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Integrated TB-HIV Services at PSI Clinical Social Franchise Network (Myanmar)
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Transcript of Integrated TB-HIV Services at PSI Clinical Social Franchise Network (Myanmar)
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Integrated TB-HIV Services at PSI Clinical Social Franchise Network
(Myanmar)
Dr. Phyu Phyu SweHealth Services Manager (TB)Population Services International/Myanmar25 July 2012
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Presentation outline• TB & HIV situation in Myanmar
• National strategic plan for TB-HIV services integration
• PSI/Myanmar health service system
• Integration of TB-HIV service at PSI franchised network
• Achievement
• Challenges/Lessons learnt
• Future plan
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CHINA
LAOS
THAILAND
INDIA
BANGLADESH
KACHIN
SHAN
SAGAING
CHIN
RAKHINE
MANDALAYMAGWE
BAGO
AYARWADDYYANGON
KAYIN
KAYAH
MON
TANINTHARYI
TB & HIV Situation in Myanmar
One of the 41 high TB-HIV
burden countries
HIV prevalence among TB
patients (2010) 10.4%
TB prevalence among
PLHA (2010) 30-40%
Global TB control, 2011 , HSS 2010
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National strategic plan for TB-HIV services integration (2012-2015)
Goal: • To reduce the burden of HIV-related TB to
achieve the 2015 MDG target
Plan to scale up to all townships & public hospitals by 2015
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SQH onlySPH only SUN (SQH+SPH) SQH: Sun Quality Health
SPH: Sun Primary Health
PSI/M Health Services SystemTwo tiered social franchise network
Case management
Health talkReferrerPrimary care
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Sun Quality Health Social Franchise model
Franchisee Consumer
Technical supportProductIECs
Affordable services to
Health impactHealthy behavior
Franchiser
Fractional franchise system
Monitoring & Supervision
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2007 2009 201020032001 2004
RH STIsMalaria
PPM-DOTS
PneumoniaU5 children
PICT
Integrated Approach……
2008
ART
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2004 2005 2006 2007 2008 2009 2010 20110
5000
10000
15000
20000
25000
2223
5540
9432 10175 10357
1543816913
20914
Total TB registered cases NSS (+) cases
Achievement of PPM-DOTS program
page 8MIS data
2002 2003 2004 2005 2006 2007 2008 2009 20100
20000
40000
60000
80000
100000
120000
140000
160000
NTP + PSI
NTP only2.3%
5.1%7.6%
7.6% 8% 11.5%12.1%
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2007 2009 201020032001 2004
RH STIsMalaria
PPM-DOTS
PneumoniaU5 children
PICT
2008
TB-HIV Integration • Referral voucher to PSI/VCT • CPT• ART
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Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q12008 2009 2010 2011 2012
0
200
400
600
800
1000
1200
1400
1600
1800
7 10 11
238175
278361
282 244 273 315416
877
1207
15321441
1282
TB patients receiving HIV test HIV positive among TB patients
Provider Initiated HIV Counseling & Testing (2010)
MIS data
HIV prevalence among TB patients – 9%
PICT
Start voucher system
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2008 2009 2010 2011 20120
5,000
10,000
15,000
20,000
25,000
10,357
15,43916,913
20,917
6,351
107 1346 1897
4339
1638
Total TB registered cases TB cases receiving HCT
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(1%)(8%) (11%)
(21%)
(26%)
Achievement of TB-HIV Integrated Service
MIS data
143 out of 862 SQH clinics provide PICT
As of April
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12
One Stop Service For TB-HIV
7 SQH clinics + 2 PSI/VCT50 PLHA
ARTDOTSCPT
PICT
862 SQH clinics
143 SQH clinics
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Challenges
Double stigma Time consuming ART inavailability Data burden Client awareness on TB-HIV
co-infection Funding for sustainability &
expansion
“No ART if we found positive client” (SQHC)
“We are busy we can’t afford time” (SQHC)
“I dare not face the positive result”
” I don’t need the test” (Client)
PSI’s qualitative research on PICT service May 2012
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Future Plan
Expand PICT to cover 80% of TB registered cases at Sun clinics access the HCT service by 2015
Continue CPT for TB-HIV co-infected patients Integrate ART program to PICT clinics Strengthen ACSM activities Strengthen referral network Sustain collaboration with NTP, NAP and other
partners
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Thanks