Optimising operational use of artemether-lumefantrine
| GRANT No. | MAM-MARC-3MDG-C2-13-00088076 |
| Budget | US$ 163,236 |
| Partner | Medical Action Myanmar |
| Start | 05 November, 2013 |
| End | 31 March, 2016 |
| Coverage | - |
| Activities | - |
Areas of Work-HIV, TB, Malaria
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Support the National TB Strategy (Active Case Finding)
Support to the national tuberculosis strategy
Myanmar is among the 22 countries with the highest Tuberculosis (TB) burden in the world. The TB prevalence is twice the regional average and nearly three times the global average, with an estimated 250,000 people with the disease. There were an estimated 180,000 new TB cases in Myanmar in 2010, more than 40,000 of them in children. The number of people with drug-resistant strains of TB is growing at an alarming rate, with an estimated 9,000 cases of MDR-TB each year*. A top priority of National Health Plan Tuberculosis is one of the top three priority diseases in the Ministry of Health’s National Health Plan.
Scaling up Active Case FInding (ACF) with mobile outreach
With the additional funding support from the Global Fund New Funding Model, Myanmar has been able to scale up the national response to TB. 3MDG’s priority is to complement the national response by expanding active TB case-finding through innovative strategies not covered by the Global Fund.
In March, 2014, 3MDG announced that it will increase its support to the Ministry of Health to scale up Myanmar’s Tuberculosis control activities over the next three years. It will provide US$ 3.82 million to the Ministry of Health to strengthen and expand TB active case finding across 75 townships of Myanmar.
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Support to the National TB Strategy (MDR-TB)
Support to the national tuberculosis strategy
Myanmar is among the 22 countries with the highest Tuberculosis (TB) burden in the world. The TB prevalence is twice the regional average and nearly three times the global average, with an estimated 250,000 people with the disease. There were an estimated 180,000 new TB cases in Myanmar in 2010, more than 40,000 of them in children. The number of people with drug-resistant strains of TB is growing at an alarming rate, with an estimated 9,000 cases of MDR-TB each year*. A top priority of National Health Plan Tuberculosis is one of the top three priority diseases in the Ministry of Health’s National Health Plan.
Scaling-up mutli-drug resistant tuberculosis (MDR-TB) activities in Yangon and Mandalay Regions
3MDG funding will enable the scale-up of activities to screen, identify and provide treatment for patients with MDR-TB across 56 Townships in Yangon and Mandalay Regions, with a priority focus on urban poor populations.
The US$19 million funding will enable an additional 2,000 patients diagnosed with MDR-TB to access quality treatment, in line with the Ministry of Health’s guidelines.
Procurement
Procurement of medicines to treat MDR-TB will be the largest single expenditure out of the total $19 million financing made available. Second-line drugs (20 months regimen) for 2,000 MDR-TB patients and drugs for an additional 200 patients to be treated with a short-course regimen will be purchased. Specialized medical equipment including three Gene X-pert 16 module machines will be purchased in order to enable identification of patients suffering from MDR-TB.
Support to patients
Every patient will receive help throughout their 20 month treatment course. This includes cash and nutritional support, and transport allowances for their medical check ups. This support will be provided through community volunteers trained and recruited by NTP and implementing partners. Appropriate IEC materials and health education videos will be developed and distributed/broadcasted. Community volunteers and Basic Health Staff will also be incentivized to ensure patients are able to complete the 20 month course of MDR-TB drug treatment.
Improving quality diagnosis
Trainings will be provided for general practitioners to enable them to recognize and refer suspected cases of MDR-TB to specialized TB hospitals.
Health sector financing for the National Response to MDR-TB in Myanmar is provided by the 3MDG Fund as well as WHO, USAID CAP-TB, the Global Fund, DFAT and the World Food Programme.
* Source: National Strategic Plan for Tuberculosis Control 2011-2015
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Support to the National Strategic Plan on HIV/AIDS (Harm Reduction)
Support to the national strategic plan on HIV and Aids (Harm Reduction)
In Myanmar, HIV has the features of a concentrated epidemic among specific groups. The latest data showed HIV prevalence at over 7% among female sex workers, 8.9% among men who have sex with men, and 18% among people who inject drugs. 3MDG aims to support priority gaps in the national response to HIV that are not readily funded by the Global Fund. The main focus of 3MDG support in 2013 was on harm reduction.
TARGET BENEFICIARIES
Priority was given to townships where injecting drug use and HIV prevalence was higher. These townships are in areas of high injecting drug use along the border areas, drug trafficking routes and mining sites, for example in Kachin State.
HARM REDUCTION
HIV harm reduction interventions under 3MDG are Government-led and aligned to the National Strategic Plan for HIV and AIDS. At the end of 2013, 3MDG had commissioned nearly US$ 6.7 million in grants with 11 partners, for services in a total of 33 townships in Shan, Kachin and Mon states, and Mandalay, Sagaing and Yangon regions. A total of 9 grants were commissioned for HIV interventions and 2 grants were commissioned for integrated HIV-TB-malaria interventions. These partners provided a comprehensive package of harm reduction services, including:
- Clean needle and syringe distribution
- HIV counselling and testing services
- Referral for opioid substitution therapy
- Screening and treatment for TB and sexually transmitted infections
- Antiretroviral therapy
ADDRESSING BARRIERS TO HIV PREVENTION
Through enhanced advocacy efforts and improved awareness, it is anticipated that Myanmar may be able to effect the necessary policy and legislative reforms required in order to address its HIV epidemic. However, substantial policy and legal barriers remain that limit the effective conduct of HIV prevention activities. Discriminatory attitudes of health service providers, of the family and in the community at large towards key affected populations also constitute social barriers of isolation, judgment and exclusion. In 2013, 3MDG signed a financing agreement with UNAIDS for interventions that aim to address the substantial policy and legal barriers that limit the effective conduct of HIV prevention activities.
INTEGRATED SERVICES: HIV-TB-MALARIA
3MDG’s experience suggests that integrating service delivery across the three diseases will provide better access to services while costing less. Whilst broad integration of TB/HIV services is planned for 2014, 3MDG has already financed integrated services from two implementing partners in five hard-to-reach and priority townships (Hpakan, Waingmaw, Laukkaing in Kokang Special Region, Lashio and Patheingyi).
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Support to the National Malaria Strategy
Support to the Myanmar Artemisinin Resistance Containment framework (MARC)
Malaria is a major cause of illness and mortality amongst children and adults in Myanmar. Over three-quarters of the population live in malaria endemic areas. The emergence of artemisinin-resistant malaria on the country’s eastern borders is a serious concern, with significant global implications. A national response strategy, the Myanmar Artemisinin Resistance Containment Framework (MARC), aims to protect Artemisinin-based Combination Therapy (ACT) as an effective anti-malaria treatment.
Financing from 3MDG supports the MARC strategy and is predominantly targeted at addressing gaps in coverage, especially amongst mobile, migrant or remote populations, particularly in former conflict areas.
PROGRESS IN 2014
During 2014, almost 500,000 people suspected of having malaria received testing, which brings the number tested since 3MDG began to almost one millionpeople.
Thirty thousand new cases of malaria were treated, bringing the total number of malaria patients who have been treated through 3MDG support to almost 100,000.
Malaria prevalence is declining in the areas of the country where malaria containment programmes are established, resulting in lower numbers of people treated than earlier foreseen.
3MDG ’s malaria response went through a transition period in 2014, with the phasing out of the previous Three Diseases Fund (3DF)-supported Myanmar Artemisinin Resistance Containment (MARC) response, and the beginning of the 3MDG supported national MARC response. The focus shifted towards the early diagnosis of malaria cases and helping confirmed malaria cases to get effective and rapid Artemisinin-based Combination Therapy (ACT) treatment. This was done by expanding the areas served by the trained volunteer network and health care providers at the community level.
As the Global Fund had committed to increase its long lasting insecticide-treated nets (LLIN) coverage significantly in all high-risk areas, 3MDG significantly reduced funding for the distribution of LLINs.
FINANCING WORK FOR INNOVATION
Whilst containment programmes remain vital as part of the effort to control the spread of artemisinin-resistant malaria, there is an emerging consensus that resistance can only be addressed through malaria elimination strategies – which will require a concerted and massive effort at the national, regional and global level. Evidence to guide policy and planning is incomplete and as such, during 2014, 3MDG continued to finance work for innovation. This includes studies to model best options for containment/elimination, studies to optimize use of therapies as well as a nationwide survey to measure prevalence.
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Strengthening of prison healthcare
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videos
WATCH: Unite to End TB with Sai Sai Kham Leng!
WATCH: Unite to End TB with Sai Sai Kham Leng!