Uptake of ProviderInitiated HIV Counselling and Testing for Tuberculosis patients and family members

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Uptake of Provider-Initiated HIV Counselling and
Testing for Tuberculosis patients and family
members in MyanmarBo Myint1, Win Maung2, Moe
Zaw3, Khin Ohnmar San4, Kyaw Soe5, P
Clevenbergh61TB Regional Officer Upper Myanmar,
2 Director, Diseases Control, DoH, Myanmar
(Former Deputy Director, National Tuberculosis
Program), 3 WHO, TB Dpt, 4 Deputy Director,
National AIDS Program, Myanmar, 5 HIV/AIDS
Regional Officer Upper Myanmar, 6 International
Union Against Tuberculosis and Lung Disease,
Myanmar Office
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Introduction

• Myanmar is one of the 22 high burden tuberculosis
  countries, TB incidence 170/100 000/an
• The estimated national adult prevalence of HIV
  infection is 0.67
• In 15 sentinel sites in 2008, a sero-prevalence
  survey showed 11 adult TB patients to be HIV
  co-infected
• Integrated HIV Care (IHC) programme for
  Tuberculosis patients and family members in 8
  townships1.6 Million population
• 5 townships since May 2005 (Experienced
  implementers)
• 3 additional townships since October 2007 (New
  implementers)

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Objective

• To describe the uptake of HIV test among TB
  patients
• To compare performance in uptake of HIV test of
  new implementers versus experienced TSHC
• To describe the uptake of HIV test family members
  of TB/HIV patients

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Activities performed by the National Tuberculosis
Program in the IHC program

• Provider-initiated HIV counselling and testing to
  all adult TB patients and spouses/children of
  co-infected patients at the point of TB
  diagnosis/treatment. Same day test/result is
  obtained using two rapid HIV tests
• Referral of TB/HIV co-infected patients
• Provision of cotrimoxazole preventive therapy
• Active case detection of TB and HIV
• Defaulters tracing
• HIV prevention
• Active TB screening for HIV-infected patients
• Recording and reporting

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Recording
Number of adult TB patients registered Number of
TB patients offered HIV test Number of TB
patients HIV tested Number of HIV
co-infected patients Number of spouses/children
of TB/HIV patients offered HIV test Number of
spouses/children of TB/HIV patients HIV
tested Number of HIV infected spouses/children
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Flow of Patients (From beginning of programme
,2005 May to end of 2009 February)
Adult TB patients registered 9996 ?

Number of TB patients HIV tested 7028 (70.3)
HIV Positive
HIV Negative
2330 (33.2)
4698 (66.8)
Spouse/partner/children tested
334 spouses, 193 children
HIV Positive
HIV Negative
68 children (35) 229 spouses (68)
230 (125 children, 105 spouses)
Number enrolled 1686
Total Positive 2627
(1449 TB Patients)
(50 children, 187spouses)
?For Amarapura and Patheingyi townships,
registered adult TB patients were counted from
Oct, 07 This data was analyzed from MGH.rec file
kept at MGH(OPD)
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Gender and prevalence of TB/HIV co-infection
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Proportion of adult TB patients tested per month
in experienced versus new implementers
Myanmar New Year
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Proportion of adult TB patients tested per month
in new implementing townships health center
model C
Monitoring visits
Myanmar New Year
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Proportion of spouses/children of TB/HIV patients
tested per month in experienced (A) and new
implementers (B)
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Proportion of spouses/children of TB/HIV patients
tested per month in new TSHC model C
Monitoring visits
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Conclusion

• Experienced township health centers provide HIV
  testing to about 85 of adult TB patients
  registered
• About 1 in 3 TB patient is co-infected with HIV,
  more males than females
• About 2 in 3 spouses of TB/HIV patients and 1 in
  3 child of HIV-infected mother are HIV-infected
• Proportion of TB patients co-infected with HIV,
  proportion of spouses HIV-infected varies by
  location
• Monthly PITCT uptake fluctuates according to
  external events
• Township health centers newly implementing PITCT
  need a few months to  adapt  to this new
  activity
• Uptake of spouses varies according to TSHC and
  needs to be improved in less well performing
  centers

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Acknowledgements

• This program is funded by the Consortium
• YADANA