Peer to Peer Support Among FSWs and IDUs

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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