The Need for HIV and AIDS Care

The Need for HIV and AIDS Care

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Description: AIDS is one of 3 priority diseases of the National Health Plan in Myanmar. AIDS surveillance started in 1985 and the first HIV infection reported in 1988. An AIDS Control Program started in1989 with a short-term plan.

First AIDS Case reported in 1991 and Prevention of mother to child transmission started in 2001. HIV prevalence and trend studies, Biological Mapping of HIV virus, Qualitative and clinic based studies on Drug Uses and HIV vulnerability, Best Practice on voluntary blood donation.

 
Author: Dr. Win Myat Aye, Dr. Tint Maw, and Dr. Nan Hla Myaing (Fellow) | Visits: 2051 | Page Views: 2070
Domain:  Medicine Category: Therapy Subcategory: HIV/AIDS 
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Short URL: http://www.wesrch.com/medical/pdfME1LYYYD7XSOE
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Contents:
NEEDS FOR AND RESPONSES TO HIV/AIDS CARE INCLUDING ART IN MYANMAR

DR. WIN MYAT AYE
(Consultant Paediatrician, Specialist Hospital, Waibargi, Yangon)

DR. TINT MAW
(Medical Officer, National AIDS Programme)

DR. NAN HLA MYAING
(Medical Officer, Myanmar Anti-Narcotics Association, Yangon)
Myanmar 1

AIDS is one of the three priority diseases of the National Health Plan in Myanmar

Myanmar

2

ADMINISTRATION OF NATIONAL AIDS POLICY AND NATIONAL AIDS PROGRAMME
STATE PEACE AND DEVELOPMENT COUNCIL

NATIONAL HEALTH COMMITTEE NATIONAL AIDS COMMITTEE

CABINET

MINISTRY OF HEALTH

UN AGENCIES

DEPARTMENT OF HEALTH DISEASE CONTROL DIVISION NATIONAL AIDS/STD PROGRAMME (NAP) NGOs

WORKING COMMITTEE

STATE/DIVISION AIDS COMMITTEE

STATE/DIVISION HEALTH DEPARTMENT

AIDS/STD Regional Officers 40 AIDS/STD TEAMS

TOWNSHIP AIDS COMMITTEE

TOWNSHIP HEALTH DEPARTMENT

VILLAGE AIDS VOLUNTEERS

RURAL HEALTH CENTER Myanmar

3

Milestones of HIV/AIDS Prevention and Control in Myanmar
1. 2. 3. 4. 5. 6. 7. 8. 9.

AIDS surveillance started in 1985 First HIV infection reported in 1988 AIDS Control Program started in1989 with a short-term plan National AIDS Committee established in 1989 First AIDS Case reported in 1991 Sentinel surveillance started in 1992 Prevention of mother to child transmission started in 2001 100% condom use program started in 2001 ART for people living with AIDS started in public sector in 2003

Myanmar

4

Research Activities
Carried out intra-departmentally & in co-operation with Department of Medical Research, Department of Health Planning, National NGOs and International NGOs
-

HIV prevalence and trend studies Biological Mapping of HIV virus Qualitative and clinic based studies on Drug Uses and HIV vulnerability Best Practice on voluntary blood donation Joint TB/HIV epidemiological studies
Myanmar 5

-

Research Activities (cont.)
Knowledge, Attitude and Practice (KAP) studies, qualitative surveys and assessment Laboratory based virology studies Study on Clinical Profile and ethnographic composition of HIV/AIDS patients HIV prevalence and risk behaviour research on CSWs Analysis of findings from VCCT sites for HIV/AIDS
Myanmar 6

HIV/AIDS Situation in Myanmar (1988 - December 2002)
HIV positives detected Reported AIDS Cases Reported AIDS deaths Estimated number of people living with HIV/AIDS (end 2001) 177,279 45033 6438 2755

Myanmar

7

Male Female 491 497 825 5829 10031 8932 5173 2366 1211 502 222 186 185 901 1744 2139 1661 1029 540 271 129 81 42

Age and Sex Distribution of Cumulative HIV Positive Cases (1988 - December 2002, Myanmar)
0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 & > 540 1211 271 502 129 222 81 186 42 185 46
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 100 150 200 250 300 350 400 450 500 550 600 650 700 750 800 850 900 950 000 050 1 1

497 491 825 901

5829 1744 10031 2139 8932 1661 5173 1029 2366

46 Unknown

35959

9074

0

Total 45033

Total Number of Cases Female
Prepared by National AIDS Program

Male 8

Myanmar

MYANMAR NATIONAL AIDS PROGRAM HIV Sentinel Surveillance Results Mar. 1992 - Mar. 2002
80 70

Percent(%)

60 50 40 30 20 10 0
92 S 93 M 95 S 96 M 96 S 97 M 93 S 94 M 94 S 95 M

IDUs

CSWs

97 S 98 M

98 S 99 M

IDUs MCH

CSWs M.STD BLOOD DONOR

F. STD RECRT

Overall Data
Myanmar 9

99 S 00 M 01 M 02 M

92 M

National AIDS Committee (NAC) Meeting decisions
8th NAC meeting - To develop a Master Strategic Plan (2001-2005) for HIV/AIDS prevention, control and care - Not to use condoms as an evidence for prostitution. A policy guideline letter distributed to every police station in the country dated 1st November 2000, Ministry of Home.

Myanmar

10

National Plan for Care and Treatment of PLWHA Expansion Programme in Myanmar National Strategic Plan includes - Enhanced capacity for management of OIs - Increased psycho-social support for PLWHAs - Training of Health care providers for ART & treatment of OIs Expansion Programme in the UN Joint Plan on HIV/AIDS
- To improve quality and access to care and treatment services for PLWHA - To improve quality and access to VCCT services - To reduce risk of mother to child transmission of HIV
Myanmar 11

National Plan for Care and Treatment of PLWHA (cont.) Policy All hospitals in the country will provide services for PLWA Community home based care is encouraged Human Resource Training and Development - Training of health staff on ART (as part of CME) - Training of community & NGOs on home based care - Develop national guidelines: ART, VCCT, CHBC, PMCT Financial Resources (2003) - UN partners - Other donors US $ 1.05 million US $ 1.47 million
Myanmar 12

Prophylaxis and Treatment of Opportunistic Infections
Priority Since very few PLWHA can afford to drugs for ART, managing OIs effectively in both public and private sectors is encouraged. Human Resource Training Training of MOs and GPs on management of OIs Training of laboratory personnel on diagnosis of OIs TB/HIV Joint Programme Started since 1998 in selected sites including border areas (Joint trainings, drug supply, VCCT for TB patients) A model district will be developed in Mandalay in 2003 Financial Resources: WHO, JICA, UNDP
Myanmar 13

Antiretroviral Therapy
Priority: One of the main strategies Good entry point for advocacy and education Laboratory Support: VCCT, Investigations for OIs, CD4+ Count Drug Management: National Guidelines developed Supervision by NAP and Medical Care Division Where to deliver: Specialist Hospital, Waibargi , Yangon General Hospital ,TB Hospital in Mandalay and Kyaington Hospital (Eastern Shan State)
Myanmar 14

Antiretroviral Therapy (cont.)
How to deliver: National Guidelines for case selection, treatment regime, laboratory investigations, follow-up, & counselling Selection Committee/Supervisory Committee Financial Resources: AZG (Holland), DFID, UNDP, & probably GFATM, UNICEF (for women, pregnant mother & children) Human Resources: AIDS/STD staff & local health staff for VCCT, safe delivery, Nevirapine treatment, follow-up, birth-spacing & care Local NGOs & volunteers for community mobilization
Myanmar 15

Current Situation of HIV/AIDS Care and Treatment
1. VCCT Situation: Available in 36 AIDS/STD Clinics Available in all township hospitals for in-patients Human Resource Training and Development: 700 Counsellors& social workers, 75 Lab. Techs. were trained Financial Resources: UNICEF, WHO for HIV test kits and training 2. Prophylaxis and treatment of OIs such as TB, PCP, Fungal and other infections AZG is supporting treatment of OIs in Waibargi Hospital NAP is supporting drugs for OIs to hospitals in the border areas National TB Programme is supporting drugs for TB Myanmar
16

Current Situation of HIV/AIDS Care and Treatment (cont.)
3. Antiretroviral Therapy Only AZG supported programme is being carried out for 100 patients in 2003 Funds requested from DFID for 150 more patients in Ygn & Mdy 4. Non-medical care components Community Home Based Care for educating the families and volunteers (by MNA, MMCWA, MRCS, I-NGOs such as WVI) Psycho-social support given by religious sector and NGOs

Myanmar

17

Capacity of Province and District Administrator and Organizer

For all PHA & affective families & relatives Financial support Social and Psychosocial support By donation By negotiating with donors, suppliers & supporters

Myanmar

18

Involvement of PHA & civil society in implementation & planning
PHA

- as a member of Country Coordinating Mechanism (CCM ) for GFATM proposal - as out-reach workers - as peer educators

Civil society � UN parters, INGOs,NGOs, other associations involve
in planning, implementation of AIDS care by collaborating, cooperating with national AIDS control Program of Ministry of Health
Myanmar 19

Health system and services
Comprehensive care package Counseling Manual Home Based Care Manual ( A resource and Training Guide For Care Givers, Sept.2002), Home care kit Safety Precaution and Disinfection Methods (Manual) National Treatment guidelines for HIV/AIDS (including ART treatment )

Myanmar

20

Strengths and Constraints
1. Strengths Political commitment, Voluntary spirit of people, Support by extended families 2. Problems Limited financial and human resources Compliance of PLWHA Low utilization of VCCT services Limited laboratory facilities for OI, CD4, Viral Load Fear for stigma exists 3. Needs for External Support Expansion of VCCT services More drugs for OI and HAART Strengthening of laboratory services

Myanmar

21

Monitoring and Evaluation
1. Monitoring The monitoring of the AIDS prevention and control activities is being carried out by the National AIDS Programme at all levels of administration. Activities implemented at the township level is monitored by the respective Township Health Department and also by the State and Divisional Health Department. As part of this monitoring process monthly and quarterly reports are prepared by the National AIDS Programme.

Myanmar

22

Access to care & treatment by PHA
-Community Cost Sharing (CCS) almost covers the whole county -Free of charge treatment given for poor who can not afford to CCS -Needle distribution program and condom promotion, substitution treatment among IDUs in selected townships -100% condom promotion program (in targeted population), peer education program and -Voluntary Confidential Counseling & Testing for IDUs, CSWs and Migrants

Myanmar

23

Monitoring and Evaluation (contd.)
2. Evaluation Programme review meeting is conducted once a year to evaluate the strengths and weaknesses of the programme and to analyze the lessons learnt from the past before embarking in the future planning. External review teams have been invited by the Ministry of Health in collaboration with the UN Agencies to evaluate the programme activities implemented. Using the recommendations from the review process, future plans were made in the context of guidelines from the National Health Committee and within the framework of the National Health Plan.
Myanmar 24

National Health Committee (NHC) decisions on HIV/AIDS In the 34th NHC meeting (24-4-2002) To reach AIDS Control Activities to rural areas with continuous monitoring and evaluation. The 35th NHC meeting (11-6-2002) To strengthen AIDS control and care activities through integration of public, private , NGO sectors and community Special NHC meeting (16-7-2002) To strengthen & upgrade AIDS Committees at all levels
Myanmar 25

Myanmar

26

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