The [him] moderator is keeping an eye on the International AIDS Society conference in Rome but all that is coming out of it so far is hype and blather. He will post on it later.

Here are the only abstracts presented with the word Myanmar in them. No abstracts contain the word Burma.

[him] moderator

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Penicillium marneffei infection among HIV-infected patients in Yangon division and Kachin state, Myanmar
A. Chhetri1, A. Thida1, K. Marlar Lwin1, A. Lancilot2, V. Pardessus3, F. Sivignon3

1Medecins Du Monde, Clinical Section, Yangon, Myanmar, 2Medecins Du Monde, Yangon, Myanmar, 3Medecins Du Monde, Paris, France

Background: Penicillium marneffei is a dimorphic fungus, endemic in South-east Asia. However, scanty study of Penicillium marneffei has been reported in the literatures from Myanmar. This study aims to further illustrate the epidemiological and clinical characteristics of patients with penicillium marnefeei among HIV infected patients in Myanmar.
Methods: This is a descriptive study; the clinical data of 16 patients who had penicilliosis during the inclusive period of January to December 2010 were retrospectively analyzed.
SETTING: Resource poor primary care clinics run by an INGO, Medecins Du Monde. The data was extracted from a clinic site at Yangon division and two sites at Kachin state, Myanmar.
Results: Of the 961 HIV positive patients attending clinics, penicilliosis represented 1.7% of opportunistic infections. The patients were fairly young males (81%) median (IQR) of 30 (23 to 40 years). Of the total patients, 10(62%) were attributed to intravenous drug users (IDU), one was a commercial sex worker and two were MSM (man having sex with man) and three of the patients were partners of IDUs. The main symptoms were persistent fever (98%), hepatomegaly (69%), lymphadenopathy(51%), Anemia (72%) and characteristic skin lesions (100%). The median CD4 count was 71/µL. Due to resource poor setting, we could only make presumptive diagnosis by microscopic examination of Wright-Giemsa stained smears of skin lesions. The sensitivity of Wright -Giemsa penicilium from skin lesions in two series was reported as 90% and 100% respectively. Itraconazole monotherapy were administered in thirteen patients as available standard therapy and three patients received amphotericinB followed by Itraconozole.13(81%) survived as well as all those that received amphotericinB during the study period.
Conclusion: Penicilliosis should be considered in patients with febrile illness with low CD4 count and molluscum contagiosum-like skin lesions. The prognosis can be improved by early diagnosis through confirmatory diagnosis and appropriate antifungal therapy.

http://pag.ias2011.org/abstracts.aspx?aid=1934

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Risk factors of meta-amphetamine abuse among methadone maintenance treatment clients in Yunnan province, China
Y. Chang

The Red Cross Hospital of Yunnan Province, Personnel, Kunming, China

Background: Use of meta-amphetamine, a stimulant drug, may lead to unprotected sex with more than one partner at a time. This brings more risks to the HIV/AIDS transmission beyond the IDUs, especially women. Our objective is to investigate the proportion and frequencies of meta-amphetamine abuse among MMT clients and its risk factors.
Methods: 1514 clients from thirteen out of sixty-eight MMT clinics in Yunnan received urine tests for meta-amphetamine and questionnaires. We also conducted a continuous urine tests (once every three to five days, eighteen tests in all) among 149 clients from the selected seven MMT clinics. Chi-square tests and multiple linear regression were used for results analysis.
Results: Among the 1514 MMT clients(235 women) tested, 188 were tested positive for meta-amphetamine and counts for 12.4%. The risk factors included: different location (a China-Myanmar border prefecture counts for 91.5%, OR=16.51,P<0.01), male(94.7%, OR=3.64,P<0.01), Dai people (56.4%,OR=6.42,P<0.01), married or cohabited (67.6%, OR=1.70,P<0.01), education level of junior high or under (87.2%, OR=1.82,P<0.01), farmers (64.4%, OR=3.44,P<0.01), MMT enrollment more than half-a-year (89.9%, OR=2.74,P<0.01). The HIV negative rate among the urine meta-amphetamine positive clients was 72.9%. As for the result of continuous urine tests, positive frequencies of ten and above,one to nine,and zero times were 22.2%,20.1% and 57.7%,respectively. Besides the factors mentioned above, a higher positive frequency was also significantly associated with the group who had not heard of or received services of needle and syringe exchange,opportunistic infections treatment,anti-retroviral treatment and HIV mother-to-infant transmission interruption.
Conclusion: Relatively high frequency of meta-amphetamine abuse is found among MMT clients in Yunnan, China. It is necessary to be more creative in MMT services and to reinforce comprehensive prevention and treatment for HIV/AIDS and poly drug use.

http://pag.ias2011.org/abstracts.aspx?aid=565

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Think outside the disease box
A. Yu Naing1, K.T. Hein2, P.W. Htun3, K.M. Htet4

1AHRN - Asian Harm Reduction Network, Medical Intervention Unit, Yangon, Myanmar, 2AHRN - Asian Harm Reduction Network, Medical Intervention Unit, Lashio, Myanmar, 3AHRN - Asian Harm Reduction Network, Medical Intervention Unit, Pharkant, Myanmar, 4AHRN - Asian Harm Reduction Network, Medical Intervention Unit, Bahmaw, Myanmar

Issue: Incessant fear of arrest coupled with deeply rooted overall stigma and discrimination and insensitive attitudes or lack of knowledge from medics is too often a drug users predicament. The medical model and its strict alignment with diseases neglects a pre-set understanding of addiction and leaves drug users in the cold for their overall health and psychosocial issues.
Setting: Myanmar is no exception. Drug users are hidden, stigmatized, homeless with chaotic lifestyles and tons of unaddressed basic health needs. Social re-integration is almost non-existent. On top of that, medics behaving like 'God' make available treatment less meaningful. Unspecified holistic treatment goals are enough to label drug users as irresponsible with 'poor' adherence, exacerbated because of the resource poor setting.
Project: AHRN implements community based DICs in sites in Kachin and Northern Shan State with high prevalence of drug use. Medical interventions are integrated and provide client matching PHC, TB, STIs, TB-HIV, Malaria screening, diagnosis and treatment and symptomatic drug treatment but many health issues remain untreated or treatment is unavailable. The disease model does not work and neglects chronic addiction issues and related health. To address this internal guidelines are developed, continuous training/coaching is given and linkages with counselors, peers? are strengthened. Ultimate aim: medic's attitude focuses on overall health of a person and not on a patient with diseases.
Outcomes: Changing the attitude of medics is an arduous process and relapse (just as with any addiction) happens. Nevertheless, positive outcomes are observed: more acceptance of treatment limitations; more 'thinking outside the disease box' like acceptance that moral support is valid (and sometimes) only treatment; acceptance of chronic addiction; better relations based on respect and dignity with the drug users (not only patient anymore); better linkages within the team?
Now AHRN drug users are happier with their health specialists?

http://pag.ias2011.org/abstracts.aspx?aid=1498

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Women who use drugs: do we care in Myanmar?
A. Yu Naing1, T.T. Aye2, M.M. Thu3, S.T. Nang4

1AHRN (Asian Harm Reduction Network), Medical Intervention Unit, Yangon, Myanmar, 2AHRN (Asian Harm Reduction Network), Medical Intervention Unit, Laukkai, Myanmar, 3AHRN (Asian Harm Reduction Network), Medical Intervention Unit, Pharkant, Myanmar, 4AHRN (Asian Harm Reduction Network), Medical Intervention Unit, Seng Taung, Myanmar

Issue: FGDs with drug users indicate that up to 30% of all drug users in Myanmar might be female with a significant proportion involved in sex-work, which exacerbates their vulnerability to HIV/AIDS. The combination of drug use and sex-work raises stigma & discrimination with alienation from social ties such as family, children and the community. Being easily labeled as immoral, they are blamed for not fulfilling their traditional roles. Often partners will discourage them to access services.
Setting: 'China White' heroin #4 is the most prevalent used drug in Myanmar among women; while ATS use is rapidly gaining popularity. Many female users are engaged in street-based or brothel-based sex-work, mainly in border areas and 'hot-spots' such as Jade mines in Kachin state. Existing harm reduction services have gender sensitive format but nevertheless does not attract female users.
Project: AHRN, operational in Myanmar since 2003, has 3 (2 in the jade mining area and1 at the Myanmar-Chinese border) established medical interventions specifically for needs of female users. To enhance access, separate DIC were implemented; female doctors, counselors and outreach workers were recruited and medically, next to the usual interventions, more attention was given on STI screening/treatment and reproductive health. Strong condoms and gel were distributed among ATS users.
Outcomes: Inclusion of female staff, female friendly separate DIC, regular coaching, gender sensitive IEC-communication strategies and expansion of medical interventions tailored to female needs have increased access and treatment retention of the target group. Numbers at health services, STIs screening and treatment are growing and their enhanced self-esteem and participation has encouraged self-help group initiatives. Previously about 4% of drug users reached by AHRN were female, currently this is more than 10%. 2,396 female drug users and partners have been reached (222 SW), 242 STI screenings done and 31,572 condoms disseminated amongst women.

http://pag.ias2011.org/abstracts.aspx?aid=1500

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Four year survival rate of a cohort of TB/HIV-infected patients followed in the public sector in Myanmar
Z. Zaw Myo Tun1, M. Moe Zaw2, T. Thandar Lwin2, S. Khin Ohnmar San3, B. Bo Myint4, S. Sai Phone Kyaw5, T. Kyaw Thu6, W. Win Maung7, P. Clevenbergh8

1The Union, Mandalay, Myanmar, 2National Tuberculosis Program, DoH, Nay Pyi Taw, Myanmar, 3National AIDS Programme, Nay Pyi Taw, Myanmar, 4National Tuberculosis Program, Mandalay, Myanmar, 5Mandalay General Hospital, Mandalay, Myanmar, 6Mandalay Teaching Hospital, Mandalay, Myanmar, 7Dpt Diseases Control, DoH, Nay Pyi Taw, Myanmar, 8International Union Against Tuberculosis and Lung Disease, HIV, Mandalay, Myanmar

Background: In collaboration with the public sector, National AIDS and Tuberculosis programs, The Union is supporting an HIV care program in Mandalay, since May 2005. The entry door is the TB program where adult TB cases are offered provider-initiated counseling and testing for HIV. TB/HIV co-infected patients are referred to a specialist HIV OPD to receive comprehensive HIV care.
Methods: Patient's charts were extracted for demographic, clinical, biological data, and outcomes up to 4 years after starting ART.
Results: Between May 2005 and January 2009, 9726 adult TB patients were registered, 6952 patients tested for HIV; 2345 patients were HIV-infected, 1545 patients attended the HIV OPD and 1386 patients were started on ART. Patients were median age: 34 [IQR: 29-39] years, sex ratio male/female: 3.3/1, risk factors: heterosexual: 93%, homosexual: 1%, IVDU: 4%, other: 2%. Patients had a median BMI: 17.6 [15.6-19.5] kg/m², median CD4: 110 [58-183] cells/µl, median haemoglobin: 10.3 [9.1-11.6] g/dl. ART was started a median of 119 [69-227] days after TB treatment. At 6, 12, 24, 36 and 48 months after ART, distribution of patients “alive on treatment”, “defaulters” and “death” were: 93%, 0%, and 7%; 87%, 0% and 13%; 80%, 1%, and 19%; 79%, 1%, and 20%; 76%, 2%, and 22%, respectively. At 6, 12, 24, 36 and 48 months after starting ART, median CD4 count was: 151, 221, 268, 331, and 363 cells/µl, respectively. The proportion of malnourished/normal BMI patients was 65/35, 45/55, 34/66, 31/69, 33/67 and 30/70 at 0, 6, 12, 24, 36 and 48 months after ART, respectively.
Conclusion: Most patients are diagnosed at advanced stages of disease. Four years after starting ART, 76% patients are “alive on treatment”. The retention rate in this cohort of TB/HIV co-infected patients, in the public sector in Myanmar, compares well with other cohorts in resources-limited setting.

http://pag.ias2011.org/abstracts.aspx?aid=1710

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Survival rates during the first 36 months highly active antiretroviral therapy among most at-risk populations in resource limited setting, Myanmar
W.M. Myint1, A. Thida1, K.M. Lwin1, F. Sivignon2

1Medecins Du Monde, Yangon, Myanmar, 2Medecins Du Monde, Paris, France

Background: The National Strategic Plan for HIV/AIDS in Myanmar sets interventions for the reduction of HIV transmission among MARPs as highest priority. Outcomes of HAART in high risk groups in Yangon, Myanmar, have not been systematically described.
Methods: : All patients who enrolled in the HAART program at MDM clinic Feb-2005 to Dec-2007 were included in this prospective cohort study. Intensive adherence counseling was done before starting HAART, followed by monthly adherence counseling. Adherence was assessed based on patient's self-reports, as well as on pill count check at surprise home visits. Patients who missed monitoring visits were actively followed by the outreach teams composed of counselors and adherence supporters. During the first 36 months of treatment, adherence and survival rates were analyzed.
Results: Among the 227 included patients 98 were sex workers, 95 MSM, and 34 partnersof those. Mean age was 30.8 (SD±7.8 years), median CD4 count 97((IQR 37-208) cells/µL, with 30% of patients having a baseline CD4 < 50. Among them, 80.6% of patients were clinically staged as WHO stage 3 or 4. Survival rates at 12month, 24 month and 36 months were 91.8 % (MSM 92.6%, SW-88.8%), 88.6 % (MSM 90.5 %, SW 84.7 %) and 85.9 % (MSM 88.4%, SW-81.6 %) respectively.
Main causes of non-survival were death or lost to follow-up.
Conclusion: Although some constraints exist, HAART programming can be implemented successfully among high risk populations and contribute to impact at national level in settings with limited resources such as Myanmar. Providing a comprehensive package including intensive adherence support leads to positive outcomes. The method of adherence checking: patient self-report combined with adherence counseling by efficient health care team is corner stone for scaling up of the program.

http://pag.ias2011.org/abstracts.aspx?aid=2567