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Opportunities
and
Challenges for Scaling
up T2.0
Myanmar
(13 September 2012)
• Land area - 676,578 km2
• Total population - Apx(60)M
(Female-30M, Male-29.72M,
Sex ratio, M/100F-98.87)
• No. of State & Regions -
(14)
• No. of District - (69)
• No of Township – (330)
National Strategic Plan on HIV/AIDS (2011-2015)
STRATEGIC PRIORITY I STRATEGIC PRIORITY II STRATEGIC PRIORITY III
Prevention of the transmission of HIV Comprehensive Continuum of Care Mitigation of the impact of HIV on
through unsafe behaviour in sexual for people living with HIV people living with HIV and their
contacts and injecting drug use families
•Female sex workers and their sexual
partners Psychosocial, economic &
VCCT, ART, community
•Clients of female sex workers and their nutritional support
home-based care, health
sexual partners
facility-based care for adults
and children
•Men who have sex with men, male
Orphans and vulnerable
sex workers and
children infected and
their clients and the sexual partners
affected by HIV
of all groups PMCT and Reproductive
Health
•Injecting drug users, drug users
and their sexual partners
•Prison or rehabilitation facility
populations
•Mobile & Migrant Populations and
communities affected by population
movement
•Uniformed services
•Young People
•Workplace
Health (including Private Health Sector), Non-Health & Community Systems Strengthening
Favourable environment for reducing stigma and discrimination
Strategic Information, Monitoring and Evaluation, and Research
BACKGROUND HISTORY Of ANTIRETROVIRAL THERAPY
IN MYANMAR
In 2003, started with INGO (AZG ) at Specialist Hospital
(Waibagi) in Yangon.
In 2005, National AIDS Programme started at –
Specialist Hospital (Waibagi),
Mandalay General Hospital &
4 Tsp along Myanmar Thai border with the support of FHAM.
In 2005, Integrated HIV Care Program (IHC) with UNION
at Mandalay
In 2006 - FHAM + GF Round 3,
In 2007 - 3DF + CERF + Daewoo,
2011 onward– GF Round 9
Estimated number of people living with Estimated number of AIDS Deaths
HIV/AIDS (Adults + Children) (Adults + Children)
213,668 20000 15,741
16000
12000
8000
4000
0
1985 1990 1995 2000 2005 2010 2015
Estimated number of New HIV Estimated number of ART
Infections Needed
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
2011 2012 2013 2014 2015
15+ <15 needing PMCT
International/National NGOs providing ANTIRETROVIRAL THERAPY
1. MSF (Holland) • (Yangon, Lashio, Myitkyina,Phakant , Sittwe)
2. MSF (Swiss) • (Dawei)
3. MDM • (Yangon, Myitkyina,Moegaung)
4. AFXB • (Yangon)
5. AMI • (Yangon)
6. Consortium • (Save The Children , CARE ,MSI, MNA )
7. IOM • (Mawlamyaing)
8. Malteser • ( Mong Lar, Pangkham )
9. Alliance • (Yangon, Thanphyuzayat)
10. PSI • (Yangon, Nyaung Don )
11. AHRN • (Myitkyina)
12. Pyigyi Khin • (Taungyi , Myingyan )
13. Ratanamyitta
14. UNION • (Mandalay-7,Taungyi, Lashio ,Pakokku ,Monywa,Meikhtila,Myingyan )
Number of AIDS patients receiving ART (2002-June 2012)
2012 June 44,661
2011 40,128
2010 29,825
2009 21,138
2008 15,191
2007 11,193
2006 5,639
2005 2,527
2004 484
2003 121
2002 17
0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000
Distribution by townships of people receiving ART and ART sites
National AIDS Programme
VCCT service
CD4 machine locations
SAGAING-(1) KACHIN
(Hosp.-IHC) (3) NGO sites
(AZG & MDM)
MANDALAY- (6)
(4 Hosp.-IHC & SHAN NORTH- (1)
2 PHL)
NAYPYITAW-(1) SHAN EAST- (2)
(Hosp.) (Hosp. & NGO)
MAGWAY-(2) SHAN SOUTH- (1)
(Hosp. & IHC) (Hosp.)
YANGON-(7)
(3 Hosp., 2 NHL & MON-(1)
2NGO) (IOM)
RAKHINE-(1)
(AZG) TANINTHARYI-(1)
(MSF-H)
AYARWADDY-(1)
(Hosp.)
(Govt. -7 + NGO-21)
Total-28 tunnyuntoo71@gmail.com 10
CONTINUUM OF CARE FRAMEWORK
Primary Health
Care
Health post
Secondary Mobile service
Health Care Decentralization
Community Care
-ART hospitals &
NGO sites
(100) Sites NGOs/CBOs
Faith-based-orgs
PMCT (253) tsp
Volunteers
& (38) Hospitals
PLHIV Network
SHG
Specialist & PLHIV
Specialized
care
Family
facilities PLHIV
(2) Sites HBC (24) Teams
The Entry (Ygn)
Point Tertiary Health
Care
SUPPORT
PEER HOME BASED CARE
PLHIV
Updated National Guidelines for ART and PMCT
based on WHO 2010 Guidelines
TB/HIV collaborative activities
TB/HIV Sentinel Surveillance
5 townships in 2005
20 townships in 2010
25 townships in 2012
Isoniazid Preventive Therapy (IPT) for PLHIV
Pilot Project started in 2009 (7 townships in Mandalay,
Lashio & Tachileik)
Expanded to Monywa, Magwe & Pathein in 2011
Then to Mawlamyaing, Pyay & Dawei in 2012
Expansion of VCCT centers at TB clinics
10 sites in 2010
7 sites in 2012
ART needs, targets (2010-2015)
140000
125,463 125,043 124,286 123,915
120000
104,000
100000 93,196
84,200
76,095
80000 85,899
69,000
58,600 72,165
60000
45,000 61,673
51,000
40000 32,000 40,128
29,825
20000
0
2010 2011 2012 2013 2014 2015
people on ART Targets in NSP ART need
Opportunities and
Challenges for Scaling up T2.0
Increasing scale up of ART and PMCT
Involvement of PLHIVs in Care, Support and
Treatment
Assessment and rolled out of CoC in selected
townships
Decentralization of ART services
Dissemination of updated National Guideline for
ART and PMCT based on WHO 2010 Guideline
CD4 Networking among partners
Increase number of partners reporting for survival
analysis (>80%)
Opportunities and
Challenges for Scaling up T2.0(contd.)
Resource limitation (Financial and Human)
Inadequate coverage of ART provision –
currently, only 30% of patients in need are on
treatment.
Restricted capacity of Basic Health Staff in
providing care and treatment services including
ART especially at PHC settings.
Limited availability of point of care diagnostics
and monitoring tools.
Limited coverage of HIV testing and
counselling services
Opportunities and
Challenges for Scaling up T2.0(contd.)
• Need more linkages and integration with other
related sectors.
• Weak coordination and information sharing from
private sectors( GPs& private hospitals) providing
ART.
• Inadequate individual patient tracking system from
diagnosis to treatment including follow up &referral.
• Need further strengthening of existing PSM.
• Stigma and discrimination .
Thank you for attention
NSP New ART targets presented in Technical & Strategy
Group (TSG)meeting
ART target 2012 2013 2014 2015
ART need* 125,463 125,042 124,286 123,915
NSP ART 58,600 69,000 84,200 100,400
Target
ART coverage 51,000 61,673 72,165 85,899
% of ART
41% 49% 58% 69%
coverage
*Asian Epidemiological Model (AEM) Myanmar 2010‐2015
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