Philippe Clevenbergh never imagined he would end up living in Myanmar when he came to The Union in 2004. He was a busy physician treating HIV/AIDS patients at Paris’s Hôpital Lariboisière.
Nevertheless, in 2006, he launched The Union’s Integrated HIV Care for TB Patients Living HIV/ AIDS (IHC) Programme in Mandalay, which has since become one of the country’s four leading providers of antiretroviral treatment (ART). Some 14,000 patients receive ART through The Union today.
In the beginning: Par Par and Mar Mar
In the beginning, two French-trained doctors, known as Mar Mar and Par Par, handled all the patients from five townships at Mandalay General Hospital. They were overwhelmed and enrollment was slow until Clevenbergh hired the first local Union employee to take over tasks from patient follow-up to writing reports.
Then enrollment increased, but many people were turned away because they lived in the wrong township or they had HIV, but not TB, so they didn't qualify – a situation which did not make sense to Clevenbergh. "How can you tell people who come knocking at your door to go back where they came from?" he says.
Unlocking the barriers
He was determined to expand, first to all seven Mandalay townships, then to sites beyond the city. He also renovated facilities, hired staff, involved community volunteers and dropped both the residency requirement and the need for dual diagnosis. Throughout, the Yadana Consortium operated by Total/MGTC, supported the programme. From an initial grant of USD 200,000, funding has risen to USD 800,000 a year.
In 2010, IHC really took off when Clevenbergh obtained additional support from the Three Diseases Fund (3DF) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund).
"Suddenly we had lots of drugs and no doctors", recalls Clevenbergh. "This was like having a refrigerator full of food and not being able to feed anyone". He ramped up staffing, and today 100 employees, including 27 doctors and 10 nurses, work for The Union Office in Myanmar.
IHC offers expertise in TB, HIV, TB-HIV, pregnant mother-to-child transmission (PMTCT) and paediatric HIV. The Union also helped the Mandalay Public Health Laboratory obtain high-tech diagnostic and monitoring facilities with grants from the Global Fund and the Fondation Mérieux.
93% treatment success after one year
93% of IHC patients have treatment success after more than one year – that is, they have an undetectable viral load and are not contagious. Adherence is good because, according to Clevenbergh, HIV treatment has improved. The drugs have fewer side effects, and patients need only two pills a day. Under these conditions, people can lead a normal life.
Challenges ahead: the virus will not fail
Despite the progress made, only 40% of patients in Myanmar who need ART receive it. "This is expected to reach 75% in 2016, but in the meantime, how many will die?"
For IHC, the mortality rate is 15% in the first six months because Myanmar has few prevention programmes and no active case finding, so people come to treatment very late. Another issue is that first-line drugs are only good for five to ten years – not life.
"The mix of drugs has to be altered periodically to keep ahead of the virus", says Clevenbergh. The drugs might fail, but the virus will not fail, so new drugs and a vaccine need to be in the pipeline.
"Every year 10,000 patients are put on ART, but there are 15,000 new infections. People tell me to wait and be patient. For me, I cannot be patient. At least, since 2010, no patient has been rejected by IHC. This is a very nice feeling for the doctors and other staff – and for me too."
