In Myanmar, just one-half of the people living with HIV have access to life-saving antiretroviral therapy (ART). One of the factors impacting access is that publicly funded HIV services are provided at central hospitals, requiring patients to travel long distances and receive care in an unfamiliar setting. To address this barrier, Myanmar’s National AIDS Program prioritized decentralization of ART services.
[Photo: Dr. Wafaa El-Sadr]
However, patients were not always willing to be transferred from the central hospitals, where they were accustomed to receiving care. And, in some cases, health care workers at new local sites were inadequately trained to support HIV patients effectively.
“To achieve HIV epidemic impact, it is critical to mobilize community and peer groups to take part in the provision of health care,” said Dr. Wafaa El-Sadr, director of ICAP. “Together with health care workers, they can ensure access to health services and the provision of patient-centered quality HIV care.”
With support from PEPFAR through the CDC, ICAP partnered with Myanmar’s Ministry of Health to provide on-the-job training in HIV treatment and counseling for the staff at the new ART sites. ICAP also began partnering with groups and networks for people living with HIV, as well as facility-based medical officers and specialist physicians from ART initiation centers, to train existing peer supporters to provide patient information on new local ART treatment options and drive demand for the local services. In these talks, peer supporters would also provide one-on-one counseling to interested patients. As a result of this peer support, providers have been able to engage patients in care more fully; many patients have grown to trust the peer supporters and are then willing to receive HIV care at one of the new sites.
In one year, over 190 patients have transitioned their care from central ART centers to a new treatment site at Hlaing Tharyar Hospital. Through ICAP’s technical assistance, the peer model is now viewed as a positive opportunity to support efforts to decentralize care, ease the burden of health care workers at central ART centers, build the capacity of local health care workers to provide ART treatment, and increase access to care for people living with HIV outside of Myanmar’s major cities.
“With help from the peer supporters, health care workers at the hospital are able to task shift to accommodate more patients,” said Dr. El-Sadr, who is also professor of Epidemiology and the Dr. Mathilde Krim-amfAR Chair of Global Health at Columbia’s Mailman School of Public Health. “They are able to provide counseling, schedule patients for follow-up visits, and support the referral of patients to other hospitals as needed.”