The Union advances treatment for TB and MDR-TB patients living with HIV in Myanmar

Every day, The Union Office in Myanmar administers antiretroviral therapy (ART) to patients with HIV, conducts active case-finding and aids treatment adherence for tuberculosis (TB) and multidrug-resistant TB (MDR-TB) patients, as well as providing comprehensive healthcare services and support to people within that network.

A person living with HIV is 20-30 times more likely to develop active TB, and TB is a leading cause of death in people infected with HIV. Myanmar - where medical infrastructure is lacking and cultural taboos still contribute to stigma and shame over disease - is listed among the 30 high-burden countries for TB, MDR-TB and TB-HIV. The Union is challenging these issues by establishing a network of volunteers and community-support networks to deliver medication, spread information and awareness, and assist with treatment adherence.

One of the patients treated through The Union’s programmes in Myanmar is a 33 year old woman, Thin Thin Aye (name has been changed), living in a township of Mandalay and surviving on scarce resources. She first came to The Union in 2008 via the Integrated HIV Care (IHC) Programme, which delivers ART and tests and treats patients for TB. She had just discovered she was HIV positive and was also infected with TB. She immediately started on ART and TB treatment.

Through treatment in the IHC programme, she was cured of TB and was doing well with her ART until 2014 when, due to several personal stresses, she stopped coming into the clinics and volunteers were unable to locate her. Patients commonly have trouble continuing treatment as daily medication requires a degree of stability that many TB and HIV patients simply do not. Finding the time and money to visit clinics - often located in urban centres far from patients’ homes - for regular check-ups, and including daily medication in sometimes unpredictable routines can make continued treatment difficult or impossible for many patients.

To counter this, The Union relies on a network of volunteers who work in the communities and deliver medicine to patients daily. These volunteers, often TB survivors or people living with HIV themselves, also engage the community in outreach programmes, conduct information sessions and encourage testing and treatment. It was this group of volunteers that managed to locate the woman, who had since developed MDR-TB. She restarted ART and was immediately initiated on treatment for MDR-TB.

Volunteers visited her in her home every evening to administer MDR-TB medicines, provide support and help connect her with the network of people living with HIV in her community. Thanks to this intervention and the vast support network that ensures patients are not isolated from their communities, Thin Thin Aye is eight months into her MDR-TB treatment and is doing well with her ART. The volunteers continue to visit her daily.

TB-HIV services, such as the one described here, are delivered by The Union Office in Myanmar via two programmes, the Integrated HIV Care (IHC) Programme – through which 25,155 patients currently receive ART – and the Community Based MDR-TB Care Project, with partners National AIDS Programme, National TB Programme and Department of Public Health.