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Posts Tagged ‘Mae Sot District’

Bolstering access to life-prolonging drugs for people with HIV/AIDS

Posted by African Press International on September 3, 2013

MAE SOT,  – Efforts are under way in Myanmar to bolster access to life-prolonging drugs for people with HIV/AIDS, but tens of thousands will probably still be left out, say health experts.
“All the ingredients are there to make this work, but a comprehensive and integrated plan concerning all actors and activities is needed to ensure a proper and rapid implementation,” Peter Paul de Groote, head of mission for Médecins Sans Frontières (MSF), told IRIN.

In June, the Global Fund to Fight AIDS, Tuberculosis and Malaria pledged more than US$160 million over the next four years to Myanmar to improve access to anti-retroviral (ARV) drugs for patients, including those in neglected border regions and some controlled by ethnic armed groups.

“The challenge is that some of the areas are not directly managed by the government,” Eamonn Murphy, country coordinator for the Joint UN Programme on HIV/AIDS (UNAIDS), explained. “However, I think there is a genuine commitment to provide services in these areas.”

According to UNAIDS, there are about 220,000 people with HIV in Myanmar of whom 120,000 are in need of ARVs. From 2011 to June 2013, ARV treatment coverage climbed from 32 percent of diagnosed patients to nearly 50 percent, inching closer to the government target of 85 percent by the end of 2016.

In 2012, Myanmar officials declared that the availability of ARV treatment had expanded to nearly 100 sites – up from 57 in 2008.

Yet, more than 70 percent of those treated were in the nation’s two largest cities, Yangon and Mandalay, along with Kachin State, while coverage in other areas remained inadequate.

The Global Fund is currently in talks with various stakeholders on access to war-torn border regions and expects to roll out services in 2014.

“We envisage an expansion of services to these areas with life-saving drugs being brought into the conflict zones and other hard-to-reach areas,” said Andrew Hurst, a Global Fund spokesperson.

But despite the Global Fund boost, Myanmar is still looking for other donors to fill a $110 million funding gap in its national response up to the end of 2016, Murphy said.

Furthermore, some health workers claim HIV prevalence – the third highest in the Asia-Pacific region – could be worse than reported as scarce healthcare in border regions, compounded by a fluid migrant population, may have further spread the virus.

“I think that there are thousands of unknown HIV cases,” said Aye Aye Mar, founder of Social Action for Women (SAW), a non-profit group that supports Burmese HIV patients in the Thai border town of Mae Sot. “We will never know if they have the virus and many won’t know themselves because they don’t get tested.”

WHO guidelines could boost ARV demand

MSF, the largest ARV provider in Myanmar, also predicts a greater demand for treatment after the World Health Organization set new guidelines in June stating that adult patients with CD4 (a white blood cell that targets infection) counts of 500 or below should receive ARVs when immune systems are stronger.

Myanmar’s ARV policy of treating adults with CD4 counts of 350 or below will need to be updated, allowing more infected people to access the drugs, MSF officials say.

“For this, many more treatment sites will have to be opened in areas where so far no treatment is available,” de Groote said.

Seeking help in Thailand

Meanwhile, many impoverished Burmese living with HIV/AIDS continue to cross the Thai-Burmese border in the hope of receiving free treatment in Thailand.

Ma Yin Nu left her eastern Karen State village in 2007 when her daughter became severely malnourished after years of being mistakenly treated for tuberculosis.

“She was in very bad shape. I thought she would die and even the doctors expected it,” said Ma Yin Nu, adding that she herself probably transmitted the HIV virus to her daughter at birth after a blood transfusion at a Burmese hospital.

With ARV treatment, her daughter, Phyoe Thandar Win (17), has since seen her CD4 count skyrocket from two to more than 1,000, and is now healthy enough to attend school. She lives at a SAW shelter, which teaches women to sew garments that are sold to pay for their ARVs (about $170 per month).

“I would be happier living in my village,” she said. “But I need to stay here longer to get treatment.”

Under a Global Fund grant, the Thai government offers free ARV drugs to at least 2,700 foreigners nationwide, but many more remain on waiting lists. Only 70 people are eligible in the Mae Sot area, the main hub for Burmese migrants coming into Thailand, health workers say.

sk/ds/cb  source http://www.irinnews.org

 

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Tun Aung Kyaw says his TB was misdiagnosed

Posted by African Press International on August 22, 2013

Tun Aung Kyaw says his TB was misdiagnosed

WANGPHA,  – Struggling to breathe, Burmese migrant Tun Aung Kyaw sits up slowly in bed for a routine check-up at a Thai tuberculosis (TB) clinic along the 1,800km Thai-Burmese border.

This is the third round of treatment for the 29-year-old, who believes Burmese health workers misdiagnosed him with regular TB twice when he actually had multi-drug-resistant TB (MDR-TB), a form of the infectious disease harder to diagnose and cure.

“Even though I was on TB treatment I got weaker and eventually I was bed-ridden,” Tun Aung Kyaw told IRIN.

After 14 months of treatment, Tun Aung Kyaw’s condition never improved as the disease had destroyed his left lung. He now faces a two-year regimen of care to see if he can finally defeat the MDR-TB strain, which has a treatment success rate of almost 60 percent in South-East Asia, according to the Global Tuberculosis Report 2012 by the World Health Organization (WHO).

Inadequate detection and treatment are major obstacles and can result in cases of drug-resistant TB (DR-TB) such as MDR-TB, say health experts.

“Drug-resistant TB is a very significant health concern for Myanmar,” Peter Paul de Groote, the country’s head of mission for Médecins Sans Frontières (MSF), told IRIN.

Around 8,900 new cases of DR-TB are reported each year, but only 800 patients had access to treatment at the end of 2012, he said.

TB burden

Myanmar is among the world’s top 22 TB-burden countries with a prevalence rate of 525 cases per 100,000 people, more than three times the global average.

It is also a high burden country for MDR-TB, a complex strain immune to first-line drugs that requires two years of treatment, four times longer than non-resistant TB.

MDR-TB treatment costs nearly US$5,000 per patient, roughly 100 times more than the regular strain, according to an October 2012 WHO report.

From 22 to 23 August, WHO, along with MSF and Myanmar’s Ministry of Health, plan to hold a DR-TB symposium in Yangon aimed at ramping up services throughout the country, including neglected border regions.

“There are immense challenges in providing DR-TB treatment, and health care in general, to the remote border areas of Myanmar,” de Groote said.

Health experts fear countless more cases remain hidden in rural eastern Myanmar where armed conflict, rough terrain, lack of awareness and scarcehealth care can discourage TB-infected people from seeking care.

Proposed approaches for battling DR-TB include counselling to help patients cope with long and toxic courses of treatment, decentralized care in home communities, and rapid diagnosis to treat patients correctly and prevent further cases.

To do this, Thandar Lwin, manager of Myanmar’s National TB Programme, has urged the Burmese government to step up efforts to support TB measures, 94 percent of which are donor funded.

TB-infected patients live in these huts for the duration of their treatment at the Wangpha TB clinic

“The government budget is not enough and it is difficult to increase more than the previous year,” she said during an international TB workshop earlier this year. “There is a need for evidence to persuade the government that investment in health is worthwhile.”

In 2013, Myanmar is projected to have a US$22 million funding gap for TB care and control services, the WHO report said. On the other hand, rapideconomic growth may help ease the problem in the longer term.

Border run

Many Burmese are forced to seek TB care at donor-funded clinics along the Thai border, home to roughly one million migrants and displaced persons.

Two health clinics run by Shoklo Malaria Research Unit (SMRU), a Mae Sot-based field station for the Mahidol University-Oxford University Tropical Medicine Research Programme in Bangkok, offer free treatment and are inundated with patients.

From 2010 to March 2013, SMRU supported more than 810 TB patients, but had to refer 70 percent of them, and pay for their care at local Thai hospitals due to limited capacity.

About 18 percent of patients tested for first-line drug susceptibility at SMRU clinics had some form of DR-TB. Almost half have already been successfully treated, with others still on the regimen.

In June 2013, SMRU opened a specialized TB clinic in the village of Wangpha, near the Thai border town of Mae Sot, to handle the overflow. Plans are also under way to expand in-patient care at the second clinic since 60 percent of TB patients, especially those with drug resistance, need to be supervised by clinic staff.

Sein Sein, manager of the TB clinic, said several patients initially came in after showing symptoms for several months, when treatment should be sought if persistent coughing lasts for at least two weeks.

“Many patients only come for treatment when they are really sick, so they stay in the community and continue to spread the disease,” she said.

According to WHO, there were an estimated 650,000 cases of MDR-TB among 12 million TB cases worldwide in 2012.

sk/ds/cb source http://www.irinnews.org

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