1. MSF Experience on Use of HIV Viral Load testing in Myanmar

2.  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

3. 3  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.

4. 4 MSF installed one Cavidi VL system in Yangon – Mid 2009

5.  Manual Extraction of RT enzyme and amplification  Takes 2 days for one lab tech  Leave overnight for final reading 5

6.  Final Reading on the next morning  Takes 5 Minutes only  Results obtained through a computer software  29 samples per each run 6

7. 7 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

8.  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 8

9.  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  1 st priority – Clinically and immunologically suspected treatment failure  Yearly monitoring for patients on 2 nd line (a rising VL could be targeted with intense adherence counseling) 9

10. 10 2.5Hr Boat 6Hr Car 2.5 Hr Air

11.  A simple analysis of VL vs CD4 of 3801 patients with suspected immunological failure receiving 1 st 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 11

12.  VL should be the first routine adherence monitoring tool  Support promoting retention on 1 st line ART  Critical role in preventing unnecessary switch to 2nd line regimen 12