Progress and Challenges of Implementing Decentralized HIV Testing For Prevention of Mother-to-Child Transmission of HIV - Myanmar.

BackgroundMyanmar has adopted point-of-care (POC) HIV testing for its prevention of mother-to-child transmission of HIV program, and was initiated in 84 townships in 2013. This study assessed the progress of HIV testing uptake from 2012, one year prior to POC testing, to 2015, and the challenges faced by service providers during the rapid rollout of this testing strategy.MethodsThis serial cross-sectional study included 23 townships randomly selected from the 84 townships. An open-question survey was used to collect information on the challenges faced by service providers. A random effects logistic model was used for assessing the progress of HIV testing uptake among urban and rural health center groups.ResultsHIV testing uptake for antenatal care (ANC) attendees increased from 60% to 90% for rural and from 70% to 90% for urban attendees. The proportion of ANC attendees who were tested at their first visit increased from 70% to 80% for rural and from 70% to 90% for urban attendees. In addition, the proportion receiving same-day test results increased from less than 10% to 90% for both groups. Major challenges faced during the initial rollout included low health awareness among pregnant women, fear of stigma and discrimination, long travel times and costs, and increased workloads of providers in rural settings.Conclusions and global health implicationsThe program should consider recruiting local volunteers to help reduce the workloads of service providers. Professional education based on need and continued mentoring and quality control schemes for HIV testing need to be in place. This decentralized strategy would be applicable to other resource-limited countries

Influence of Y-doped induced defects on the optical and magnetic properties of ZnO nanorod arrays prepared by low-temperature hydrothermal process

One-dimensional pure zinc oxide (ZnO) and Y-doped ZnO nanorod arrays have been successfully fabricated on the silicon substrate for comparison by a simple hydrothermal process at the low temperature of 90°C. The Y-doped nanorods exhibit the same c-axis-oriented wurtzite hexagonal structure as pure ZnO nanorods. Based on the results of photoluminescence, an enhancement of defect-induced green-yellow visible emission is observed for the Y-doped ZnO nanorods. The decrease of E(2)(H) mode intensity and increase of E(1)(LO) mode intensity examined by the Raman spectrum also indicate the increase of defects for the Y-doped ZnO nanorods. As compared to pure ZnO nanorods, Y-doped ZnO nanorods show a remarked increase of saturation magnetization. The combination of visible photoluminescence and ferromagnetism measurement results indicates the increase of oxygen defects due to the Y doping which plays a crucial role in the optical and magnetic performances of the ZnO nanorods

Early Success With Retention in Care Among People Living With HIV at Decentralized ART Satellite Sites in Yangon, Myanmar, 2015–2016

Introduction: Myanmar is one of the countries in the Asia-Pacific region hit hardest by the HIV epidemic that is concentrated among urban areas and key populations. In 2014, the National AIDS Programme (NAP) launched a new model of decentralized service delivery with the establishment ART satellite sites with care delivered by HIV peer workers.Methods: ART satellite sites are implemented by non-government organizations to service high burden HIV areas and populations that suffer stigma or find access to public sector services difficult. They provide continuity of HIV care from outreach testing, counseling, linkage to care, and retention in care. Anti-retroviral (ART) initiation occurs at health facilities by specialist physicians. We conducted a retrospective cohort study of people living with HIV (PLHIV) who were initiated on ART from 2015 to 2016 at five ART satellite sites in Yangon, Myanmar to assess outcomes and time from enrolment to ART initiation.Results: Of 1,339 PLHIV on ART treatment in 2015–16, 1,157 (89%) were retained, and 5% were lost from care and 5% reported dead, at the end of March 2018. Attrition rates (death and lost-to-follow-up) were found to be significantly associated with a CD4 count ≤ 50 cells/mm3 and having baseline weight ≤ 50 kg. Median time taken from enrolment to ART initiation was 1.9 months (interquartile range: 1.4–2.5).Conclusion: We report high rates of retention in care of PLHIV in a new model of ART satellite sties in Yangon, Myanmar after 3 years of follow-up. The delays identified in time taken from enrolment to ART initiation need to be explored further and addressed. This initial study supports continuation of plans to scale-up ART satellite sites in Myanmar. To optimize outcomes for patients and the program and accelerate progress to reduce HIV transmission and end the HIV epidemic, operational research needs to be embedded within the response

HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis.

BACKGROUND: Pretreatment drug resistance in people initiating or re-initiating antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTIs) might compromise HIV control in low-income and middle-income countries (LMICs). We aimed to assess the scale of this problem and whether it is associated with the intiation or re-initiation of ART in people who have had previous exposure to antiretroviral drugs. METHODS: This study was a systematic review and meta-regression analysis. We assessed regional prevalence of pretreatment drug resistance and risk of pretreatment drug resistance in people initiating ART who reported previous ART exposure. We systematically screened publications and unpublished datasets for pretreatment drug-resistance data in individuals in LMICs initiating or re-initiating first-line ART from LMICs. We searched for studies in PubMed and Embase and conference abstracts and presentations from the Conference on Retroviruses and Opportunistic Infections, the International AIDS Society Conference, and the International Drug Resistance Workshop for the period Jan 1, 2001, to Dec 31, 2016. To assess the prevalence of drug resistance within a specified region at any specific timepoint, we extracted study level data and pooled prevalence estimates within the region using an empty logistic regression model with a random effect at the study level. We used random effects meta-regression to relate sampling year to prevalence of pretreatment drug resistance within geographical regions. FINDINGS: We identified 358 datasets that contributed data to our analyses, representing 56 044 adults in 63 countries. Prevalence estimates of pretreatment NNRTI resistance in 2016 were 11·0% (7·5-15·9) in southern Africa, 10·1% (5·1-19·4) in eastern Africa, 7·2% (2·9-16·5) in western and central Africa, and 9·4% (6·6-13·2) in Latin America and the Caribbean. There were substantial increases in pretreatment NNRTI resistance per year in all regions. The yearly increases in the odds of pretreatment drug resistance were 23% (95% CI 16-29) in southern Africa, 17% (5-30) in eastern Africa, 17% (6-29) in western and central Africa, 11% (5-18) in Latin America and the Caribbean, and 11% (2-20) in Asia. Estimated increases in the absolute prevalence of pretreatment drug resistance between 2015 and 2016 ranged from 0·3% in Asia to 1·8% in southern Africa. INTERPRETATION: Pretreatment drug resistance is increasing at substantial rate in LMICs, especially in sub-Saharan Africa. In 2016, the prevalence of pretreatment NNRTI resistance was near WHO's 10% threshold for changing first-line ART in southern and eastern Africa and Latin America, underscoring the need for routine national HIV drug-resistance surveillance and review of national policies for first-line ART regimen composition. FUNDING: Bill & Melinda Gates Foundation and World Health Organization

Decentralization of HIV testing and the cascade of HIV treatment for mothers and infants in Myanmar

Decentralization of HIV testing and the cascade of HIV treatment for mothers and infants in MyanmarbySan HoneDoctor of Philosophy in EpidemiologyUniversity of California, Los Angeles, 2017Professor Roger Detels, ChairBackground: Joining hands with the global community, Myanmar has committed to move towards the elimination of mother to child transmission of HIV. The 1.5-decade Prevention of Mother to Child Transmission of HIV (PMCT) program in Myanmar introduced point-of-care testing in 2013 for all Antenatal Care (ANC) attendees as an approach towards community based interventions. This study assessed progress along the cascade of PMCT services and also the challenges faced by service providers during the initial phase of implementing the new intervention. Methods: A serial cross sectional study was employed to assess progress of HIV testing uptake from 2013 to 2015 in 228 townships. The progress for urban and rural health center groups was assessed in a sample of 23 townships where the decentralized testing activity was initiated in 2013. A cohort study was used to assess the factors associated with compliance to prescribed medication among pregnant women living with HIV and their HIV exposed infants. Results: During the study period, the median HIV testing coverage among ANC attendees increased from 20 to 90%, increasing proportions being tested at their first ANC visit and receiving their results on the same day. Travel times and costs, and heavy workloads of primary care providers were identified as obstacles for ANC attendees to receive all essential services in a single ANC visit. Structural gaps such as inadequate logistic supplies and limited availability of services for diagnosis and treatment of HIV exposed infants at primary care level were also identified as challenges that hindered the progress of program implementation. Fear of stigma and discrimination remain as major challenges for successful implementation of the PMCT program in Myanmar.Conclusions: Urgent remedial action is required to improve logistical delivery of supplies to health care centres, and to identify and establish proper linkage for early diagnosis and treatment of HIV-exposed infants. There is also a need to recruit and train local volunteers as alternative health care cadres. Continuous mentoring from supervisors and quality control measures for HIV testing should be implemented. The program should identify appropriate strategies for addressing stigma and discrimination against pregnant women and their families living with HIV. Key words: Elimination of mother to child transmission of HIV; Prevention of mother to child transmission of HIV; community based intervention; decentralized HIV testing; primary care provider

Decentralization of HIV testing and the cascade of HIV treatment for mothers and infants in Myanmar

Decentralization of HIV testing and the cascade of HIV treatment for mothers and infants in MyanmarbySan HoneDoctor of Philosophy in EpidemiologyUniversity of California, Los Angeles, 2017Professor Roger Detels, ChairBackground: Joining hands with the global community, Myanmar has committed to move towards the elimination of mother to child transmission of HIV. The 1.5-decade Prevention of Mother to Child Transmission of HIV (PMCT) program in Myanmar introduced point-of-care testing in 2013 for all Antenatal Care (ANC) attendees as an approach towards community based interventions. This study assessed progress along the cascade of PMCT services and also the challenges faced by service providers during the initial phase of implementing the new intervention. Methods: A serial cross sectional study was employed to assess progress of HIV testing uptake from 2013 to 2015 in 228 townships. The progress for urban and rural health center groups was assessed in a sample of 23 townships where the decentralized testing activity was initiated in 2013. A cohort study was used to assess the factors associated with compliance to prescribed medication among pregnant women living with HIV and their HIV exposed infants. Results: During the study period, the median HIV testing coverage among ANC attendees increased from 20 to 90%, increasing proportions being tested at their first ANC visit and receiving their results on the same day. Travel times and costs, and heavy workloads of primary care providers were identified as obstacles for ANC attendees to receive all essential services in a single ANC visit. Structural gaps such as inadequate logistic supplies and limited availability of services for diagnosis and treatment of HIV exposed infants at primary care level were also identified as challenges that hindered the progress of program implementation. Fear of stigma and discrimination remain as major challenges for successful implementation of the PMCT program in Myanmar.Conclusions: Urgent remedial action is required to improve logistical delivery of supplies to health care centres, and to identify and establish proper linkage for early diagnosis and treatment of HIV-exposed infants. There is also a need to recruit and train local volunteers as alternative health care cadres. Continuous mentoring from supervisors and quality control measures for HIV testing should be implemented. The program should identify appropriate strategies for addressing stigma and discrimination against pregnant women and their families living with HIV. Key words: Elimination of mother to child transmission of HIV; Prevention of mother to child transmission of HIV; community based intervention; decentralized HIV testing; primary care provider

The properties of tantalum modified lithium niobate thin films prepared by a diol-based sol-gel process

LiNb$_{1-x}$TaxO3 thin films were successfully deposited on Pt(111)/Ti/SiO2/Si(100) substrates by spin coating with a diol-based sol-gel technology and rapid thermal annealing. The effects of various processing parameters, including Ta content (0$\leq x\leq1$) and heating temperature (500 ~ 800 °C), on the growth and properties of thin films were investigated. With the increase of Ta content, the grain size of film decreased slightly, and the maximum f factor (the degree of c-axis orientation) of the films were obtained in the composition of x = 0.2. As the composition of film varied from x = 0 to x = 1, the relative dielectric constant of film increased from 33 up to 62, and the dielectric loss factor (tanδ) also increased from 0.00374 to 0.00686, respectively. The coercive field, Ec, and remanent polarization, Pr, decreased but pyroelectric coefficient, γ, increased from 2.76 × 10−8 up to 4.51 × 10−8 C/cm2 K. The pyroelectric figures of merit, Fv and Fm, indicated that film with Ta content of 20 mol% and heating temperature of 700 °C exhibited the optimized pyroelectric characteristics and could be applied for high-performance pyroelectric thin-film detectors