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

Fluctuations in Serum magnesium and Systemic Arterial Blood Pressures during the Menstrual Cycle in young reproductive women

Introduction: The menstrual cycle involves a sequence of structural, functional, and hormonal changes in the reproductive system. This is linked and controlled by cyclical fluctuations in the levels of FSH, LH, estrogen, and progesterone. Because of these cyclical fluctuations, there might also be associated cyclical changes of magnesium and systemic arterial blood pressures during the menstrual cycle. Purpose: To assess the changes in serum magnesium level and systemic arterial blood pressures during the menstrual cycle in young reproductive women. Methodology: the sample population is 40 apparently healthy young reproductive-aged 18- 25years female students from the University of Medicine, Magway participated in this study. Systemic arterial blood pressures were measured by indirect method. The serum magnesium level was measured by spectrophotometry. These measurements were done in the early follicular phase (EF), the peri-ovulatory phase (PO), and the midluteal phase (ML) of the menstrual cycle. The serum magnesium levels were significantly (p <0.001) lower, and the systolic blood pressures were significantly higher (p <0.05) in the PO than the EF and the ML. In the EF, there was a significant negative correlation between serum magnesium level and diastolic blood pressure (r= - 0.374, p <0.05) and mean arterial pressure (r = -0.354, p < 0.05) but no significant correlation with systolic blood pressure. In the PO, there was no significant correlation between serum magnesium level and systemic arterial blood pressures. In the ML, there was significant negative correlation between serum magnesium level and systolic blood pressure (r = -0.651, p <0.001), diastolic blood pressure (r = -0.607, p <0.001), and mean arterial pressure (r = -0.661, p <0.001). Conclusion: The study concludes that serum magnesium level has a negative effect on blood pressure changes and the blood pressure-lowering effect of magnesium. These changes are related to the fluctuation of estrogen levels during the menstrual cycle. KEYWORDS: Serum magnesium, systemic arterial blood pressures, menstrual cycle reproductive syste

Underweight Prevalence Among Young Adults from Rural Areas, Salin Township, Magwe Region

Maintaining a normal body mass index (BMI) throught the life-span of a person may reduce occurence as well as the burden of non-communicable diseases (NCDs), in terms of years lived with disability and premature death. Lifestyle and socioeconomic factors like physical activity and availability of healthy or unhealthy food may contribute to both extremes of BMI, namely under-weight and overweight/ obesity

Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25–74 years old citizens in Yangon Region, Myanmar: a cross sectional study

Abstract Background Recent societal and political reforms in Myanmar may upturn the socio-economy and, thus, contribute to the country’s health transition. Baseline data on urban-rural disparities in non-communicable disease (NCD) risk factors are not thoroughly described in this country which has been relatively closed for more than five decades. We aim to investigate urban-rural differences in mean values and the prevalence of selected behavioral and metabolic risk factors for non-communicable diseases and 10-years risk in development of coronary heart diseases (CHD). Methods Two cross-sectional studies were conducted in urban and rural areas of Yangon Region in 2013 and 2014 respectively, using the WHO STEPwise approach to surveillance of risk factors of NCDs. Through a multi-stage cluster sampling method, 1486 participants were recruited. Results Age-standardized prevalence of the behavioral risk factors tended to be higher in the rural than urban areas for all included factors and significantly higher for alcohol drinking (19.9% vs. 13.9%; p = 0.040) and low fruit & vegetable consumption (96.7% vs. 85.1%; p = 0.001). For the metabolic risk factors, the tendency was opposite, with higher age-standardized prevalence estimates in urban than rural areas, significantly for overweight and obesity combined (40.9% vs. 31.2%; p = 0.023), obesity (12.3% vs.7.7%; p = 0.019) and diabetes (17.2% vs. 9.2%; p = 0.024). In sub-group analysis by gender, the prevalence of hypercholesterolemia and hypertriglyceridemia were significantly higher in urban than rural areas among males, 61.8% vs. 40.4%; p = 0.002 and 31.4% vs. 20.7%; p = 0.009, respectively. Mean values of age-standardized metabolic parameters showed higher values in urban than rural areas for both male and female. Based on WHO age-standardized Framingham risk scores, 33.0% (95% CI = 31.7–34.4) of urban dwellers and 27.0% (95% CI = 23.5–30.8) of rural dwellers had a moderate to high risk of developing CHD in the next 10 years. Conclusion The metabolic risk factors, as well as a moderate or high ten-year risk of CHD were more common among urban residents whereas behavioral risk factors levels were higher in among the rural people of Yangon Region. The high prevalences of NCD risk factors in both urban and rural areas call for preventive measures to reduce the future risk of NCDs in Myanmar

Prevalence and diversity of avian haemosporidians may vary with anthropogenic disturbance in tropical habitats in Myanmar

This database and its components are subject to a Creative Commons Attribution-Noncommercial-ShareAlike International licence 4.0.Avian malaria and related haemosporidians (genera Haemoproteus, Plasmodium and Leucocytozoon) infect most clades of bird. Although these parasites are present in almost all continents, they have been irregularly studied across different geographical regions. Despite the high bird diversity in Asia, the diversity of avian haemosporidians in this region is largely unknown. Moreover, anthropogenic changes to habitats in tropical regions may have a profound impact on the overall composition of haemosporidian communities. Here we analyzed the diversity and host association of bird haemosporidians from areas with different degrees of anthropogenic disturbance in Myanmar, revealing an unexplored diversity of these parasites (27% of newly-discovered haemosporidian lineages, and 64% of new records of host–parasite assemblages) in these tropical environments. This newly discovered diversity will be valuable for detecting host range and transmission areas of haemosporidian parasites. We also found slightly higher haemosporidian prevalence and diversity in birds from paddy fields than in individuals from urban areas and hills, thus implying that human alteration of natural environments may affect the dynamics of vector-borne diseases. These outcomes provide valuable insights for biodiversity conservation management in threatened tropical ecosystems.This research was funded by the Spanish Ministry of Economy and Competitiveness (ref. CGL2015-64650P) and Junta de Extremadura (ref. IB16121). J.M. was supported by a postdoctoral contract from the University of Extremadura (Junta de Extremadura—IB16121) (from May 2018 to September 2019) and a postdoctoral grant from the Juan de la Cierva Subprogram (FJCI-2017-34109), with the financial sponsorship of the MICINN (September 2019—ongoing). S.M.A. was supported by Junta de Extremadura (GR18047 research group BBB028 and IB16121) and the project “Aves y Enfermedades Infecciosas Emergentes: impacto de las especies exóticas y migratorias en la transmisión de malaria aviar y el virus del Nilo Occidental” from the Ayudas Fundación BBVA a Equipos de Investigación Científica 2019. L.G.L. was supported by Junta de Extremadura (PO17024, Post-Doc grant). The 1st zoological section of The Natural History Museum Vienna supported the study by paying the article-processing charges.Peer reviewe

Prevalence and diversity of avian haemosporidians may vary with anthropogenic disturbance in tropical habitats in myanmar

Avian malaria and related haemosporidians (genera Haemoproteus, Plasmodium and Leu-cocytozoon) infect most clades of bird. Although these parasites are present in almost all continents, they have been irregularly studied across different geographical regions. Despite the high bird diversity in Asia, the diversity of avian haemosporidians in this region is largely unknown. Moreover, anthropogenic changes to habitats in tropical regions may have a profound impact on the overall composition of haemosporidian communities. Here we analyzed the diversity and host association of bird haemosporidians from areas with different degrees of anthropogenic disturbance in Myan-mar, revealing an unexplored diversity of these parasites (27% of newly-discovered haemosporid-ian lineages, and 64% of new records of host–parasite assemblages) in these tropical environments. This newly discovered diversity will be valuable for detecting host range and transmission areas of haemosporidian parasites. We also found slightly higher haemosporidian prevalence and diversity in birds from paddy fields than in individuals from urban areas and hills, thus implying that human alteration of natural environments may affect the dynamics of vector-borne diseases. These outcomes provide valuable insights for biodiversity conservation management in threatened tropical ecosystems

Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study

Abstract Background Non-communicable diseases (NCDs), malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors. Methods A nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15–64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs) and 95 % confidence intervals (CIs) for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs). Results The prevalence of hypertension was 30.1 % (95 % CI: 28.4–31.8) in males and 29.8 % (28.5–31.1) in females. The mean BMI was 21.7 (SD 4.3) kg/m2 for males and 23.0 (5.1) kg/m2 for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1–3.3, females: OR = 2.3; 2.0–2.7) and high waist circumference (males: OR = 3.4; 1.8–6.8, females: OR = 2.7; 2.2–3.3). In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension. Conclusions The prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe trends in the risk factors, especially modifiable factors, which will most likely be on rise. Studies on effectiveness on interventions are needed, and policies to reduce the burden of NCD risk factors should be implemented if proven effective in similar settings

Performance and Outcomes of Routine Viral Load Testing in People Living with HIV Newly Initiating ART in the Integrated HIV Care Program in Myanmar between January 2016 and December 2017

Myanmar has introduced routine viral load (VL) testing for people living with HIV (PLHIV) starting first-line antiretroviral therapy (ART). The first VL test was initially scheduled at 12-months and one year later this changed to 6-months. Using routinely collected secondary data, we assessed program performance of routine VL testing at 12-months and 6-months in PLHIV starting ART in the Integrated HIV-Care Program, Myanmar, from January 2016 to December 2017. There were 7153 PLHIV scheduled for VL testing at 12-months and 1976 scheduled for VL testing at 6-months. Among those eligible for testing, the first VL test was performed in 3476 (51%) of the 12-month cohort and 952 (50%) of the 6-month cohort. In the 12-month cohort, 10% had VL &gt; 1000 copies/mL, 79% had repeat VL tests, 42% had repeat VL &gt; 1000 copies/mL (virologic failure) and 85% were switched to second-line ART. In the 6-month cohort, 11% had VL &gt; 1000 copies/mL, 83% had repeat VL tests, 26% had repeat VL &gt; 1000 copies/mL (virologic failure) and 39% were switched to second-line ART. In conclusion, half of PLHIV initiated on ART had VL testing as scheduled at 12-months or 6-months, but fewer PLHIV in the 6-month cohort were diagnosed with virologic failure and switched to second-line ART. Programmatic implications are discussed

Clinical and molecular surveillance of artemisinin resistant falciparum malaria in Myanmar (2009–2013)

Abstract Background Emergence of artemisinin-resistant malaria in Southeast Asian countries threatens the global control of malaria. Although K13 kelch propeller has been assessed for artemisinin resistance molecular marker, most of the mutations need to be validated. In this study, artemisinin resistance was assessed by clinical and molecular analysis, including k13 and recently reported markers, pfarps10, pffd and pfmdr2. Methods A prospective cohort study in 1160 uncomplicated falciparum patients was conducted after treatment with artemisinin-based combination therapy (ACT), in 6 sentinel sites in Myanmar from 2009 to 2013. Therapeutic efficacy of ACT was assessed by longitudinal follow ups. Molecular markers analysis was done on all available day 0 samples. Results True recrudescence treatment failures cases and day 3 parasite positivity were detected at only the southern Myanmar sites. Day 3 positive and k13 mutants with higher prevalence of underlying genetic foci predisposing to become k13 mutant were detected only in southern Myanmar since 2009 and comparatively fewer mutations of pfarps10, pffd, and pfmdr2 were observed in western Myanmar. K13 mutations, V127M of pfarps10, D193Y of pffd, and T448I of pfmdr2 were significantly associated with day 3 positivity (OR: 6.48, 3.88, 2.88, and 2.52, respectively). Conclusions Apart from k13, pfarps10, pffd and pfmdr2 are also useful for molecular surveillance of artemisinin resistance especially where k13 mutation has not been reported. Appropriate action to eliminate the resistant parasites and surveillance on artemisinin resistance should be strengthened in Myanmar. Trial registration This study was registered with ClinicalTrials.gov, identifier NCT02792816