Programmatic definitions.

<p>Programmatic definitions.</p

Cascade of PMTCT program in Central Women Hospital, Mandalay, Myanmar.

<p>HIV; ^<b>¶</b>Human Immunodeficiency virus. *babies less than 9 months of age who were under regular follow-up and had not tested for HIV.</p

Low mother-to-child HIV transmission rate but high loss-to-follow-up among mothers and babies in Mandalay, Myanmar; a cohort study

<div><p>Introduction</p><p>Loss-to-follow-up (LTFU) throughout the Prevention of Mother-To-Child Transmission (PMTCT) cascade remains one of the major threats to the success of PMTCT programs. In this study, we aimed to determine the mother-to-child transmission rate in a programmatic setting and to determine factors associated with LTFU among enrolled mothers and unfavorable outcomes among HIV-exposed babies which includes being HIV positive, death and LTFU.</p><p>Methods</p><p>A retrospective cohort study reviewing routinely collected data in an Integrated HIV care program, Mandalay, Myanmar in June 2016.LTFU means mother/infant missing appointed visit for more than three months.</p><p>Results</p><p>Of 678 pregnant women enrolled in PMTCT program between March 2011 and June 2014, one stillbirth and 607 live births were recorded in this cohort. Of 457 HIV-exposed babies with HIV-test recorded at the end of the intervention, nine (2%) were HIV-positive. Pregnant women’s and exposed-babies’ LTFU rate was 7 per 1000 person-years, and 10 per 1000 person-years respectively. PMTCT option B protocol was found to be significantly associate with maternal LTFU [adjusted Hazard Ratio (aHR) 95% CI: 3.52 (1.38–8.96)] when compare to mothers receiving option B+/lifelong antiretroviral therapy (ART). Weight <2.5 Kg at enrolment, receiving mixed-feeding, vaginal delivery and option B PMTCT protocol were significantly associated with unfavorable outcomes among exposed babies [aHR(95% CI): 5.40 (1.66–17.53), 5.91(1.68–20.84), 2.27 (1.22–4.22) and 2.33 (1.16–4.69) respectively].</p><p>Conclusion</p><p>Mother-to-child HIV transmission rate in this public hospital-based program was lower than the 5% national target, which indicates a successful PMTCT intervention. However, a high proportion of HIV-infected mothers and exposed babies LTFU was recorded. Lifelong ART provision to HIV-positive pregnant women was shown to reduce exposed babies’ LTFU, death and transmission rate (unfavorable outcomes) in this setting. Lessons learned from this program could be used to inform policy and practice in the country, while the programmatic challenge of LTFU should be urgently addressed.</p></div

Characteristics and factors associated with loss to follow up among HIV-infected mothers enrolled in prevention of mother to child transmission program Mandalay, Myanmar, March 2011- June 2014.

<p>Characteristics and factors associated with loss to follow up among HIV-infected mothers enrolled in prevention of mother to child transmission program Mandalay, Myanmar, March 2011- June 2014.</p

Characteristics and factors associated with unfavorable outcomes (HIV+ diagnosis, death and loss to follow up) among HIV-exposed babies in prevention of mother to child transmission program, Mandalay, Myanmar, March 2011-June 2014.

<p>Characteristics and factors associated with unfavorable outcomes (HIV+ diagnosis, death and loss to follow up) among HIV-exposed babies in prevention of mother to child transmission program, Mandalay, Myanmar, March 2011-June 2014.</p

Nelson Aalen curve showing the cumulative hazard of switching to second-line ART after starting first-line ART at the Integrated HIV Care program, Myanmar, between 2005 and 2015

<p>Nelson Aalen curve showing the cumulative hazard of switching to second-line ART after starting first-line ART at the Integrated HIV Care program, Myanmar, between 2005 and 2015</p

Nelson Aalen curve showing the cumulative hazard of virological failure in patients on first-line ART initiated at Integrated HIV Care program, Myanmar, between 2005 and 2015.

<p>Nelson Aalen curve showing the cumulative hazard of virological failure in patients on first-line ART initiated at Integrated HIV Care program, Myanmar, between 2005 and 2015.</p

Rates and predictors of switching to second-line ART in patients on first-line ART, Integrated HIV and Care Program, Myanmar, between 2005 and 2015.

<p>Rates and predictors of switching to second-line ART in patients on first-line ART, Integrated HIV and Care Program, Myanmar, between 2005 and 2015.</p

Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths

<div><p>Background</p><p>The community-based MDR-TB care (CBMDR-TBC) project was implemented in 2015 by The Union in collaboration with national TB programme (NTP) in 33 townships of upper Myanmar to improve treatment outcomes among patients with MDR-TB registered under NTP. They received community-based support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each project township had a project nurse exclusively for MDR-TB and a community volunteer who provided evening directly observed therapy (in addition to morning directly observed therapy by NTP).</p><p>Objectives</p><p>To determine the effect of CBMDR-TBC project on death and unfavourable outcomes during the intensive phase of MDR-TB treatment.</p><p>Methods</p><p>In this cohort study involving record review, all patients diagnosed with MDR-TB between January 2015 and June 2016 in project townships and initiated on treatment till 31 Dec 2016 were included. CBMDR-TBC status was categorized as “receiving support” if project initiation in patient’s township was before treatment initiation, “receiving partial support” if project initiation was after treatment initiation, and “not receiving support” if project initiation was after intensive phase treatment outcome declaration. Time to event analysis (censored on 10 April 2017) and cox regression was done.</p><p>Results</p><p>Of 261 patients initiated on treatment, death and unfavourable outcomes were accounted for 13% and 21% among “receiving support (n = 163)”, 3% and 24% among “receiving partial support (n = 75)” and 13% and 26% among “not receiving support (n = 23)” respectively. After adjusting for other potential confounders, the association between CBMDR-TBC and unfavourable outcomes was not statistically significant. However, when compared to “not receiving support”, those “receiving support” and “receiving partial support” had 20% [aHR (0.95 CI: 0.8 (0.2–3.1)] and 90% lower hazard [aHR (0.95 CI: 0.1 (0.02–0.9)] of death, respectively. This was intriguing. Implementation of CBMDR-TBC coincided with implementation of decentralized MDR-TB centers at district level. Hence, patients that would have generally not accessed MDR-TB treatment before decentralization also started receiving treatment and were also included under CBMDR-TBC “received support” group. These patients could possibly be expected to sicker at treatment initiation than patients in other CBMDR-TBC groups. This could be the possible reason for nullifying the effect of CBMDR-TBC in “receiving support” group and therefore similar survival was found when compared to “not receiving support”.</p><p>Conclusion</p><p>CBMDR-TBC may prevent early deaths and has a scope for expansion to other townships of Myanmar and implications for NTPs globally. However, future studies should consider including data on extent of sickness at treatment initiation and patient level support received under CBMDR-TBC.</p></div

Criteria to identify presumptive MDR-TB under programme setting who were referred to X-pert MTB/RIF testing facilities, Myanmar, 2015–16.

<p>Criteria to identify presumptive MDR-TB under programme setting who were referred to X-pert MTB/RIF testing facilities, Myanmar, 2015–16.</p