MERAL Myanmar Education Research and Learning Portal
Item
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Identifying the demographic, epidemiological and clinical characteristics of people living with HIV (PLHIV ) is essential to inform optimal management strategies in this resource-limited country.Methods: To create a “snapshot” of the PLHIV seeking anti-retroviral therapy (ART ) in Myanmar, data were collected from the registration cards of all patients who had been prescribed ART at two large referral hospitals in Yangon, prior to March 18, 2016.Results and discussion: Anti-retroviral therapy had been prescribed to 2643 patients at the two hospitals. The patients’ median [interquartile range (IQR)] age was 37 (31–44) years; 1494 (57%) were male. At registration, inject-ing drug use was reported in 22 (0.8%), male-to-male sexual contact in eleven (0.4%) and female sex work in eleven (0.4%), suggesting that patients under-report these risk behaviours, that health care workers are uncomfortable enquiring about them or that the two hospitals are under-servicing these populations. All three explanations appear likely. Most patients were symptomatic at registration with 2027 (77%) presenting with WHO stage 3 or 4 disease. In the 2442 patients with a CD4+ T cell count recorded at registration, the median (IQR) count was 169 (59–328) cells/mm3. After a median (IQR) duration of 359 (185–540) days of ART, 151 (5.7%) patients had died, 111 (4.2%) patients had been lost to follow-up, while 2381 were alive on ART. Tuberculosis (TB) co-infection was common: 1083 (41%) were already on anti-TB treatment at registration, while a further 41 (1.7%) required anti-TB treatment during follow-up. Only 21 (0.8%) patients were prescribed isoniazid prophylaxis therapy (IPT ); one of these was lost to follow-up, but none of the remaining 20 patients died or required anti-TB treatment during a median (IQR) follow-up of 275 (235–293) days.Conclusions: People living with HIV in Yangon, Myanmar are generally presenting late in their disease course, increasing their risk of death, disease and transmitting the virus. A centralised model of ART prescription struggles to deliver care to the key affected populations. TB co-infection is very common in Myanmar, but despite the proven efficacy of IPT, it is frequently not prescribed."}]}, "item_1583103108160": {"attribute_name": "Keywords", "attribute_value_mlt": [{"interim": "HIV"}, {"interim": "Myanmar"}, {"interim": "Anti-retroviral therapy"}, {"interim": "Tuberculosis"}, {"interim": "Isoniazid prophylaxis therapy"}, {"interim": "Key affected populations"}, {"interim": "Resource limited settings"}]}, "item_1583103120197": {"attribute_name": "Files", "attribute_type": "file", "attribute_value_mlt": [{"accessrole": "open_access", "date": [{"dateType": "Available", "dateValue": "2021-01-28"}], "displaytype": "preview", "download_preview_message": "", "file_order": 0, "filename": "HIV_care_in_Yangon_Myanmar_successes_challenges_an.pdf", "filesize": [{"value": "755 KB"}], "format": "application/pdf", "future_date_message": "", "is_thumbnail": false, "licensetype": "license_0", "mimetype": "application/pdf", "size": 755000.0, "url": {"url": "https://meral.edu.mm/record/7860/files/HIV_care_in_Yangon_Myanmar_successes_challenges_an.pdf"}, "version_id": "f5842048-0d32-4dcf-bfb1-fcfa07e010ca"}]}, "item_1583103131163": {"attribute_name": "Journal articles", "attribute_value_mlt": [{"subitem_issue": "14", "subitem_journal_title": "AIDS Res Ther", "subitem_pages": "1-7", "subitem_volume": "10"}]}, "item_1583105942107": {"attribute_name": "Authors", "attribute_value_mlt": [{"subitem_authors": [{"subitem_authors_fullname": "Ne Myo Aung"}, {"subitem_authors_fullname": "Hanson, Josh"}, {"subitem_authors_fullname": "Tint Tint Kyi"}, {"subitem_authors_fullname": "Zaw Win Htet"}, {"subitem_authors_fullname": "Cooper, David A."}, {"subitem_authors_fullname": "Boyd, Mark A."}, {"subitem_authors_fullname": "Mar Mar Kyi"}, {"subitem_authors_fullname": "Htin Aung Saw"}]}]}, "item_1583108359239": {"attribute_name": "Upload type", "attribute_value_mlt": [{"interim": "Publication"}]}, "item_1583108428133": {"attribute_name": "Publication type", "attribute_value_mlt": [{"interim": "Journal article"}]}, "item_1583159729339": {"attribute_name": "Publication date", "attribute_value": "2021-01-28"}, "item_title": "HIV care in Yangon, Myanmar; successes, challengesand implications for policy", "item_type_id": "21", "owner": "100", "path": ["1608053322572"], "permalink_uri": "http://hdl.handle.net/20.500.12678/0000007860", "pubdate": {"attribute_name": "Deposited date", "attribute_value": "2021-01-28"}, "publish_date": "2021-01-28", "publish_status": "0", "recid": "7860", "relation": {}, "relation_version_is_last": true, "title": ["HIV care in Yangon, Myanmar; successes, challengesand implications for policy"], "weko_shared_id": -1}
HIV care in Yangon, Myanmar; successes, challengesand implications for policy
http://hdl.handle.net/20.500.12678/0000007860
http://hdl.handle.net/20.500.12678/0000007860c86918b8-b120-4ab4-87b9-88fee0f275c8
ff7e29d2-60fe-4fc8-abe8-d167be61d54e
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Publication type | ||||||
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Journal article | ||||||
Upload type | ||||||
Publication | ||||||
Title | ||||||
Title | HIV care in Yangon, Myanmar; successes, challengesand implications for policy | |||||
Language | en | |||||
Publication date | 2021-01-28 | |||||
Authors | ||||||
Ne Myo Aung | ||||||
Hanson, Josh | ||||||
Tint Tint Kyi | ||||||
Zaw Win Htet | ||||||
Cooper, David A. | ||||||
Boyd, Mark A. | ||||||
Mar Mar Kyi | ||||||
Htin Aung Saw | ||||||
Description | ||||||
Background: Approximately 0.8% of adults aged 18–49 in Myanmar are seropositive for Human Immunodeficiency Virus (HIV ). Identifying the demographic, epidemiological and clinical characteristics of people living with HIV (PLHIV ) is essential to inform optimal management strategies in this resource-limited country.Methods: To create a “snapshot” of the PLHIV seeking anti-retroviral therapy (ART ) in Myanmar, data were collected from the registration cards of all patients who had been prescribed ART at two large referral hospitals in Yangon, prior to March 18, 2016.Results and discussion: Anti-retroviral therapy had been prescribed to 2643 patients at the two hospitals. The patients’ median [interquartile range (IQR)] age was 37 (31–44) years; 1494 (57%) were male. At registration, inject-ing drug use was reported in 22 (0.8%), male-to-male sexual contact in eleven (0.4%) and female sex work in eleven (0.4%), suggesting that patients under-report these risk behaviours, that health care workers are uncomfortable enquiring about them or that the two hospitals are under-servicing these populations. All three explanations appear likely. Most patients were symptomatic at registration with 2027 (77%) presenting with WHO stage 3 or 4 disease. In the 2442 patients with a CD4+ T cell count recorded at registration, the median (IQR) count was 169 (59–328) cells/mm3. After a median (IQR) duration of 359 (185–540) days of ART, 151 (5.7%) patients had died, 111 (4.2%) patients had been lost to follow-up, while 2381 were alive on ART. Tuberculosis (TB) co-infection was common: 1083 (41%) were already on anti-TB treatment at registration, while a further 41 (1.7%) required anti-TB treatment during follow-up. Only 21 (0.8%) patients were prescribed isoniazid prophylaxis therapy (IPT ); one of these was lost to follow-up, but none of the remaining 20 patients died or required anti-TB treatment during a median (IQR) follow-up of 275 (235–293) days.Conclusions: People living with HIV in Yangon, Myanmar are generally presenting late in their disease course, increasing their risk of death, disease and transmitting the virus. A centralised model of ART prescription struggles to deliver care to the key affected populations. TB co-infection is very common in Myanmar, but despite the proven efficacy of IPT, it is frequently not prescribed. | ||||||
Keywords | ||||||
HIV, Myanmar, Anti-retroviral therapy, Tuberculosis, Isoniazid prophylaxis therapy, Key affected populations, Resource limited settings | ||||||
Journal articles | ||||||
14 | ||||||
AIDS Res Ther | ||||||
1-7 | ||||||
10 |