TB/HIV in Prisons in Myanmar by Médecins Sans Frontières (Doctors Without Borders)

TB/HIV in Prisons in Myanmar PRESENTED BY DR.THANT ZAW WIN (DEPUTY DIRECTOR) PRISONS DEPARTMENT MINISTRY OF HOME AFFAIRS (23-8-2013)

Introduction to Prison Health Care System  43 Prisons, 46 Camps in Myanmar  About (50000) to (60000) prisoners

 One 50-beded Hospital (Insein Central Prison)  Two 25-beded Hospitals(Mandalay Central Prison,

Tharyawaddy Central Prison)  Every prison or camp has a clinic.  Every prisoner has the right to get health care service of OPD clinic(manpowered by at least 1 doctor, 1 health assistant, 2 nurses, 2 nurse aids) at every prison or camp.  At prison hospitals, X-Ray and Lab technicians are available for medical investigations. Dr. Thant Zaw Win (Deputy Director), Prisons Department

Prisons under Prisons Department, MOHA Yangon Region

Insein Central Prison

Ayeyarwaddy Region

Mandalay Region

12. Pathein Prison 13. Myaung Mya Prison

2. Mandalay Central Prison 3. Myin Chan Prison

14. Hinthada Prison 15. Ma-U-Bin Prison

4. Mate Hti Lar Prison 5. Ramelthin Prison

16. Phyar Bon Prison Shan State

6. Nyaung Oo Prison Bago Region

17. Taung Gyi Prison 18. Lashio Prison

7. Tharawaddy Central Prison 8. Taung Ngu Prison

19. Kyine Tone Prison 20. Lauk Kine Prison

9. Bago Prison 10. Pyi Prison

21. Mine Sat Prison 22. Thi Paw Prison

11. Paung Tel Prison Dr. Thant Zaw Win (Deputy Director), Prisons Department

Prisons under Prisons Department, MOHA(cont;) Sagaing Region

Thanintharyi Region

23.

Kalay Prison

34.

Myeik Prison

24.

Mone Ywar Prison

35.

Dawi Prison

25.

Shwe Bo Prison

36.

26.

Ka Thar Prison

27.

Khan Dee Prison Rakhine State

28. Sittway Prison 29. Kyauk Phyu Prison 30. Bu Thee Taung Prison 31. Than Twel Prison Magwe Region 32.

Tha Yet Prison

33.

Pakhotkhu Prison

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Kawt Taung Prison Kachin State 37.

Myit Kyee Nar Prison

38.

Bamaw Prison

39.

Pu-tha-O Prison Kayar State 40.

Loi-kaw Prison Kayin State 41.

Pha-an Prison

Mon State 42.

Mawlamyaing Prison

43.

Tha Htone Prison

HR Setup for Health Care in Prisons in Myanmar Sr.

Rank

Numbers

Chief Medical Officer

Deputy Chief Medical Officer

Hospital Medical Superintendent

Doctors

Dental Surgeon

Health Assistant

Nurse (Sister)

Nurse

Midwife

10.

X-Ray Technician

11.

Lab Technician

Total Dr. Thant Zaw Win (Deputy Director), Prisons Department

148 5

TB Care in Prisons  TB patients in prisons get DOTS(Anti-TB Treatment) by

the guidelines of Myanmar National TB Programme.  Starting from (11-Jul-2012), we opened TB Treatment Center inside Insein Central Prison Hospital as an Other Reporting Unit of National TB Programme in order to take care of TB patient in a wider range.  Our TB Treatment Center arranges Referral Letter for the released TB patients to the nearest TB Treatment Center under National TB Programme so that they could get the complete Anti-TB treatment. Dr. Thant Zaw Win (Deputy Director), Prisons Department

(16-8-2013) Current TB Patients in the prisons in Myanmar

1 2 3 4 5 6 7 8 9 10 11

Prison

Insein Central Prison Mandalay Central Prison Tharyarwady Central Prison Nyaung Oo Prison Ramelthin Prison Lashio Prison Matehtilar Prison Thipaw Prison Pathein Prison Myaungmya Prison Ma-U-Bin Prison

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Current TB Patients Male Female Total 29 5 34 28 4 32 15 1 16 3 3 5 1 6 1 1 27 4 31 1 1 -

Remark

(16-8-2013) Current TB Patients in the prisons in Myanmar (continued)

Prison

12 Hinthada Prison 13 Phyarbon Prison 14 Mawlamyaing Prison 15 Pha-an Prison 16 Tha Htone Prison 17 Kyine Tone Prison 18 Taunggyi Prison 19 Loikaw Prison 20 Mine Sat Prison 21 Kalay Prison 22 Kathar Prison 23 Shwe Bo Prison Dr. Thant Zaw Win (Deputy Director), Prisons Department

Current TB Patients Male Female Total 2 2 11 11 1 1 2 2 3 3 5 2 7 1 1 1 1 1 1 -

Remark

(16-8-2013) Current TB Patients in the prisons in Myanmar (continued)

Prison

24 Mone Ywar Prison 25 Pakhotkhu Prison 26 Khan-dee Prison 27 Myin Chan Prison 28 Tha-yet Prison 29 Taung-ngu Prison 30 Pyi Prison 31 Bago Prison 32 Paung Thel Prison 33 Myitkyinar Prison 34 Bamaw Prison 35 Pu-tha-o Prison Dr. Thant Zaw Win (Deputy Director), Prisons Department

Current TB Patients Male Female Total 3 3 2 2 3 3 4 4 2 2 6 6 1 1 5 1 6 1 1 -

Remark

(16-8-2013) Current TB Patients in the prisons in Myanmar (continued)

Prison

Current TB Patients Male

Female

Total

37 Dawei Prison

38 Myeik Prison

39 Sit-tway Prison

40 Bu Thee Taung Prison

41 Kyauk Phyu Prison

42 Than Twel Prison

43 Lauk Kine Prison

185

205

36 Kawt Thaung Prison

Total Dr. Thant Zaw Win (Deputy Director), Prisons Department

Remark

Insein Central Prison Hospital, TB Ward

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Teams visited to Insein Central Prison ď&#x201A;&#x2014; Head of Yangon Region of Myanmar National TB

Programme, Medical Superintendent of Aung San TB Hospital leaded the TB Mobile Team with full TB investigation equipments and visited to Insein Central Prison at 16-Jul-2012 for investigating of TB-suspect prisoners. ď&#x201A;&#x2014; TB Mobile Team planned to visit to Insein Central Prison twice a year.

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team's Visits to Insein Central Prison Team Leader : Dr. Daw Tin Mi Mi Khine

Screened inmates

Anti-TB Treatment given

Date Male Female Child

Total

Male Female Child

Total

First Visit

(16-7-12) to (18-7-12)

349

154

508

Second Visit

(28-1-13) to (30-1-13)

201

290

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Head of Yangon Region of National TB Programme, Medical Superintendent of Aung San Hospital & TB Mobile Team is inspecting & investigating TB Suspect Prisoners while visiting Insein Central Prison on 16-Jul-2012 Dr. Thant Zaw Win (Deputy Director), Prisons Department

X-Ray technicians investigating TB suspect patients while TB Mobile Team visit to Insein Central Prison on 16-Jul-2012

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team is investigating TB suspect prisoners while visiting to Insein Central Prison on 16-Jul2012

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Head of Yangon Region of National TB Programme, Medical Superintendent of Aung San Hospital & TB Mobile Team is inspecting & investigating TB Suspect Prisoners while visiting Insein Central Prison on 29-Jan-2013 Dr. Thant Zaw Win (Deputy Director), Prisons Department

Insein Prison Hospital M.S Dr. Zaw Win & Deputy Chief Medical Officer of Prisons Department and members TB Mobile Team are inspecting & investigating TB Suspect Prisoners while visiting Insein Central Prison on 29-Jan-2013 Dr. Thant Zaw Win (Deputy Director), Prisons Department

X-Ray technicians investigating TB suspect patients while TB Mobile Team visit to Insein Central Prison on 28-Jan-2013

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team's Visit to Tha-Yet Prison Date : 16-2-2013 to 18-2-2013

Team Leader : Dr. Tin Maung Swe

Male

Female

Total

Total Numbers of screened prisoners

139

150

Number of prisoners examined by Sputum for AFB

101

Number of prisoners examined by CXR(PA) View

139

150

Number of prisoners started Anti-TB Treatment

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team's Visit to Pyi Prison Date : 7-5-2013 to 10-5-2013

Team Leader : Dr. Daw Nyein Nyein Aye

Male

Female

Total

234

262

Number of prisoners examined by Sputum for AFB

Number of prisoners examined by CXR(PA) View

234

262

Total Numbers of screened prisoners

Number of prisoners started Anti-TB Treatment

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team's Visit to Pathein Prison Date : 21-5-2013 to 23-5-2013

Team Leader : Dr. Hnin Hnin Aung

Male

Female

Total

Total Numbers of screened prisoners

255

310

Number of prisoners examined by Sputum for AFB

207

260

Number of prisoners examined by CXR(PA) View

252

310

Number of prisoners started Anti-TB Treatment

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team visited Pathein Prison in May, 2013 Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team's Visit to Moneywar Prison Date : 5-6-2013 to 7-6-2013

Team Leader : Dr. Aye Thein

Male

Female

Total

321

406

Number of prisoners examined by Sputum for AFB

Number of prisoners examined by CXR(PA) View

321

406

Total Numbers of screened prisoners

Number of prisoners started Anti-TB Treatment

Dr. Thant Zaw Win (Deputy Director), Prisons Department

TB Mobile Team's Visit to Pha-An Prison Date : 17-6-2013 to 21-6-2013

Team Leader : Dr.Nay Win Lin

Male

Female

Total

300

100

400

Number of prisoners examined by Sputum for AFB

116

Number of prisoners examined by CXR(PA) View

Number of prisoners started Anti-TB Treatment

Total Numbers of screened prisoners

Dr. Thant Zaw Win (Deputy Director), Prisons Department

(16-8-2013) Current HIV Patients in the prisons in Myanmar

Prison

HIV M

Total M

HIV+TB

HIV under ART

Total M

Total

Remark

1 Insein Central Prison

204 258 462

177 87

264 MSF-CH

2 Mandalay Central Prison

178 44

222

100 32

132 IHC

3 Tharawady Central Prison

4 Nyaung Oo Prison

5 Ramelthin Prison

6 Lashio Prison

121

7 Mate-hti-lar Prison

8 Thi Paw Prison

9 Pathein Prison

10 Myaung Mya Prison

11 Ma-U-Bin Prison

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Own Cost

87 AZG Own Cost Own Cost

(16-8-2013) Current HIV Patients in the prisons in Myanmar (continued)

Prison

12 Hinthada Prison 13 Phyar Bon Prison 14 Mawlamyine Prison 15 Pha-an Prison 16 Tha Htone Prison 17 Kyine Tone Prison 18 Taung Gyi Prison 19 Loi-kaw Prison 20 Mine Sat Prison 21 Kalay Prison 22 Shwe Bo Prison 23 Mone Ywar Prison

M 1 1 14 2 3 4 22 9 1 1

HIV HIV+TB HIV under ART F Total M F Total M F Total 1 1 1 1 1 1 6 20 3 3 4 3 7 2 4 3 1 1 2 2 4 8 1 1 3 3 6 4 26 2 2 20 3 23 1 1 1 1 1 10 1 1 2 3 5 6 -

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Remark

Own Cost Care Myanmar Own Cost Own Cost IHC Own Cost

(16-8-2013) Current HIV Patients in the prisons in Myanmar (continued)

Prison

HIV

HIV+TB

HIV under ART

Remark

Total

24 Mone Ywar Prison

25 Pakhotku Prison

26 Khan Dee Prison

27 Myin Chan Prison

28 Ta Yet Prison

29 Taung Ngu Prison

30 Pyi Prison

31 Bago Prison

32 Paung Tel Prison

33 Myit Kyi Nar Prison

111

69 AZG

34 Bamaw Prison

43 AZG

35 Pu-tha-O Prison

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Own Cost

(16-8-2013) Current HIV Patients in the prisons in Myanmar (continued)

Prison

HIV

HIV+TB

HIV under ART

Remark

Total

36 Kawthaung Prison

37 Dawei Prison

38 Myeik Prison

NAP

39 Sittway Prison

NAP

40 Bu Thee Taung Prison

41 Kyauk Phyu Prison

42 Than Twel Prison

43 Lauk Kine Prison

Total

687 394 1081 95

Dr. Thant Zaw Win (Deputy Director), Prisons Department

107 478 169 647

HIV Care in prisons ď&#x201A;&#x2014; Collaborating with NAP and other INGOs, Prisons

Department is trying to get ART and OI Management for all HIV patients in prisons around the country. ď&#x201A;&#x2014; Teams of National AIDS Programme(NAP) visited once a month to prisons to screen CSWs(Commercial Sex Workers) detained in prisons.

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Collaboration with MSF(Switzerland) at Insein Central Prison ď&#x201A;&#x2014; Prisons Department is collaborating with MSF(Switzerland) at

Insein Central Prison since 25-Oct-2010. ď&#x201A;&#x2014; Since collaborated with MSF(Switzerland), we have registered 502 male PLWHA prisoners and 826 female PLWHA prisoners at Insein Central Prison up to the end of July, 2013.

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Summary of HIV patients at Insein Central Prison since collaborated with MSF(Switzerland) (25-10-2010) to (16-8-2013)

Sr.

Description

Male

Female

Total

Remark

1 Registered HIV Patients

502

826

1328

2 Current HIV Patients

224

262

486

4 All registered patients under ART

348

284

632

5 Current patients under ART

177

264

3 Expired Patients after registered

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Started at (25-10-2010)

MSF(Switzerland) visited to TB Ward at Insein Central Prison Dr. Thant Zaw Win (Deputy Director), Prisons Department

MSF(Switzerland) Clinic in Insein Central Prison compound Dr. Thant Zaw Win (Deputy Director), Prisons Department

Yangon Region Team of NAP visited to Insein Central Prison Dr. Thant Zaw Win (Deputy Director), Prisons Department

Collaboration with The Union at Mandalay Central Prison ď&#x201A;&#x2014; Prisons Department is collaborating with The Union at

Mandalay Central Prison since 17-Aug-2011. ď&#x201A;&#x2014; We have registered and shown 228 male PLWHA prisoners and 67 female PLWHA prisoners at Mandalay Central Prison to The Union up to the end of July, 2013.

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Summary of HIV patients at Mandalay Central Prison since collaborated with The Union (17-8-2011) to (7-8-2013)

Sr.

Description

Male

Female

Total

1 Registered HIV Patients

228

295

2 Current HIV Patients

199

246

4 All registered patients under ART

161

211

5 Current patients under ART

100

132

Remark

Started at (17-8-2011)

3 Expired Patients after registered

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Collaboration with The Union for PLWHA(Prisoners Living With HIV/AIDS) at Mandalay Central Prison Dr. Thant Zaw Win (Deputy Director), Prisons Department

Collaboration with The Union for PLWHA(Prisoners Living With HIV/AIDS) at Mandalay Central Prison (14-8-2013) Dr. Thant Zaw Win (Deputy Director), Prisons Department

Training for Health Staff from Prisons Department ď&#x201A;&#x2014; National TB Programme organized for the training of

health staff(doctors) from MOHA (21-12-2011) to (23-122011). ď&#x201A;&#x2014; National TB Programme organized for the training of health assistants from MOHA (3-12-2012) to (6-12-2012).

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Opening Ceremony of Training on DOTS Strategy for Health Staff(Doctors) from Ministry of Home Affairs (21-12-2011) Dr. Thant Zaw Win (Deputy Director), Prisons Department

Opening Ceremony of Training on DOTS Strategy for Health Assistants from Ministry of Home Affairs (3-12-2012) Dr. Thant Zaw Win (Deputy Director), Prisons Department

Regional Workshop on Scaling Up Engagement of Prisons in TB Control (From 10-12-2012 To 14-12-2012) (Indonesia) Dr. Thant Zaw Win (Deputy Director), Prisons Department

A Medical Officer of Prisons Department delivered a health education speech to male inmates from Insein Central Prison Dr. Thant Zaw Win (Deputy Director), Prisons Department

A Medical Officer of Prisons Department delivered a health education speech about Nutrition to female inmates from Insein Central Prison

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Director General of Correctional Department, U Than Htay, is inspecting Insein Central Prison Hospital Dr. Thant Zaw Win (Deputy Director), Prisons Department

Director General of Correctional Department, U Than Htay, is addressing speech at the Meeting of Prisons Department, Health Department, NAP and NTP at Naypyitaw at 29-7-2013 Dr. Thant Zaw Win (Deputy Director), Prisons Department

Meeting of Prisons Department, Health Department, NAP and NTP at Naypyitaw at 29-7-2013 Dr. Thant Zaw Win (Deputy Director), Prisons Department

Meeting of Prisons Department, Health Department, UN-AIDS, 3MDG Fund, NAP, NTP and The Union at Naypyitaw at 29-7-2013 Dr. Thant Zaw Win (Deputy Director), Prisons Department

Challenges(1) ď&#x201A;&#x2014; MSF (Switzerland) will leave from Insein

Central Prison at the end of this year(2013); so the ART, OI treatment, follow-up, regular check-up for PLWHA(Prisoners Living With HIV/AIDS) are the greatest challenge for the future management of HIV patients in Insein Central Prison. Dr. Thant Zaw Win (Deputy Director), Prisons Department

Challenges(2) ď&#x201A;&#x2014; We have 43 prisons and 46 camps around

the country. We are trying to supply ART and OI drugs for the central prisons but for the countryside regional prisons we are still struggling to get supply of investigations (Blood tests, sputum tests, etc) and even for essential OI drugs. Dr. Thant Zaw Win (Deputy Director), Prisons Department

Challenges(3) ď&#x201A;&#x2014; Despite of Prisons Deparment's provision

of essential drugs, the requirement of OI drugs for HIV prisoner patients is still a great challenge.

Dr. Thant Zaw Win (Deputy Director), Prisons Department

Thank you very much for your kind attention

Dr. Thant Zaw Win (Deputy Director), Prisons Department