1. Integrated TB-HIV Services at PSI Clinical Social Franchise Network (Myanmar)
Dr. Phyu Phyu Swe
Health Services Manager (TB)
Population Services International/Myanmar
25 July 2012

2. 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

3. TB & HIV Situation in Myanmar
CHINA
LAOS
THAILAND
INDIA
BANGLA
DESH
KACHIN
SHAN
SAGAING
CHIN
RAKHINE
MANDALAY
MAGWE
BAGO
AYARWADDY
YANGON
KAYIN
KAYAH
MON
TANINTHARYI
One of the 41 high TB-HIV burden countries
HIV prevalence among TB patients (2010) 10.4%
TB prevalence among PLHA (2010) %
Population millions
Regions/States
Townships
Estimated incidence all forms (2010) /100,000 pop.
Estimated prevalence of TB (2010) /100,000 pop.
Estimated TB mortality (2010) /100,000 pop.
(Global TB control: a short update to the 2010 report, WHO, Geneva. 2011)
According to National TB prevalence survey:
- TB prevalence is times increase than previous expectation
Detected only 60%
Nearly 50% of TB cases detected in survey showed no classical TB symptoms
Global TB control, 2011 , HSS 2010

4. 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
Collaborative TB/HIV activities by NTP & NAP started in 2005 in 7 Townships and reached 17 district/township & 1 public hospital in 2011
Based on partial integration and cross referral
Scale up plan for
Scale-up
# of new townships per year
# of new hospitals per year
# of new townships and hospitals
Cumulative # of townships and hospitals
Targets by 2015
Impact target
the number of TB deaths among people living with HIV is reduced by 50% compared to a baseline of 2004
Coverage targets
100% of TB patients with an HIV test result recorded in the TB register
100% of HIV-positive TB patients receive CPT during TB treatment
100% of HIV-positive TB patients receive life saving ART
100% of PLHIV enrolled in HIV care, including in PMTCT care and in harm reduction services, are screened for TB
100% of eligible PLHIV newly enrolled in HIV care are started on IPT
100% of health care facilities providing services to PLHIV with demonstrable TB infection control practices. 4

5. PSI/M Health Services System Two tiered social franchise network
Case management
Health talk
Referrer
Primary care
SQH only
SPH only
SUN (SQH+SPH)
SQH: Sun Quality Health
SPH: Sun Primary Health

6. Sun Quality Health Social Franchise model
Technical support
Product
IECs
Affordable services to
Health impact
Healthy behavior
PSI provides quality products with highly subsidized price, technical support and other necessaries like IEC to Sun doctors and then they provide them to consumers with agreed price which is affordable to poor people.
PSI/M launched PPM-DOTS program in 2004 with the support of MoH. Unlike the other programs, all services & products related to TB are FOC.
Franchiser
Franchisee
Consumer
Monitoring & Supervision
Fractional franchise system

7. Integrated Approach……
PPM-DOTS
ART
PICT
2001
2003
2004
2007
2008
2009
2010 RH
STIs
Pneumonia
U5 children
Malaria

8. Achievement of PPM-DOTS program
12.1%
7.6%
11.5% 8%
NTP + PSI
7.6%
NTP only
5.1%
2.3%
MIS data

9. TB-HIV Integration PPM-DOTS STIs RH Referral voucher to PSI/VCT CPT
ART
PPM-DOTS
PICT
2001
2003
2004
2007
2008
2009
2010
STIs
Pneumonia
U5 children RH
Malaria

10. Provider Initiated HIV Counseling & Testing (2010)
PICT
Start voucher system
HIV prevalence among TB patients – 9%
MIS data

11. Achievement of TB-HIV Integrated Service
(1%)
(8%)
(11%)
(21%)
(26%)
107 (2%), 1346 (32%),1897 (43%)
coverage – 3% of total TB registered case
HIV prevalence – about 20%
As of April
143 out of 862 SQH clinics provide PICT
MIS data

12. One Stop Service For TB-HIV
ART
DOTS
CPT
PICT
7 SQH clinics + 2 PSI/VCT
50 PLHA
143 SQH clinics
862 SQH clinics

13. Challenges “No ART if we found positive client” (SQHC) Double stigma
Time consuming
ART inavailability
Data burden
Client awareness on TB-HIV co-infection
Funding for sustainability & expansion
“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

14. 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

15. Thanks