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Peer to Peer support among FSWs and IDUs
Myanmar DRTB symposium
Dr. Wai Moe Myint NOUS SOIGNONS CEUX QUE LE MONDE OUBLIE PEU A PEU
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Size estimates of FSW 60,000 and IDU 75,000 Recent decrease in HIV prevalence, with HIV prevalence for FSW =7.1% and HIV prevalence among IDU=18% (HSS 2012) Challenges with the number or percentage of at risk population getting treatment on TB or TB/HIV, as many of them may have been getting treatment from health centers and not being identified as at risk populations
» MDM-France,providing
comprehensive HIV prevention and care program to the high risk populations, > Drug user in Kachin State • Myitkyina township • Moegaung township • Mohnyin township
> FSW/MSMs in Yangon region
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MDM activities in FSWs/MSMs/PWID > Behaviour change communication > STI management and general healthcare > Treatment of opportunistic infections and provision of HAART > TB/HIV activities • TB awareness raising • Diagnosis of TB • TB treatment and follow-up
> Harm reduction activities (in Kachin State) including Opioid Substitution activities
Dr. Wai Moe Myint
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Getting patients in care Âť
Concerns on treatment and Adherence of FSWs and IDUs > Mobility > Drug related problems > Co morbidities > Specific drug interactions > Difficulty in finding a care taker
Ensuring TB/HIV treatment, maintaining adherence » Comprehensive package of prevention and care » »
> Outreach education, STI, HIV test and counseling > PLH care, TB/HIV, ART Link to opiod substitution treatment for IDUs Peer education and adherence support
“Intended results could only be achieved with engagement and participation of targeted groups”
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Peer support as a part of HIV/TB activities Âť
Peer to peer support > Awareness raising > Adherence support visits > Supporting patients as care takers > Support group activities for patients on treatment > Organizing self help groups-nutrition activities, income raising activities > Continuing support for patients referred
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Peer support, building capacity Âť
Capacity building of peers > Motivated patients, including ex SW and ex IDUs, stable on treatment are trained on adherence support training-composed on 12 modules > Number of participants not limited to the number of peers working for adherence support > Peers are encourage to participate in peer trainings on HIV prevention activities > Peers recruited as needs on the number of patients and geographical distribution, based on a set of criteria, supervised by a steering group > Organizing regular trainings, refresher trainings
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Participation of peers in treatment process » » »
Peers involved in the treatment selection process Works closely with opioid treatment peers Schedule adherence visits > More frequent visit on initial phase of the treatment, > More frequent visit to patients with constraints on adherence > Family counseling > Referral for patients for opioid substitution > Following missing patients / follow up reminders “Patients receiving adherence visits from outreach staffs as well as adherence support peers”
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Support for peer support » » » »
Monitoring of peers Adaptation of adherence tools to be used by peers Regular peer workshops Supervisor to identify > Constraints peers are facing > Facilitate peers to find solution, on regular workshops > Propose supports for peer activity > Identify training needs > Mobilize peers
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Follow up of adherence Âť Âť
Adherence visits Referral of patients to partners > Patients are used to be referred to partners > Adherence and follow up visits could be make sure
Individual patients followed (ART+ TB ) 1000 900 800 700 600 500 400 300 200 100 0
outreach staffs
peer
Yangon (FSWs Myitkyina and MSMs) (I/DU)
Moegaung Hopin (I/DU) (I/DU) Dr. Wai Moe Myint
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TB/HIV adherence visits number of contacts I/DU (HPN) I/DU(MGG) I/DU (MKN) FSW and MSM(Ygn) 0%
20%
40%
60%
80%
100% outreach staffs Peers
Dr. Wai Moe Myint
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Peer to peer support as strengthening adherence Âť Peer support is an important component and clearly
Âť
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benefit the
community > Improving awareness > Improving assess to care > Improving treatment adherence > Reducing stigma Peer involvement in the adherence support team can benefit continuous adherence support in difficult to reach settings
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Challenges » » » » » »
Retention of peers, burn outs Transport constraints in following missing patients Constraints with following seasonal workers Continuing support after referral Pre treatment retention Reaching to female drug users
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THANK YOU