Nini Tun, Cho Lwin Oo, Cho Myat Nwe, Lutgarde Lynen, Tom Decroo, Frank Smithuis, Tinne Gils
<p>People who inject drugs (PWID) are disproportionally affected by HIV acquisition [<span>1</span>]. Myanmar, a large producer of opium, has an estimated 116,000 PWID, among whom an estimated 26.4% are people living with HIV [<span>2, 3</span>]. Needle sharing contributed to one-third of the national HIV incidence in 2018 [<span>4</span>]. The national harm reduction programme includes prevention and care for HIV, viral hepatitis C (HCV), other sexually transmittable infections and tuberculosis (TB), needle and syringe exchange (NSE), and opiate substitution therapy (OST) for PWID [<span>4</span>]. Yet, nationally, only 24.0% of PWID were tested for HIV, and 47.8% of HIV-positive PWID were on antiretroviral treatment (ART) [<span>3</span>]. Even in Yangon, PWID experience barriers to access NSE and OST [<span>5</span>].</p><p>Putao is a remote sparsely populated district on the slopes of the Himalayas in the far North of Myanmar [<span>6</span>]. Sources of income include agriculture, and gold mines operated by increasing numbers of migrant workers. Opioid cultivation sites exist [<span>6</span>]. Heroin injecting is common in Putao, among miners, and in rural communities [<span>7</span>]. Access to health services for PWID is tremendously challenging. Poor road infrastructure, lack of public transport and extreme remoteness of the villages hamper physical access. OST is restricted to government hospitals. Like elsewhere, PWID are insufficiently aware about the risks of heroin use, associated blood-borne infections, and available care [<span>5</span>] and often stigmatized by community members [<span>8</span>].</p><p>Before 2012, no PWID-specific harm reduction services existed in Putao. HIV testing and ART initiation were provided at a public hospital, where only seven ART patients were registered as PWID before 2012.</p><p>Medical Action Myanmar (MAM), a medical organization, is present in Putao since 2012. In a first phase, MAM provided clinic-based primary care services, following a request by a local organization and because no other non-governmental organizations were present. Due to a lack of key population data and PWID-specific services, and a suspicion of PWID presenting with advanced HIV, MAM started clinic-based HIV testing and treatment, while referring TB patients to a local organization for treatment and care. The high incidence of malaria and TB and difficulties with linkage to care prompted MAM to set up a network of community health workers (CHWs) providing malaria, TB and primary healthcare services in remote communities in 2014. CHWs were selected by MAM and village leaders among community volunteers, trained by MAM, and incentivized per diagnosis, referral, and treated malaria or TB patient. Trained CHWs received a joint certificate from the Ministry of Health and MAM. Due to the remoteness of the Putao district, clinic-based HIV services were insufficient to reach most PWID. Between 2012 and 2017, only 144 PWID were initiat
{"title":"Improving access to integrated community-based HIV, HCV and harm reduction services for people who inject drugs in Putao district, North Myanmar","authors":"Nini Tun, Cho Lwin Oo, Cho Myat Nwe, Lutgarde Lynen, Tom Decroo, Frank Smithuis, Tinne Gils","doi":"10.1002/jia2.26355","DOIUrl":"https://doi.org/10.1002/jia2.26355","url":null,"abstract":"<p>People who inject drugs (PWID) are disproportionally affected by HIV acquisition [<span>1</span>]. Myanmar, a large producer of opium, has an estimated 116,000 PWID, among whom an estimated 26.4% are people living with HIV [<span>2, 3</span>]. Needle sharing contributed to one-third of the national HIV incidence in 2018 [<span>4</span>]. The national harm reduction programme includes prevention and care for HIV, viral hepatitis C (HCV), other sexually transmittable infections and tuberculosis (TB), needle and syringe exchange (NSE), and opiate substitution therapy (OST) for PWID [<span>4</span>]. Yet, nationally, only 24.0% of PWID were tested for HIV, and 47.8% of HIV-positive PWID were on antiretroviral treatment (ART) [<span>3</span>]. Even in Yangon, PWID experience barriers to access NSE and OST [<span>5</span>].</p><p>Putao is a remote sparsely populated district on the slopes of the Himalayas in the far North of Myanmar [<span>6</span>]. Sources of income include agriculture, and gold mines operated by increasing numbers of migrant workers. Opioid cultivation sites exist [<span>6</span>]. Heroin injecting is common in Putao, among miners, and in rural communities [<span>7</span>]. Access to health services for PWID is tremendously challenging. Poor road infrastructure, lack of public transport and extreme remoteness of the villages hamper physical access. OST is restricted to government hospitals. Like elsewhere, PWID are insufficiently aware about the risks of heroin use, associated blood-borne infections, and available care [<span>5</span>] and often stigmatized by community members [<span>8</span>].</p><p>Before 2012, no PWID-specific harm reduction services existed in Putao. HIV testing and ART initiation were provided at a public hospital, where only seven ART patients were registered as PWID before 2012.</p><p>Medical Action Myanmar (MAM), a medical organization, is present in Putao since 2012. In a first phase, MAM provided clinic-based primary care services, following a request by a local organization and because no other non-governmental organizations were present. Due to a lack of key population data and PWID-specific services, and a suspicion of PWID presenting with advanced HIV, MAM started clinic-based HIV testing and treatment, while referring TB patients to a local organization for treatment and care. The high incidence of malaria and TB and difficulties with linkage to care prompted MAM to set up a network of community health workers (CHWs) providing malaria, TB and primary healthcare services in remote communities in 2014. CHWs were selected by MAM and village leaders among community volunteers, trained by MAM, and incentivized per diagnosis, referral, and treated malaria or TB patient. Trained CHWs received a joint certificate from the Ministry of Health and MAM. Due to the remoteness of the Putao district, clinic-based HIV services were insufficient to reach most PWID. Between 2012 and 2017, only 144 PWID were initiat","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annabelle Choong, Yi Ming Lyu, Cheryl C. Johnson, Rachel Baggaley, Magdalena Barr-DiChiara, Muhammad S. Jamil, Nandi L. Siegfried, Christopher K. Fairley, Eric P. F. Chow, Virginia Macdonald, Jason J. Ong