Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study.

Autor:	Thinn KK; Department of Public Health, Myanmar Ministry of Health and Sports, Yangon, Myanmar khinekhinethinn21@gmail.com., Thekkur P; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.; Centre for Operational Research, The Union South-East Asia Office, New Delhi, India., Kyaw NTT; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar., Aye NS; Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar., Zaw TM; Yangon Regional Public Health Department, Ministry of Health and Sports, Yangon, Myanmar., Soan P; Department of Public Health, Myanmar Ministry of Health and Sports, Naypyidaw, Naypyidaw Union Territory, Myanmar., Hone S; Department of Public Health, Myanmar Ministry of Health and Sports, Naypyidaw, Naypyidaw Union Territory, Myanmar., Oo HN; Department of Public Health, Myanmar Ministry of Health and Sports, Naypyidaw, Naypyidaw Union Territory, Myanmar.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2019 Dec 03; Vol. 9 (12), pp. e032678. Date of Electronic Publication: 2019 Dec 03.
DOI:	10.1136/bmjopen-2019-032678
Abstrakt:	Objectives: In 2017, Myanmar implemented routine viral load (VL) monitoring for assessing the response to antiretroviral therapy (ART) among people living with HIV (PLHIV). The performance of routine VL testing and implementation challenges has not yet assessed. We aimed to determine the uptake of VL testing and factors associated with it among PLHIV initiated on ART during 2017 in ART clinics of Yangon region and to explore the implementation challenges as perceived by the healthcare providers. Design: An explanatory mixed-methods study was conducted. The quantitative component was a cohort study, and the qualitative part was a descriptive study with in-depth interviews. Setting: Six ART clinics operated by AIDS/sexually transmitted infection teams under the National AIDS Programme. Primary Outcome Measures: (1) The proportion who underwent VL testing by 30 March 2019 and the proportion with virological suppression (plasma VL <1000 copies/mL); (2) association between patient characteristics and 'not tested' was assessed using log binomial regression and (3) qualitative codes on implementation challenges. Results: Of the 567 PLHIV started on ART, 498 (87.8%) retained in care for more than 6 months and were eligible for VL testing. 288 (57.8%, 95% CI: 53.3% to 62.2%) PLHIV underwent VL testing, of which 263 (91.3%, 95% CI: 87.1% to 94.4%) had virological suppression. PLHIV with WHO clinical stage 4 had significantly higher rates of 'not being tested' for VL. Collection of sample for VL testing only twice a month, difficulties in sample collection and transportation, limited trained workforce, wage loss and out-of-pocket expenditure for patients due to added visits were major implementation challenges. Conclusions: The VL test uptake was low, with only six out of ten PLHIV tested. The VL testing uptake needs to be improved by strengthening sample collection and transportation, adopting point-of-care VL tests, increasing trained workforce, providing compensation to patients for wage loss and travel costs for additional visits. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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