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Khin Nyein Chan Medical Coordinator

MSF Experience on Use of HIV Viral Load testing i n Myanmar. Khin Nyein Chan Medical Coordinator. HIV program in Myanmar. Moe Gaung. Waing Maw. MSF HIV/ART program started since 2003 17 TB/HIV clinics Yangon Region Taninthayi Region Kachin State Shan State Rakhine State

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Khin Nyein Chan Medical Coordinator

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  1. MSF Experience on Use of HIV Viral Load testing in Myanmar KhinNyein ChanMedical Coordinator

  2. HIV program in Myanmar Moe Gaung Waing Maw • MSF HIV/ART program started since 2003 • 17 TB/HIV clinics • Yangon Region • Taninthayi Region • Kachin State • Shan State • Rakhine State • >30,000 patients are on HAART

  3. Activities • HIV Prevention – focusing on SW, MSM, DU • HIV Care and Support including – HTC, PMTCT, OI management, HAART • Laboratory services • Network of CD4 facility, 1 Cavidi Viral Load system, GeneXpert,Biochemistry, etc.

  4. HIV Viral Load monitoring MSF installed one Cavidi VL system in Yangon – Mid 2009

  5. HIV Viral Load monitoring (Cont.) • Manual Extraction of RT enzyme and amplification • Takes 2 days for one lab tech • Leave overnight for final reading

  6. HIV Viral Load monitoring (Cont.) • Final Reading on the next morning • Takes 5 Minutes only • Results obtained through a computer software • 29 samples per each run

  7. Why Cavidi System? • Very feasible for resource limited settings.. • Does not require sterile environment/molecular laboratory • Allows for decentralised testing • Subtype independent technology • Affordable cost • However, • Technician dependent • Capacity per lab tech: • Collection and Transportation of specimen

  8. Capacity of VL monitoring in MSF • Max. Capacity using 2 full time lab tech: - 3 runs (87) per week – 156 runs (4524) per year • Current patients on MSF Treatment • >29,000patients on first line • Nearly 1000patients on second line • 3 patients on third line

  9. Country Situation • Estimated patients need of ART – 125,000 • Currently on ART - >50,000 • 2 Viral Load facilities – MSF Cavidi system and MoH PCR system • MSF Criteria for VL testing • 1st priority – Clinically and immunologically suspected treatment failure • Yearly monitoring for patients on 2nd line (a rising VL could be targeted with intense adherence counseling)

  10. Transportation of specimen 6Hr Car 2.5Hr Boat 2.5 Hr Air

  11. Viralvs. immunological monitoring • A simple analysis of VL vs CD4 of 3801 patients with suspected immunological failure receiving 1st line ART >1yr shows • 20% (755) - confirmed failure and of those failure, 8% (58) has CD4 >350 • 66% (2505) has undetectable VL and of those 66%, 33%(828) has CD4 <200 11

  12. VL: An essential tool in ART package • VL should be the first routine adherence monitoring tool • Support promoting retention on 1st line ART • Critical role in preventing unnecessary switch to 2nd line regimen

  13. THANK YOU

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