AHRN) 10 A, Hlaing Myint Mo Lane 7, Hlaing Townhip, Yangon, Myanmar Tel: + 95-1- 539154 and Tel/Fax: + 95-1-507089

Theme Traininggpggy & workshops/Strengthening Healthcare Systems

Title Prioritising TB, TBTB--DrugDrug Use & TB-HIV C oo--ifinfec tion among drug users in Myanmar

Mya Thida Aung - Training Officer (HIV-TB), Dr. Khin Pa Pa Naing - Medical Authors Coordinator (TB Component), Htun Htun Lynn - Training Officers (TB) and Siddharth Singh - Technical Team Leader

Willy De Maere - Technical Director Presenter Asian Harm Reduction Network (AHRN) 10 A, Hlaing Myint Mo Lane 7, Hlaing Townhip, Yangon, Myanmar Tel: + 95-1- 539154 and Tel/Fax: + 95-1-507089

1 Project

These proj ect acti v ities are suppor te d by 3 Diseases Fund (3DF) in Myanmar with the objectives: Goal: • Due to the higgyh morbidity and mortalit y related to TB in Myanmar reducing the burden of the disease by enhancing the provision of prevention, treatment and care for drugg( users (i.e. comprehensive package; Purpose: • To red uce the inc idence o f TB, TB/drug use re la te d issues and TB/HIV co-infection among drug users, families/partners in identified high risk drug using sites in Myanmar. 2 Project tasks

• AtfttdidtAssessment of target audience and partner agencies; • 3 tailor made training modules on TB, TB-Drug Use and TB/HIV co-infection; • Conducting training workshops on TB and TB/HIV for DIC-stfftaff an dTBd TB-Drug use for DOTS staff (NTP); • Inter-agency referral protocol; • Develop, field test and disseminate 3 IEC on TB, TB-Drug Use and TB/HIV co-infection f/for/among drug users; • KAP Survey among the target group.

3 Partnership

• Partner agencies assessment was conducted in the beginning of the project activities through a questionnaire and interviews; • The questionnaire was responded on by 32 agencies from Government, International NGOs, local NGOs and the UN system; • Findings guided training direction, target groups and methodologies; • Transparency in Assessment: great advocacy and networking.

4 Tailor-made modules

• 3 modldules were deve lope d and field tested in consultations with TB desk- WHO, NTP and NAP etc. • Existing modules, guidelines, protocols and relevant resources on TB, drug use and HIV were (re)searched and adapted; • Module 1: Tuberculosis (TB) • MdlModule 2Tb2: Tubercu los i(TB)/Dis (TB)/Drug use • Module 3: Tuberculosis (TB)/HIV co-infection

5 Training workshops • In total 11 training workshops were held in Northern Shan & Kachin States and Yangon Division; • Two ToT in Lashio and Yangon were done in collaboration with the NTP and State Health Division, Northern Shan State • Sites covered under training workshops: – Northern Shan State: Lashio, Kone Nyaung, Muse, Theinni, Laukkai and Tanyan; Kachin State: Myitkyina, Pharkant, Hopin, Moegaung, & Bamo; Yangon Division (CBI network);

6 Beneficiaries

• Tot a l 188 par tic ipan ts from drug treatment/services and 44 from HIV specific facilities; • Total 78 participants from GO including DOTS providers, supervisors and community health educators working in DOTS services; • GOs: NAP, NTP, DTCs, STI Teams and CCDAC; • INGOs: AHRN, AZG-MSF (H), CARE, MdM, AMDA, ADRA, World Vision, World Concern, Malteser, Burnet, PSI, Save the Children and AMI; • UN agencies: UNODC (Drug treatment services) and WFP; • LNGOs: CBI, MANA, Metta, BDA, MCC, MBCA, CMRFT, Oasis, S wift , YET , CSI , VSWA and PMG ; 7 Feedback on modules

• 266 participants fdffffrom different professiona l background (medicos and non-medicos) attended the training workshops; • Following table summarizes the feedback received duringggp 11 training workshops

Table 1: Evaluation Sheet Summary Module Useful Very Useful Others Tuberculosis (TB) 33% 52% 13% Tuberculosis (TB)/Drug Use 42% 45% 12% Tuberculosis (TB)/HIV co- 37% 52% 10% infection (Source: AHRN Training Record 2008) 8 IEC and HE sessions

• 3IEC(100003 IEC (10,000 each) were developed and field tested using FGDs with drop- in-centres attendees; • HE tips were deve lope d/fie ld tested to include TB and TB/HIV co-infection in regular HEs;

9 KAP and Referral Protocol

• 398 drug users interviewed in 2 sites in Lashio and Laukkai (Northern Shan State): TB and TB/HIV co- ifinfec tion know ldledge highly improved; • Referral protocol between drug services, HIV services and TB services developed for discussion;

10 Project impact

• IdTB&kldImproved TB awareness & knowledge among Drug Users communities; • Approach that integrates TB related interventions in existing programs for drug users and stimulates referral with DOTS Team for detection and treatment through networking; • Imppgroved TB/Drug Use & TB/HIV co-infection knowledge and skills among public health staffs of Drug Users and DOTS services; • Some of the challenges on TB & TB/HIV co- infection treatment and care for the target groups of Drug Users has been addressed.

11 Lessons learnt

• FtlikhFront line workers have liftiless information on these three key topics; • Internal trainings in many agencies do not happen regularly; • Specific IEC materials are limited (especially for specific targe t groups ); • TB/HIV, drug resistance and MDRTB are believed to be increasing; • Inter-sectoral cooperation is needed at all levels of field operation; • There is a need to establish outlets for addressing myths and misconceptions at field level;

12 AHRN model: TB-Drug use-TB-HIV

13 Follow up: Year 2

Tbl2LTable 2: Last 5 mont hs data Project sites Referrals ATT HIV Remarks Lashio 67 7 4 2 Northern Shan to NTP for (6 AHRN+1 VCCT (HIV Positive) State screening NTP) Laukkai 60 14 9 2 Northern Shan to NTP for (10 AHRN+4 VCCT (HIV Positive) State screening NTP/AZG) Also follow- up in prison Pharkant 97 28 24 16 Kachin State to AZG for (12 AHRN+ VCCT (HIV positive) screening 12 AZG) (AHRN + (AHRN + AZG AZG) (Source: AHRN DICs Record 2008-2009)

14 Collaboration

• Screening and diagnosis services are provided by NTP or AZG (where no NTP); • ATT medici ne ( Cat I, II, III) are prov ide d by NTP/donors; • HIV rel at ed servi ces are li nk ed with STI s – Team; • TtTreatmen tdht adherence an dflld follow up ikis key responsibility of AHRN Team (i.e. DOTS supervisors/treatment facilitators) • Nutritional support through WFP Food Assistance Program;

15 Acknowledgement

• These pro jec t ac tiv ities are jus t the beg inn ing o f an endless work which certainly we cannot do alone. • Year 2 AHRN 6 DIC/ORP are eqqppuipped to address TB, TB-Drug Use and TB-HIV Co-infection.

Sincere thanks to WHO-WHO-SEAROSEARO and WHO HIV Team in Myanmar who extended their support to AHRN to make it possible!