Early Success With Retention in Care Among People Living With HIV at Decentralized ART Satellite Sites in Yangon, Myanmar, 2015–2016

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/mm 3 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.

Effect of peer support intervention on anxiety, depression and quality of life among female breast cancer patients on chemotherapy in Yangon, Myanmar: randomized controlled trial

“…Questionnaire At baseline, this study found that the global health status/QOL of all participants was fair with a mean score of 61.8 ± 20.1. It was comparable to the reference value of 61.8 ± 24.6 which was reported in a 49 countries study by the EORTC group (Scott et al, 2008), but lower than the scores in previous Myanmar study (Htet, 2016) and Morocco study (El Fakir et al, 2016) (66.1 ± 21.2 and 68.5 ± 18.5 respectively), and higher than in Egypt (RAM et al, 2018) and Iran (Shafaie et al, 2019b) studies (51.9 ± 25.7 and 59.1 ± 17.4 respectively).…”

“…The reference value for global health status/QOL among breast cancer patients by EORTC quality of life group was 61.8±24.6 in a total of 49 countries study (Scott et al, 2008). In Myanmar, the global health status/QOL scale among breast cancer patients was 66.08±21.19 (Htet, 2016).…”

“…Participants with cancer stage 3 were more likely to be affected HRQOL for 3.07 times than stage 1. Moreover, upset by hair loss is a minor influencing factor for HRQOL of breast cancer survivors (Htet, 2016).…”

“…In these mentioned studies, QOL of the patients were assessed during the different courses of treatment. In the previous cross-sectional study in Myanmar (Htet, 2016) which was conducted among 200 breast cancer patients in the radiotherapy ward, all participants received combination therapies (Surgery + Chemotherapy, or Surgery + Chemotherapy + Radiotherapy). In the cross-sectional study in Morocco (El Fakir et al, 2016) in which 1463 breast cancer patients participated, participants received surgery only or chemotherapy only or combination therapies.…”

Health seeking behavior and experiences related to HIV treatment of people living with HIV (PLHIV) in Yangon, Myanmar

“…funding of the HIV response in Myanmar came from Global fund 13 . Nevertheless, the proportion of government spending on HIV increased threefold since 2012, representing 12% of the overall funding for HIV in 2015 13 In Myanmar, antiretroviral therapy (ART) has been provided free of charge at public and private NGO facilities 14 . Regarding ART provision, after HIV status was confirmed patients were enrolled and assessed for eligibility for ART initiation.…”