The following paragraph from a recent press release from MSF (Holland) is key to understanding the call to strengthen the health care system in Myanmar to support the country in meeting global targets.
“This includes scaling up treatment, strengthening human resources and improving the overall health and laboratory infrastructure. Furthermore, it is crucial that changes are made in the delivery of HIV/AIDS services such as restructuring health staff duties relating to HIV/AIDS and accelerating the decentralization of medical services for people living with HIV/AIDS.”
Two years ago it was found that 56% of people on antiretroviral treatment in the country were receiving it in Yangon and Mandalay.
Jamie
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MSF urgently calls for faster scale-up and new approaches to fight HIV/AIDS in Myanmar
As World AIDS Day approaches on December 1, Médecins Sans Frontières (MSF)/Doctors Without Borders calls for increasing efforts to support the Ministry of Health’s National AIDS Program (NAP) to meet the 2016 World Health Organization (WHO) HIV/AIDS global targets, together with improving the quality of care for people living with HIV/AIDS.
MSF commends the Myanmar health authorities in their efforts to effectively take control of HIV/AIDS diagnosis and treatment and support the global “Getting to Zero” campaign. However, while Myanmar is currently on track to reach the ambitious 2016 targets, last year the WHO expanded the criteria for people with HIV/AIDS that qualify for treatment.
While MSF welcomes this positive step in the global fight against the disease, this change will lead to a large expansion in the number of HIV/AIDS patients requiring antiretroviral (ARV) treatment and associated supportive medical care in Myanmar. Therefore it imposes extra challenges on the already existing constraints for Myanmar to meet the new 2016 global targets. As Myanmar develops economically, it may in future not qualify to receive the same levels of international donor money and resources to fund the strengthening of its health system.
“In close collaboration with the Ministry of Health’s National AIDS Program, MSF firmly believes the way forward in this situation is adapting and innovating in the way HIV/AIDS is addressed in Myanmar,” said MSF Myanmar Country Health Director Dr Nana Zarkua. “This includes scaling up treatment, strengthening human resources and improving the overall health and laboratory infrastructure. Furthermore, it is crucial that changes are made in the delivery of HIV/AIDS services such as restructuring health staff duties relating to HIV/AIDS and accelerating the decentralization of medical services for people living with HIV/AIDS.”
Since April 1, in Bhamo General Hospital, Kachin State, MSF and the NAP have been working in close collaboration to implement a new model of care that has resulted in a dramatic increase in the number of HIV/AIDS patients diagnosed and treated free-of-charge by the NAP, using medication financed by The Global Fund. These are patients that may have otherwise been failed to be diagnosed and treated at all, or not have reached HIV/AIDS services soon enough. In Lashio, Shan State, MSF has relocated, expanded and upgraded our HIV/AIDS and TB clinic to improve the delivery of health services to our patients.
This year in Dawei, Thanintharyi Region MSF introduced for the first time in Myanmar a more effective, simple and humane oral treatment (valganciclovir) for Cytomegalovirus (CMV) retinitis, a neglected opportunistic disease linked to HIV/AIDS which can cause permanent blindness. This was also the first time MSF used this pill in any of its HIV/AIDS projects around the world – a medication that has been standard treatment for CMV retinitis in rich countries since 2001. All of MSF’s patients diagnosed with CMV retinitis in Myanmar will be receiving valganciclovir by 2015. MSF is lobbying internationally for a greater reduction in the price of this drug, which is still out of reach for so many. MSF is also urging WHO to include guidelines for the management of this disease into national treatment protocols. Currently, in low income countries such as Myanmar, treatment guidelines do not exist.
As the first and largest HIV/AIDS actor in Myanmar, currently treating over 35,000 patients across the country, including more than 3,000 co-infected tuberculosis (TB) patients, MSF remains committed to the fight against HIV/AIDS in Myanmar.
Inauguration of Insein Clinic
On 29 November, MSF will officially inaugurate the largest HIV/AIDS and TB clinic in Myanmar, currently treating approximately 10,000 HIV/AIDS patients, many of whom suffer from other co-infections. Currently, in close cooperation with the Ministry of Health’s National TB Program (NTP), MSF is also treating 45 patients for DR-TB in Insein Clinic, all of which are co-infected with HIV/AIDS.
MSF invested a great deal of resources into Insein Clinic to ensure it adheres to international guidelines regarding HIV/AIDS management, infection control and patient supervision and treatment. The facility was also specifically designed to play a key role in the fight against drug-resistant TB (DR-TB) – an extremely serious global health emergency that directly affects Myanmar, which is a WHO-classified high-burden TB country.
However, while such clinics and the Myanmar health authorities’ scale-up process in the general population are crucial steps in the fight against HIV/AIDS and DR-TB, these positive steps forward cannot fully address the scale of the challenges that lay ahead alone. In the years to come, MSF will focus on targeting hard-to-reach HIV/AIDS populations such as children, co-infected patients with poor access to treatment for neglected diseases such as DR-TB, CMV retinitis and hepatitis C viral (HCV) infection, sexual minorities such as MSM groups, migrant workers, drug users, sex workers and other displaced or isolated people who find it challenging to access HIV/AIDS diagnosis or treatment.
MSF urges all organisations and international partners involved in supporting the fight against HIV/AIDS to accelerate efforts to assist the Myanmar health authorities to adapt their HIV/AIDS strategies to reflect the realities of the significant challenges ahead.
For more information on MSF activities in Myanmar and other activities around the world in Myanmar and English languages, please visit www.msfmyanmar.org or www.msf.org for English only.
MSF has been in Myanmar since 1992 and is currently providing health care in Kachin, Shan and Rakhine states, as well as in Yangon and Thanintharyi regions to tens of thousands of people from many ethnic origins. MSF was among the first responders to cyclones Nargis and Giri, providing medical assistance, survival items and clean water resources for hundreds of thousands of people.
