity using 2 full time lab tech: - 3 runs (87) per week 156 runs (4524) per year Current patients on MSF Treatment >29,000 patients on first line Nearly 1000 patients on second line 3 patients on third line 8 Slide 9 Estimated patients need of ART 125,000 Currently on ART - >50,000 2 Viral Load facilities MSF Cavidi system and MoH PCR system MSF Criteria for VL testing 1 st priority Clinically and immunologically suspected treatment failure Yearly monitoring for patients on 2 nd line (a rising VL could be targeted with intense adherence counseling) 9 Slide 10 10 2.5Hr Boat 6Hr Car 2.5 Hr Air Slide 11 A simple analysis of VL vs CD4 of 3801 patients with suspected immunological failure receiving 1 st line ART >1yr shows 20% (755) - confirmed failure and of those failure, 8% (58) has CD4 >350 66% (2505) has undetectable VL and of those 66%, 33%(828) has CD4