Since 2005, The Union has implemented health programmes in Myanmar, including tuberculosis (TB) active case finding, integrated HIV care and community based multi-drug resistant TB (MDR-TB). They are all entirely integrated “in, by, with the public health services” and are support the Department of Public Health, the Ministry of Health and Sports in Myanmar. The Union has been supporting the National Tuberculosis Program (NTP) and the National AIDS Program (NAP) to strengthened their capacities to deliver and maintain high quality services. The Union’s work in Myanmar is undertaken with support from the Global Fund. The Union delivers the health projects with over 300 staff and over 600 community volunteers in 59 townships in five states and regions covering a population of nearly 12 million through the country.
Programme to Increase Catchment of Tuberculosis Presumptives (PICTS)
The Union’s PICTS programme works with the NTP to address health problems in the community and increase TB case findings. PICTS implements case finding activities in 13 townships covering a population of over three million people. The focus is on bolstering the community-led efforts while providing technical assistance to the NTP. Through the mobilisation of an extensive volunteer network, community members distribute information on TB symptoms and how to access treatment, conduct door-to-door health education and outreach, provide TB contact tracing, identify people with presumptive TB, facilitate sputum transport between clinics and patients’ homes and enhance case holding activities.
In 2020, PICTS expanded its community-based TB case finding activities in Hopong Township, Southern Shan State. This led to the 200 presumptive TB referral cases and diagnosis of eight new drug resistant-TB cases.
A TB call centre was initiated for 29 townships to prevent compromises to TB control activities during COVID-19. The aim was to maintain the routine case finding activities, to support people with drug-resistant TB and to provide health information, including about COVID-19. By setting up the hotline the community could access reliable health information and receive continuous care and support for TB and other health problems.
To support routine activities during COVID-19 control measures, digital tools and an electronic recording system were created for real-time recording and reporting, reducing the burden of paper-based reporting and enhancing directly observed therapy (DOT) tracking. The ‘DOT Tracking and Side Effect Monitoring’ database and ‘Patient Referral Application’ were established with a strong security system for data storage and backup to prevent data breach.
- 4,087 health talks
- 208,686 people attended the health talks
- 8,670 presumptive TB referrals for screening
- 909 TB cases among presumptive TB referrals
- 49 sputum collection centres
- 280 volunteers
Community Based MDR-TB Care Programme
The Union’s Community Based MDR-TB Care Programme supports people with drug-resistant TB (DR-TB) including financial support, community mobilisation through trained volunteers, evening DOT services, systematic household contact screening, ensuring infection control practice and timely referral for clinical management of side effects. It is implemented in 27 high-burden townships in three regions and one state, covering a population of 6.5 million people.
In 2020, the “Quick Information Clip” campaign was initiated for side effect management of anti-TB drugs for people with DR-TB during the COVID-19 pandemic. The aim was to enhance early detection and management of common side effects and ensure timely referral to health centres for further treatment. The six-minute video clip includes the detection of side effects through a symptomatic approach, management of mild side effects and timely referral of severe symptoms. The experience gained from this approach will inform the national programme about using digital educational tool, particularly at the field level, to maintain a desirable outcome.
A pre-enrolment support package for people with DR-TB was established, including travel allowance and nutrition support for two months to avoid initial loss in pre-enrolment phase for DR-TB treatment. A telecounselling service was also provided. Additionally, a person with DR-TB was in contact or infected with COVID-19 further financial support was provided to reduce the catastrophic cost and burden. 62 newly diagnosed people with DR-TB received pre-enrolment monetary support.
During the COVID-19 pandemic, a mobile payment platform was initiated to support people with DR-TB. This platform helped people unable to receive money through automated teller machines (ATM), while allowing them to maintain social distance. It supported faster and more effective financial transfers and demonstrates how simple technology can have a big impact on people’s lives.
- 854 people with DR-TB received monthly socioeconomic support (30,000 MMK)
- 854 people with DR-TB received monthly nutrition support (28,000 MMK)
- 501 people with DR-TB received DOT from volunteers
- 854 people with DR-TB patient received nutrition support
- 43 TB/DR-TB cases notified through household contacts
- 396 volunteers
Integrated HIV Care Programme (IHC)
The IHC programme, in collaboration with the National AIDS Program, is implementing in 38 townships in four regions and one state, covering a 7.7 million population. The programme in direct support of NAP clinics provides anti-retroviral therapy (ART) and treatment for opportunistic infections. An active volunteer network of people living with HIV (PLHIV) supports the programme. They support the function of all IHC centres as well as providing counselling, home-based care and follow-up tracing. The programme also included the prevention of mother to child transmission.
The Union has integrated HIV prevention activities in 14 townships, targeting key vulnerable populations and provide training to frontline health workers to extend HIV prevention service supports through community outreach.
In the midst of COVID-19 pandemic, the PLHIV volunteer network initiated a hotline and telecounselling service for people living with HIV and high-risk people to prevent further dropouts and provide informed about IHC clinics.
HIV prevention activities including counselling services identified and reached 3,538 partners/spouses of PLHIVs, half of those were provided with HIV Testing Service (HTS). Among them, 69 HIV positive cases were confirmed and enrolled onto ART treatment. The programme also provided HIV screening to 861 children and 11 of them tested HIV positive and enrolled onto ART programme.
- 33,760 PLHIV receive active follow up on ART
- 99.6% of people with TB are screened and tested for HIV and know their HIV status
- 90.5% of PLHIV were screened for TB symptoms in their visits to IHC clinics
- 71.1% ART coverage among PLHIV with TB
- 300+ PLHIV volunteers are contributing to HIV care and prevention works
- 146 exposed babies have received early infant diagnosis within two months of birth
- 134,121 condoms were distributed through HIV prevention programme
COVID-19 Response
During the outbreak of COVID-19, the Myanmar team created the proactive and reactive COVID-19 Response plan and integrated infection prevention control measures, and developed management guidelines and protocol for programmes and staff:
- Infection Prevention Control Guideline
- Standard Operational Procedure for Chlorine Mopping at clinic areas
- Triage outpatient department flow and level of personal protective equipment (PPE)