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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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