Khin Nyein ChanMedical Coordinator
MSF Experience on Use of HIV Viral Load testing
in Myanmar
HIV program in Myanmar
MSF HIV/ART program started since 2003
17 TB/HIV clinics Yangon Region Taninthayi Region Kachin State Shan State Rakhine State
>30,000 patients are on HAART
Waing Maw
Moe Gaung
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Activities HIV Prevention – focusing on SW, MSM, DU
HIV Care and Support including – HTC, PMTCT, OI management, HAART
Laboratory services Network of CD4 facility, 1 Cavidi Viral Load system,
GeneXpert, Biochemistry, etc.
HIV Viral Load monitoring
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MSF installed one Cavidi VL system in Yangon – Mid 2009
HIV Viral Load monitoring (Cont.) Manual Extraction of RT enzyme and
amplification Takes 2 days for one lab tech Leave overnight for final reading
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HIV Viral Load monitoring (Cont.) Final Reading on the next morning
Takes 5 Minutes only
Results obtained through a computer software 29 samples per each run
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Why Cavidi System?
Very feasible for resource limited settings.. Does not require sterile environment/molecular
laboratory Allows for decentralised testing Subtype independent technology Affordable cost
However, Technician dependent Capacity per lab tech: Collection and Transportation of specimen
Capacity of VL monitoring in MSF Max. Capacity using 2 full time lab tech: -
3 runs (87) per week – 156 runs (4524) per year
Current patients on MSF Treatment >29,000 patients on first line Nearly 1000 patients on second line 3 patients on third line
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Country Situation
Estimated patients need of ART – 125,000 Currently on ART - >50,000 2 Viral Load facilities – MSF Cavidi system
and MoH PCR system MSF Criteria for VL testing
1st priority – Clinically and immunologically suspected treatment failure
Yearly monitoring for patients on 2nd line (a rising VL could be targeted with intense adherence counseling)
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Transportation of specimen
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2.5Hr
Boat
6Hr Car
2.5 Hr Air
Viral vs. immunological monitoring
A simple analysis of VL vs CD4 of 3801 patients with suspected immunological failure receiving 1st line ART >1yr shows 20% (755) - confirmed failure and of those failure,
8% (58) has CD4 >350 66% (2505) has undetectable VL and of those 66%,
33%(828) has CD4 <200
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VL: An essential tool in ART package VL should be the first routine
adherence monitoring tool
Support promoting retention on 1st line ART
Critical role in preventing unnecessary switch to 2nd line regimen
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THANK YOU