Abstract
Background:Myanmar has adopted point-of-care (POC) HIV testing for its prevention of mother-to-child transmission of HIV program, and was initiated in 84 townships in 2013. This study assessed the progress of HIV testing uptake from 2012, one year prior to POC testing, to 2015, and the challenges faced by service providers during the rapid rollout of this testing strategy.Methods:This serial cross-sectional study included 23 townships randomly selected from the 84 townships. An open-question survey was used to collect information on the challenges faced by service providers. A random effects logistic model was used for assessing the progress of HIV testing uptake among urban and rural health center groups.Results:HIV testing uptake for antenatal care (ANC) attendees increased from 60% to 90% for rural and from 70% to 90% for urban attendees. The proportion of ANC attendees who were tested at their first visit increased from 70% to 80% for rural and from 70% to 90% for urban attendees. In addition, the proportion receiving same-day test results increased from less than 10% to 90% for both groups. Major challenges faced during the initial rollout included low health awareness among pregnant women, fear of stigma and discrimination, long travel times and costs, and increased workloads of providers in rural settings.Conclusions and Global Health Implications:The program should consider recruiting local volunteers to help reduce the workloads of service providers. Professional education based on need and continued mentoring and quality control schemes for HIV testing need to be in place. This decentralized strategy would be applicable to other resource-limited countries.
Highlights
Test results were not always available on the same day, depending on the workloads of the labs.[2]. This meant that pregnant women in both urban and rural areas usually got their results during subsequent antenatal care (ANC) visits instead of on the same day
Long travel times, and inadequate supply of HIV test kits were common issues reported as major challenges for achieving adequate HIV testing coverage, testing of ANC attendees on the first visit, and same-day results.The entire system of logistical and supply management of the prevention of mother-to-child transmission (PMCT) program should be reviewed and modified to improve conditions in the field
There is an urgent need to take remedial action to ensure continuous availability of testing supplies to primary service delivery points.The program should consider making HIV testing an essential service at the first ANC visit and recruiting local volunteers that could help with community health awareness and health education to reduce the workloads of service providers
Summary
Until 2012, HIV testing was conducted according to the national HIV testing strategies, which allowed testing to be performed at health facility laboratories where there was at least one trained lab technician. This stringent testing guideline hindered practical scaling up of the PMCT program. Myanmar has adopted point-of-care (POC) HIV testing for its prevention of mother-to-child transmission of HIV program, and was initiated in 84 townships in 2013.This study assessed the progress of HIV testing uptake from 2012, one year prior to POC testing, to 2015, and the challenges faced by service providers during the rapid rollout of this testing strategy
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