HIV/AIDS and Sexually Transmitted Infections
PSI/Myanmar's HIV and STI program is comprehensive, consisting of prevention, care and treatment, aimed at low-income, at-risk populations.
The Targeted Outreach Program, consisting of interpersonal communications conducted by peer outreach workers, is the largest community-led intervention in Myanmar. The project reached more than 40,000 female sex workers and 44,000 men who have sex with men in 2013, and performed more than 20,000 HIV tests for most-at-risk populations. The Targeted Outreach Program also operates 17 drop-in centers through Myanmar for female sex workers and men who have sex with men. The drop-in centers provide an extensive range of free clinical services for key affected populations in an integrated package of care, including sexually transmitted infection testing and treatment, HIV counseling and testing, antiretroviral treatment services (directly or through referrals), directly observed short-court treatment for tuberculosis, reproductive health services, cervical cancer screening and treatment, and opportunistic infection services.
PSI/Myanmar distributes eight condom types via social marketing under the brand name “Aphaw” (“companion” in the Myanmar language). In 2013, it sold more than 24 million condoms at subsidized prices through the private sector, accounting for 83 percent of the commercial condom market.
Through private providers involved in PSI/Myanmar’s social franchising network, the following are offered:
- Syndromic management of sexually transmitted infections,
- Provider-initiated testing and counseling targeted at bridging populations and tuberculosis patients, and
- Antiretroviral treatment for people living with HIV/AIDS.
PSI/Myanmar provides tuberculosis diagnosis and directly observed short-course treatment, the international standard of care for tuberculosis treatment. Tuberculosis drugs are available free of charge from select Sun Quality Health private providers clinics throughout Myanmar. To further promote active case detection, Sun Primary Health community health workers refer suspected cases to nearby Sun Quality Health clinics and serve as treatment adherence observers. PSI/Myanmar incorporates provider-initiated testing and counseling methods to increase the number of suspected and confirmed tuberculosis cases that are tested for HIV.
PSI/Myanmar also leverages the active case detection rate in urban slum areas through two innovative channels -- interpersonal communications and pharmacies.
In 2013, more than 73,000 individuals with suspected tuberculosis were screened for the disease, and more than 22,000 cases were registered for treatment at Sun clinics. Altogether, PSI addressed 15 percent of the national burden.
A total of 17,000 individuals with suspected tuberculosis were also tested for HIV in 2013; the positivity rate among these clients was 7 percent.
For more than a decade, PSI has provided a wide range of family planning products and services to women in Myanmar through its network of private health providers, village health workers and pharmacies. In partnership with the government and local organizations, PSI continues to increase access to quality short- and long-term contraceptive methods to women in need and to build the capacity of the private sector to offer related products in more than 200 townships in Myanmar. In 2001, when PSI started its Sun social franchise network, the contraceptive prevalence rate in Myanmar was 37 percent. Private sector provision of family planning services at that time was highly limited, with most services provided through public health centers and government extension workers – and only to married women in limited geographical areas. By 2009, contraceptive prevalence had increased to 46 percent, in large part due to PSI’s program that provides millions of family planning products and more than 1.5 million reproductive health consultations annually.
In recognition of the rising mortality rate of women in Myanmar from cervical cancer, PSI has piloted a cervical cancer prevention program whereby women of reproductive age can be screened using a low-cost but highly effective method known as visual inspection with acetic acid. Those with pre-cancerous lesions are referred for appropriate treatment and follow-up.
Child Survival/Diarrheal Disease
For children younger than age 5 in Myanmar, PSI/Myanmar addresses the top two causes of death: pneumonia and diarrhea. PSI provides treatment to children for both illnesses through its network of skilled providers. It implements communications campaigns targeting caregivers on the symptoms of pneumonia and diarrhea and the need to seek appropriate care. PSI also socially markets related products, namely antibiotics for pneumonia and oral rehydration salts and zinc for diarrhea in children.
To reduce diarrhea among children, PSI/Myanmar has begun a household water treatment program and a hand-washing program.
To address under-nutrition, PSI/Myanmar implements a behaviour change program with women of reproductive age on the benefits of exclusive breastfeeding.
PSI is at the forefront of global efforts to contain antimalarial drug resistance, recently indicated on the Thailand/Myanmar border. As a major implementing partner of the Myanmar Artemisinin Resistance Containment framework, PSI delivers appropriate interventions at national scale in the private sector, contributing more to reducing malaria-related disease burden than any other non-governmental organization in the country.
Health impact and resistance containment is primarily achieved through two private sector channels: a formal network of general practitioners and village-level primary health workers who are trained, supervised and directly supplied by PSI, and a diffuse network of informal providers, such as pharmacies, itinerant drug vendors and general retail stores. These private sector agents are supplied with subsidized treatment by major pharmaceutical distributors with extensive reach across Myanmar.
The formal Sun social franchise network supported by PSI/Myanmar contributes to a general reduction in disease burden through qualified practitioners. In 2013, the Sun franchise tested approximately 350,000 suspected malaria cases and treated an estimated 50,000 confirmed cases.
The mono-therapy replacement project in the informal private sector has driven a rapid change in quality combination treatment access. From the start of the intervention in October 2012 through 2013, approximately 1.3 million treatments were delivered through this innovative subsidy mechanism and more than 200,000 cases of Plasmodium falciparum malaria were treated.
In 2013 PSI/Myanmar conducted a pilot in six townships to determine the plausibility of utilizing rapid diagnostic tests in the private sector to diagnose malaria. The results of this pilot are informing a nationwide rapid diagnostic test scale-up that is expected to reduce drug wastage, alleviate drug resistance risk to artemisinin-based combination therapy (the gold standard for malaria treatment) partner drugs, and improve overall case management practices.