prevention and treatment of hiv in myanmar
TRANSCRIPT
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Prevention and treatment of HIV in Myanmar
Medecins sans Frontieres - Holland
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Activities in Myanmar started in 1993
In 2006• Malaria (250,000 + cases / yr)• Therapeutic feeding malnourished children (4,000)• Primary health care
• HIV related activities
1.2 million patient consultations in 2006
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HIV related activities
Prevention of HIV• Health education• Condom distribution• Needle exchange• RTI diagnosis and treatment
• VCCT / PMTCT
Care for PHA• Opportunistic Infection and ART• Food & transport money• Support PHA groups
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Health education – condom promotion
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21 Thazin clinics(private clinics managed by MSF-H staff)
1. Reproductive tract infection diagnoses and treatment
2. VCCT and PMTCT
3. AIDS care
4. Other activities; malaria, tuberculosis and family
planning
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Reproductive tract infections management in sex worker friendly clinics
Diagnosis based on 1. risk behaviour assessment, 2. symptoms and physical exam 3. laboratory tests
Monthly visits to clinic or outreach (to brothels)– to detect asymptomatic RTI (> 50%)– to get a good relationship to improve the discussion
about HIV prevention
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Thazin clinics ; sex worker friendly
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Thazin clinics
HIV / AIDS – VCCT / PMTCT
– Dx and Tx of OI and ART
– Food support…..
– Transport costs…
– Home based care only for immobile patients
– PHA support groups
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Thazin clinics
Diagnoses and treatment of OI’s, TB and ART
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Thazin clinics
– Food
– Transport costs
– Home based care for immobile patients
– PHA support groups
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Thazin clinics
AIDS care centre Phakant
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Thazin clinics
IDU drop in centre Phakant
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Thazin clinics
• Other activities; – Malaria– Tuberculosis– Family planning
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Results
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Prevention in 2006
• Health education (300,000 people)
• Condom distribution (3,5 million)
• Needle exchange
• Treatment of reproductive tract infections– Thazin clinics
– Outreach treatment (Brothel based)
– 42,000 consultations, 21,000 treatments
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Gonorrhoea among FSW in Phakant (jade mine)
29.5
4.21.0
6.3
0
5
10
15
20
25
30
35
2002
2003
2004
2005
perc
enta
ge
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Syphilis
9.9
14.4
119.4
0
2
4
6
8
10
12
14
16
2002 2003 2004 2005
Trich. Vag.
6.4
9.2 9.2
7.8
0
2
4
6
8
10
2002 2003 2004 2005
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VCCT and PMTCT in 2006
• 34,000 tests
• Yangon project data ;VCCT PMTCT
0
500
1000
1500
2000
2500
3000
2003 2004 2005 20060
1
2
3
4
5
6
0
3000
6000
9000
12000
15000
18000
2003 2004 2005 20060
5
10
15
20
25
30
35TestedPositive
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HIV / AIDS care
• 18,000 PHA in the program – 6,500 PHA on ART
– 11,500 not yet on ART• Of them +/- 8,000 need ART in 2007 – 2008.
• MSF stopped admitting new PHA to the program in July 2007– Except staff members– Except family members of patients on ART
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0
2000
4000
6000
8000
2003 2004 2005 2006 2007
Patients on ART
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Selection criteria for ART
Patients are selected independently by clinic doctors according
• Clinical criteria ; stage / CD4
• Geographical area ; the patient must live in a
geographical area around the clinic
• Adherence criteria
• …..
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0
400
800
1200
1600
2000
2400
0400800
120016002000
on ARTPHA not on ART
0400
0
400
800
1200
1600
2000
2400
2800
3200
3600
4000
4400
4800
5200
5600
6000
6400
6800
7200
0
400
800
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0 - 5050 - 100100 - 200200 - 350> 350
Yangon Kachin / Shan / Rakhine
Baseline CD4 in Yangon and States
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ART patients
Township population
% of populationon ART
Yangon
- Hlaingthayar 871 247,000 0.35- Tharketar 487 197,000 0.25- Insein 382 225,000 0.17Kachin
- Myitkyina 731 264,000 0.28- Bahmo 273 102,000 0.27- Phakant 180 126,000 0.14Shan
- Lashio 559 271,000 0.21- Muse 301 81,000 0.37
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Adult survival (all projects)
Stage 3 (n=2647) & stage 4 (n=3151)
Survival Month
544842363024181260
Cum
ulat
ive
Surv
ival
1.00
.95
.90
.85
.80
.75
.70
Stage 4
Stage 3
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Child survival (all project)
Stage 3 (n=179) & stage 4 (n=100)
Survival Month
4842363024181260
Cum
ulat
ive
Surv
ival 1.00
.95
.90
.85
.80
.75
.70
Stage 3Stage 3Stage 3
Stage 4
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86%01948 – 5486%18442 – 4888%018536 – 4288%245930 – 3688%682424 – 3089%17173218 – 2490%35276612 – 1892%5846876 – 1293%39564580 – 6
Cumulative survival at the end of period
DeathsPatients entering period
Interval time
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Yangon Kachin / Shan / Rakhine
Causes of death under ART in Yangon and States
TB
Crypto
Penicilliosis
IRS
other
Non HIV related
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Program outcomes of all patients (n=6458) Program outcomes of all patients (n=6458) enrolled (July 2007)enrolled (July 2007)
Under Tx 5604 (87%)
Deaths 514 (8%)
Transferred 95 (1%)
LTF 245 (4%)
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Cooperation other organisationsDoH• CD4 and other lab tests• Food for AIDS in-patients• Medicines for individual patients• Exchange of ART• Exchange of experience ……
Other NGO’s and GPs• Training of MDs, lab, counsellors• Follow up visits by trainers• Initial supply ART, OI drugs• Clinical support hot-line
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The current situation
• Tens of thousands of people are dying every year because of AIDS.
• Little money is available for health.
• More national and international resources have to be mobilised to address the HIV situation.
• The available money should be spent better ;
– organisations are providing “comprehensive care”without ART
– this is unethical and a waste of money.
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National level
• Increase spending on health
• Recruit additional staff to manage AIDS– PHA as counselors
• Improve access to prevention – decriminalize high risk groups
• Improve access for organisations/donors – to remote areas
– to guarantee monitoring
– decrease bureaucracy
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• Myanmar is the lowest recipient of overseas aid in the world.
• Mainly due to political pressure, arguing that aid cannot reach the population of Myanmar.
• This hampers humanitarian aid and this increases suffering of the Myanmar people.
International
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• Foreign aid can reach the people of Myanmar effectively.
• There is a great humanitarian need. More money should be spent on large scale health
projects in Myanmar.
• Monitoring at the level of the beneficiary is essential– to guarantee that the population benefits
– to guarantee that donor money is spent correctly.
International
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