Integration of HIV services with primary care in Yangon, Myanmar: a retrospective cohort analysis

Smithuis

et al. 2022

Preprint

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Introduction: HIV viral load testing in resource-limited settings is often centralized, limiting access. Near point-of-care (POC) viral load testing was introduced in Myanmar in 2017. We assessed its uptake and utilization. Methods : Routine program data from three HIV clinics of Medical Action Myanmar were used. Annual viral load uptake was cross-sectionally analysed in people living with HIV (PLHIV) on antiretroviral therapy (ART) initiated between July 2009-June 2019. Attrition at two years was assessed between PLHIV with different access to viral load testing with Kaplan-Meier analysis. For those eligible for a first viral load when near POC viral load became available, a viral load cascade was constructed. We used logistic regression to explore predictors of confirmed virological failure after a first high viral load. Results: Among 5271 PLHIV who started ART between July 2009-December 2019, annual viral load uptake increased significantly after near POC was introduced. Attrition in the first two years after ART initiation was not different among those eligible for a first viral load before viral load was available, after centralized laboratory-based viral load, and after near POC viral load introduction. After introduction of near POC viral load, 92% (2945/3205) of eligible PLHIV received a first viral load, a median of 2.8 years (IQR: 1.4-4.4) after initiation. The delay was 3.7 years (IQR: 2.8-5.1) and 0.9 years (IQR: 0.6-1.4) in those becoming eligible before and after near POC viral load was available, respectively. Among those with a first viral load, 95% (2796/2945) were <=1000 copies/ml. Eighty-four % (125/149) of those with a viral load >1000 copies/ml received enhanced adherence counselling and a follow up viral load, a median of 119 days (IQR: 95-167) after the first viral load. Virological failure was confirmed in 67% (84/125), and 82% (69/84) of them were switched to second-line ART. Nine-three % (64/69) among those switched were alive on ART at end of follow-up. Having a first viral load of >=5000 copies/ml was associated with confirmed virological failure. Conclusion: Near POC viral load testing enabled rapid scale-up of viral load testing in Myanmar. PLHIV with a high viral load were adequately managed.

Section: Discussionmentioning

confidence: 80%

Near point-of-care HIV viral load testing: Uptake and utilization in suburban Yangon, Myanmar

Smithuis

et al. 2022

Preprint

Self Cite

“…Based upon existing estimates that cryptococcal meningitis prevalence is 6% in patients with CD4 < 100 at the time of antiretroviral initiation, [9] we believe the 76 patients included in this study is representative of the cases with CD4 < 100 (1460 patients) within the MAM cohort during this study period. The outcomes described suggest that mortality within the first 2 and 10 weeks of treatment (0 and 7%) were much lower than comparable published data on LMIC hospital-based cohorts in (1 7% at two weeks and 34% at 10 weeks [13,14]).…”

Section: Discussionmentioning

confidence: 96%

“…Published literature concentrates on hospital-based mortality outcomes for confirmed cryptococcal meningitis cases. However, in resourceconstrained settings outpatient management may be the only option available to deliver life-saving treatment due to social and financial barriers to hospital-based care [9].…”

Section: Introductionmentioning

confidence: 99%

“…Medical Action Myanmar (MAM) is a medical aid organisation providing outpatient HIV care integrated with other services (primary care, tuberculosis, sexual health, antenatal care) free of charge in the most socially deprived areas of the country. The MAM HIV satellite site model-of-care has been described elsewhere [9]. These clinics have been providing prevention and treatment of opportunistic infections since 2009.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ambulatory induction phase treatment of cryptococcal meningitis in HIV integrated primary care clinics, Yangon, Myanmar

et al. 2021

Background Cryptococcal meningitis (CM) is a common HIV-associated opportunistic-infection worldwide. Existing literature focusses on hospital-based outcomes of induction treatment. This paper reviews outpatient management in integrated primary care clinics in Yangon. Method This retrospective case note review analyses a Myanmar HIV-positive patient cohort managed using ambulatory induction-phase treatment with intravenous amphotericin-B-deoxycholate (0.7–1.0 mg/kg) and oral fluconazole (800 mg orally/day). Results Seventy-six patients were diagnosed between 2010 and 2017. The median age of patients diagnosed was 35 years, 63% were male and 33 (45%) were on concurrent treatment for tuberculosis. The median CD4 count was 60 at the time of diagnosis. Amphotericin-B-deoxycholate infusions precipitated 56 episodes of toxicity, namely hypokalaemia, nephrotoxicity, anaemia, febrile reactions, phlebitis, observed in 44 patients (58%). One-year survival (86%) was higher than existing hospital-based treatment studies. Conclusion Ambulation of patients in this cohort saved 1029 hospital bed days and had better survival outcomes when compared to hospital-based studies in other resource constrained settings.

“…From that time onwards, the people of the Mon country went to worship there. (Tun Aung Chain and Thein Hlaing 1996: 3)…”

Section: A ‘Mon’ and ‘Buddhist Kingdom’mentioning

confidence: 99%

Facts and Fiction: The Myth of Suvaṇṇabhūmi Through the Thai and Burmese Looking Glass

Revire

2018

TRaNS

Most scholars think that the generic name ‘Golden Land’ (Sanskrit, Suvarṇabhūmi; Pali, Suvaṇṇabhūmi) was first used by Indian traders as a vague designation for an extensive region beyond the subcontinent, presumably in Southeast Asia. Some Pali sources specifically link Suvaṇṇabhūmi with the introduction of Buddhism to the region. The locus classicus is the Sri Lankan Mahāvaṃsa chronicle (fifth century AD) which states that two monks, Soṇa and Uttara, were sent there for missionary activities in the time of King Asoka (third century BC). However, no Southeast Asian textual or epigraphic sources refer to this legend or to the Pali term Suvaṇṇabhūmi before the second millennium AD. Conversely, one may ask, what hard archaeological evidence is there for the advent of Buddhism in mainland Southeast Asia? This article re-examines the appropriation of the name Suvaṇṇabhūmi in Thailand and Burma for political and nationalist purposes and deconstructs the connotation of the term and what it has meant to whom, where, and when. It also carefully confronts the Buddhist literary evidence and earliest epigraphic and archaeological data, distinguishing material discoveries from legendary accounts, with special reference to the ancient Mon countries of Rāmaññadesa (lower Burma) and Dvāravatī(central Thailand).