Integrating PMCT in RH / MCH services in Myanmar. 6 November 2006 At Kuala Lumpur

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1 Integrating PMCT in RH / MCH services in Myanmar 6 November 2006 At Kuala Lumpur

2 Country profile 14 states and divisions, 63 districts, and 325 townships Population in 2005 was million (estimated) 70% of the population resides in rural areas Population growth rate was 2.02 (2000)

3 Background RH/MCH Total Fertility rate (2003) Estimated number of births (2003) ANC coverage- 63% (2005) Infant Mortality Rate- Urban-45.3/1000 live birth (2003) Rural- 47.1/ 1000 live birth (2003) U5 Mortality Rate- 62.1/1000 live births(2003)

4 HIV/AIDS SITUATION IN MYANMAR HIV +ve recorded = 64,478 (cumulative up to Dec. 2005) AIDS Cases (Reported) = 10,730 (cumulative up to Dec. 2005) Deaths due to AIDS (Reported) = 4,785 (cumulative up to Dec. 2005) PLWHA (estimates) = 338,911 ( 2004) Number 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1, AIDS HIV

5 100 Trends of HIV prevalence among the Urban Institution-based subpopulation group of the HIV sentinel surveillance, Myanmar, 1992 through Percent(%) M 92S 93M 93S 94M 94S 95M 95S 96M 96S 97M 97S 98M 98S 99M 99S 00M 01M 02M 03M 04M Time IDUs M.STD F. STD MCH RECRT BLOOD DONOR CSWs

6 Estimate of national HIV prevalence trend and number of PLHA in Myanmar % in Number of HIV infected pregnant women Thousands Number infected with HIV 340,000 in 2006 Thousands , 000 in

7 No of HIV infected children (0-14) 8,200 in 2006

8 Health service structure Department of Health P M C T Dis. Control NAP State/div Heath Department Pub. Health MCH R H / M C H National State/division AIDS/STD team Township Health Department Township Health centers Township & Station Hp

9 PMCT Programme 140 PMCT implementing areas 120 Number of townships Cumulative number of hospital based PMCT Cumulative number of township PMCT Year 36

10 Approach Phase 1( ) - Community based approach (focus on 70% of population residing at Rural area, 80% deliveries at home, 60% ANC at RHC) Phase 2 (2005-) township (Hospital) & Urban MCH based approach at the township level &Institutional (Hospital) based approach at tertiary and S/D level (Focus on case load & facilities, logistic ease, easy for M&S, high prevalence) To be start with areas where - potential of target population exist: evidenced by epidemiological data - existing infrastructure and manpower is feasible to implement the PMCT programme

11 Community based PMCT Model (up to Rural Health Centre level done by Basic Health Staff except testing) Pre-test Group routine ANC education includes PMCT Followed by individual counseling (Opt-in) Taking blood Send blood sample to urban lab (hospital, STD clinic) Post-test Post-test counseling NVP for preg women and/or midwife Safe Delivery either at home or hospital Infant feeding counseling Follow up, care and support

12 Community based PMTCT programme AN VCCT RHC Blood AN VCCT Post test coun Delivery ARV AN VCCT RHC Post test coun Delivery ARV Test result ARV drugs Blood Hospital/ AIDS/STD Clinic Testing Post test coun Delivery ARV

13 ANC education session with PMCT messages [Photo of RHC or Midwife working]

14 Results - Service utilization Proportion(%) PMTCT at a glance: service utilization rate increased, seroprevalence rate reduced Years VCCT HIV tested HIV positive

15 Results ARV therapy PMTCT at a glance: most of the deliveries of HIV infected pregnant women were covered by Nevirapine Proportion(%) mothers Babies Years

16 Lessons learned from Community Based PMCT Advantage Can cover home deliveries BHS s knowledge and experience of HIV Easy access to VCT for pregnant women Good follow up after delivery Challenge Logistical challenge Transport of blood samples/report Technical challenge Difficulty of supervision to large number of RHC - Difficulty in improving counseling skills of Midwifes (as low prevalence in rural area)

17 Future activities for comprehensive PMCT New things Regimen Cotrimoxazol Opt-out Lay counselor for individual pre-test information Continuum of care (support group, CHBC, ART) Strengthen linkage with RH/MCH CoC (as an entry point)

18 Integration of PMCT in RH/MCH services Implementing staff (Basic health staff/ midwife) HIV/PMCT information as a part of routine ANC Training (knowledge, theory) MCH training includes PMCT knowledge (PCPNC) Pre-service training includes PMCT knowledge

19 Future Plan Scale up PMCT up to nation wide coverage Limited funding is a bottleneck for scale up Township hospitals to provide comprehensive PMCT Identify modalities of PMCT to be a part of routine AN services Coordinated training Coordinated reporting (HMIS, HBMR) Strengthen coordination through regular coordination meeting among stakeholders

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