Abstract
Introduction: Myanmar is one of the countries in the Asia-Pacific region hit hardest by the HIV epidemic that is concentrated among urban areas and key populations. In 2014, the National AIDS Programme (NAP) launched a new model of decentralized service delivery with the establishment ART satellite sites with care delivered by HIV peer workers.Methods: ART satellite sites are implemented by non-government organizations to service high burden HIV areas and populations that suffer stigma or find access to public sector services difficult. They provide continuity of HIV care from outreach testing, counseling, linkage to care, and retention in care. Anti-retroviral (ART) initiation occurs at health facilities by specialist physicians. We conducted a retrospective cohort study of people living with HIV (PLHIV) who were initiated on ART from 2015 to 2016 at five ART satellite sites in Yangon, Myanmar to assess outcomes and time from enrolment to ART initiation.Results: Of 1,339 PLHIV on ART treatment in 2015–16, 1,157 (89%) were retained, and 5% were lost from care and 5% reported dead, at the end of March 2018. Attrition rates (death and lost-to-follow-up) were found to be significantly associated with a CD4 count ≤ 50 cells/mm3 and having baseline weight ≤ 50 kg. Median time taken from enrolment to ART initiation was 1.9 months (interquartile range: 1.4–2.5).Conclusion: We report high rates of retention in care of PLHIV in a new model of ART satellite sties in Yangon, Myanmar after 3 years of follow-up. The delays identified in time taken from enrolment to ART initiation need to be explored further and addressed. This initial study supports continuation of plans to scale-up ART satellite sites in Myanmar. To optimize outcomes for patients and the program and accelerate progress to reduce HIV transmission and end the HIV epidemic, operational research needs to be embedded within the response.
Highlights
Myanmar is one of the countries in the Asia-Pacific region hit hardest by the HIV epidemic that is concentrated among urban areas and key populations
More than 13% of these are from the Asia and Pacific region where the epidemic is concentrated in vulnerable groups or key populations (KPs)—people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW) [2]
people were living with HIV/AIDS (PLHIV), people living with HIV; Anti-retroviral therapy (ART), anti-retroviral therapy; Kg, kilogram; TDF, tenofovir; lost to followup (LTFU), lost-to-follow-up. *Column percentage; **row percentage. aThese variables were measured at the time of ART initiation
Summary
Myanmar is one of the countries in the Asia-Pacific region hit hardest by the HIV epidemic that is concentrated among urban areas and key populations. In 2014, the National AIDS Programme (NAP) launched a new model of decentralized service delivery with the establishment ART satellite sites with care delivered by HIV peer workers. Myanmar is one of the countries in the region hit hardest by the HIV epidemic and is one of the 35 UNAIDS fast track priority countries that account for 90% of new HIV infections globally. The Myanmar National Strategic Plan (NSP III) on HIV and AIDS (2016–2020) aims to end HIV as a public health threat in Myanmar by 2030 through fast tracking access to continuum of integrated and high quality services that protect and promote human rights for all [3]. Key populations suffer from stigma and discrimination and may find access to public sector ART centers difficult
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