HIV care in Yangon, Myanmar; successes, challenges and implications for policy.

Autor: Aung NM; Department of Medicine, University of Medicine 2, Yangon, Myanmar., Hanson J; Department of Medicine, University of Medicine 2, Yangon, Myanmar.; Menzies School of Health Research, Darwin, Australia.; The Kirby Institute, Sydney, Australia., Kyi TT; Department of Medical Care, Ministry of Health, Nay Pyi Taw, Myanmar., Htet ZW; Insein General Hospital, Yangon, Myanmar., Cooper DA; The Kirby Institute, Sydney, Australia., Boyd MA; The Kirby Institute, Sydney, Australia.; University of Adelaide, Adelaide, Australia., Kyi MM; Department of Medicine, University of Medicine 2, Yangon, Myanmar., Saw HA; Department of Medicine, University of Medicine 2, Yangon, Myanmar.
Jazyk: angličtina
Zdroj: AIDS research and therapy [AIDS Res Ther] 2017 Mar 04; Vol. 14 (1), pp. 10. Date of Electronic Publication: 2017 Mar 04.
DOI: 10.1186/s12981-017-0137-z
Abstrakt: Background: Approximately 0.8% of adults aged 18-49 in Myanmar are seropositive for Human Immunodeficiency Virus (HIV). Identifying the demographic, epidemiological and clinical characteristics of people living with HIV (PLHIV) is essential to inform optimal management strategies in this resource-limited country.
Methods: To create a "snapshot" of the PLHIV seeking anti-retroviral therapy (ART) in Myanmar, data were collected from the registration cards of all patients who had been prescribed ART at two large referral hospitals in Yangon, prior to March 18, 2016.
Results and Discussion: Anti-retroviral therapy had been prescribed to 2643 patients at the two hospitals. The patients' median [interquartile range (IQR)] age was 37 (31-44) years; 1494 (57%) were male. At registration, injecting drug use was reported in 22 (0.8%), male-to-male sexual contact in eleven (0.4%) and female sex work in eleven (0.4%), suggesting that patients under-report these risk behaviours, that health care workers are uncomfortable enquiring about them or that the two hospitals are under-servicing these populations. All three explanations appear likely. Most patients were symptomatic at registration with 2027 (77%) presenting with WHO stage 3 or 4 disease. In the 2442 patients with a CD4+ T cell count recorded at registration, the median (IQR) count was 169 (59-328) cells/mm 3 . After a median (IQR) duration of 359 (185-540) days of ART, 151 (5.7%) patients had died, 111 (4.2%) patients had been lost to follow-up, while 2381 were alive on ART. Tuberculosis (TB) co-infection was common: 1083 (41%) were already on anti-TB treatment at registration, while a further 41 (1.7%) required anti-TB treatment during follow-up. Only 21 (0.8%) patients were prescribed isoniazid prophylaxis therapy (IPT); one of these was lost to follow-up, but none of the remaining 20 patients died or required anti-TB treatment during a median (IQR) follow-up of 275 (235-293) days.
Conclusions: People living with HIV in Yangon, Myanmar are generally presenting late in their disease course, increasing their risk of death, disease and transmitting the virus. A centralised model of ART prescription struggles to deliver care to the key affected populations. TB co-infection is very common in Myanmar, but despite the proven efficacy of IPT, it is frequently not prescribed.
Databáze: MEDLINE
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