Abstract
Prisoners have a higher HIV prevalence and higher rates of attrition from care as compared with the general population. There is no published evidence on this issue from Myanmar. We assessed (1) HIV test uptake, HIV positivity, and enrollment in care among newly admitted prisoners between 2017 and 18 (2) Treatment outcomes among HIV-positive prisoners enrolled in care between 2011 and 18. This was a cohort study involving secondary analysis of program data. Among 26,767 prisoners admitted to the Mandalay Central Prison between 2017 and 2018, 10,421 (39%) were HIV-tested, 547 (5%) were HIV-positive, and 376 (69%) were enrolled in care. Among the 1288 HIV-positive prisoners enrolled in care between 2011 and 2018, 1178 (92%) were started on antiretroviral therapy. A total of 883 (69%) were transferred out (post-release) to other health facilities, and among these, only 369 (42%) reached their destination health facilities. The final outcomes (censored on 30 June 2019) included the following: (i) Alive and in care 495 (38%), (ii) death 138 (11%), (iii) loss to follow-up 596 (46%), and (iv) transferred out after reaching the health facilities 59 (5%). We found major gaps at every step of the HIV care cascade among prisoners, both inside and outside the prison. Future research should focus on understanding the reasons for these gaps and designing appropriate interventions to fill these gaps.
Highlights
37.9 million people were living with HIV (PLHIV) by the end of 2018 [1]
We conducted an operational research in the Mandalay Central Prison with the following objectives: (1) To assess the number and proportion tested for HIV, found HIV-positive, and enrolled in HIV care among the prisoners who were newly admitted between 2017 and 2018 (2) Among the HIV-positive prisoners enrolled in care between 2011 and 2018 to assess, (a) the treatment outcomes, number tested for viral load and found to be virally suppressed (b) the sociodemographic and clinical factors associated with attrition and not reaching the destination health facility after being transferred out
HIV care is provided by the National AIDS Program (NAP) in collaboration with the staff of the International Union Against Tuberculosis and Lung Disease (The Union) who run the Integrated HIV care (IHC) program in Myanmar [12,13]
Summary
37.9 million people were living with HIV (PLHIV) by the end of 2018 [1]. There were 1.7 million new infections and nearly half of them occurred in key populations such as female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), migrants, and people living in prisons and closed settings [1]. Bridging the remaining gap is the most challenging part and this will not happen unless we make efforts to reach out to the most vulnerable and marginalized key populations. One such group which has faced gross neglect over the years is people living in prisons and closed settings. We conducted an operational research in the Mandalay Central Prison with the following objectives: (1) To assess the number and proportion tested for HIV, found HIV-positive, and enrolled in HIV care among the prisoners who were newly admitted between 2017 and 2018 (2) Among the HIV-positive prisoners enrolled in care between 2011 and 2018 to assess, (a) the treatment outcomes, number tested for viral load and found to be virally suppressed (b) the sociodemographic and clinical factors associated with attrition (death and LFU) and not reaching the destination health facility after being transferred out (post-release)
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