title: Evolution of the health sector response to HIV in Myanmar: progress, challenges and the way forward.
abstract: Critical building blocks for the response to HIV were made until 2012 despite a series of political, social and financial challenges. A rapid increase of HIV service coverage was observed from 2012 to 2015 through collaborative efforts of government and non-governmental organisations (NGOs). Government facilities, in particular, demonstrated their capacity to expand services for antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, tuberculosis and HIV co-infection and methadone-maintenance therapy (MMT). After nearly three decades into the response to HIV, Myanmar has adopted strategies to provide the right interventions to the right people in the right places to maximise impact and cost efficiency. In particular, the country is now using strategic information to classify areas into high-, medium- and low-HIV burden and risk of new infections for geographical prioritisation - as HIV remains concentrated among key population (KP) groups in specific geographical areas. Ways forward include: •Addressing structural barriers for KP to access services, and identifying and targeting KPs at higher risk;•Strengthening the network of public facilities, NGOs and general practitioners and introducing a case management approach to assist KPs and other clients with unknown HIV status, HIV-negative clients and newly diagnosed clients to access the health services across the continuum to increase the number of people testing for HIV and to reduce loss to follow-up in both prevention and treatment;•Increasing the availability of HIV testing and counselling services for KPs, clients of female sex workers (FSW), and other populations at risk, and raising the demand for timely testing including expansion of outreach and client-initiated voluntary counselling and testing (VCT) services;•Monitoring and maximising retention from HIV diagnosis to ART initiation and expanding quality HIV laboratory services, especially viral load;•Prioritising integration of HIV and related services in high-burden areas;•Increasing the proportion of PLHIV receiving testing and treatment at public facilities by improving human resources and increasing public facilities providing these services to ensure sustainability;•Obtaining intelligence and tailoring services in hard-to-reach/under-served areas;•Strengthening planning, monitoring, and coordination capacity especially at regional levels.
authors.affiliation: National AIDS Program, Department of Public Health , Ministry of Health and Sports , Myanmar.
authors.forename: Htun Nyunt
authors.initials: HN
authors.lastname: Oo
authors.affiliation: National AIDS Program, Department of Public Health , Ministry of Health and Sports , Myanmar.
authors.forename: San
authors.initials: S
authors.lastname: Hone
authors.affiliation: World Health Organization , Country Office for Myanmar.
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Formerly World Health Organization , Regional Office for South-East Asia.
authors.forename: Amaya
authors.initials: A
authors.lastname: Maw-Naing
authors.affiliation: United Nations Joint Programme for HIV/AIDS , Myanmar.
authors.forename: Krittayawan
authors.initials: K
authors.lastname: Boonto
authors.affiliation: United Nations Joint Programme for HIV/AIDS , Myanmar.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Jacobs
authors.affiliation: United Nations Joint Programme for HIV/AIDS , Myanmar.
authors.forename: Sabe
authors.initials: S
authors.lastname: Phyu
authors.affiliation: World Health Organization , Country Office for Myanmar.
authors.forename: Phavady
authors.initials: P
authors.lastname: Bollen
authors.affiliation: United Nations Joint Programme for HIV/AIDS , Myanmar.
authors.forename: Jacquie
authors.initials: J
authors.lastname: Cheung
authors.affiliation: World Health Organization , Country Office for Myanmar.
authors.forename: Htin
authors.initials: H
authors.lastname: Aung
authors.affiliation: World Health Organization , Country Office for Myanmar.
authors.forename: May Thu
authors.initials: MT
authors.lastname: Aung Sang
authors.affiliation: World Health Organization , Country Office for Myanmar.
authors.forename: Aye
authors.initials: A
authors.lastname: Myat Soe
authors.affiliation: World Health Organization , Regional Office for South-East Asia.
authors.forename: Razia
authors.initials: R
authors.lastname: Pendse
authors.affiliation: United Nations Joint Programme for HIV/AIDS , Myanmar.
authors.forename: Eamonn
authors.initials: E
authors.lastname: Murphy