Integrated TB-HIV Services at PSI Clinical Social Franchise Network

(Myanmar)

Dr. Phyu Phyu SweHealth Services Manager (TB)Population Services International/Myanmar25 July 2012

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

2

CHINA

LAOS

THAILAND

INDIA

BANGLADESH

KACHIN

SHAN

SAGAING

CHIN

RAKHINE

MANDALAY

MAGWE

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

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

SQH only

SPH 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

Sun Quality Health Social Franchise model

Franchisee Consumer

Technical supportProductIECs

Affordable services to

Health impactHealthy behavior

Franchiser

Fractional franchise system

Monitoring & Supervision

2007 2009 201020032001 2004

RH STIsMalaria

PPM-DOTS

PneumoniaU5 children

PICT

Integrated Approach……

2008

ART

2004 2005 2006 2007 2008 2009 2010 20110

5000

10000

15000

20000

25000

2223

5540

943210175 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%

2007 2009 201020032001 2004

RH STIsMalaria

PPM-DOTS

PneumoniaU5 children

PICT

2008

TB-HIV Integration

• Referral voucher to PSI/VCT • CPT• ART

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

2008 2009 2010 2011 20120

5,000

10,000

15,000

20,000

25,000

10,357

15,43916,913

20,917

6,351

1071346 1897

4339

1638

Total TB registered cases TB cases receiving HCT

page 11

(1%)(8%) (11%)

(21%)

(26%)

Achievement of TB-HIV Integrated Service

MIS data

143 out of 862 SQH clinics provide PICT

As of April

12

One Stop Service For TB-HIV

7 SQH clinics + 2 PSI/VCT50 PLHA

ART

DOTSCPT

PICT

862 SQH clinics

143 SQH clinics

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

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

Thanks