PuatO, Northern Myanmar, people who inject heroin have high rates of HIV and hepatitis C (HCV). Specialist care for HIV and HCV is limited. Bad roads and no public transport. Heroin is cheap and easily accessible. Covid-19 and Coup d’état worsen access to health care.
Medical Action Myanmar (MAM), a non-government organization, started a harm reduction program in PutaO in 2017. Specialized HCV treatment was integrated in 2020. An innovative HIV-HCV harm reduction model includes a MAM’s HIV-HCV clinic networked with community health workers (CHWs) and peer educators (PEs). MAM doctors were trained and weekly mentored by a hepatologist from Hepatitis B Free foundation (Australia-based NGO) via zoom. HCV was diagnosed by antibody and GeneXpert. Assessment included physical examination, liver and renal function tests, and fibrosis (APRI) score calculated. Patients were counselled and with consent were treated with sofosbuvir/daclatasvir (12 weeks’ duration for those with APRI <1.5 and 24 weeks for >1.5) or sofosbuvir/velpatasvir (12 weeks’ duration). Patients with a undetected viral load at 12 weeks after completion treatment were defined as cured. CHWs and PEs provided community-based harm reduction services, including home visits, HIV/HCV/methadone counselling, sterile needle supply and referral for HIV/HCV testing and treatment.
300 HIV/HCV co-infected patients with a median age of 30 years (IQR: 25-37) were enrolled on HCV treatment. Ninety-nine % (297) were male and active or ex-intravenous drug users, and 1% (3) were female partners who did not inject drugs. By September 2022, 89.6% (269/300) completed treatment, 7.3% (22) interrupted treatment, 1.7% (5) died, 0.7% (2) stopped for other reasons and 0.7% (2) were transferred out. Among those who completed the treatment and had 12-weeks follow-up, 83% (211/255) were cured. This model was successful and could be scaled up in similar settings to increase access.