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ART program in Myanmar has been started since
2005 and there has been monitoring of patients by means of longitudinal
analysis (Cohort) in few ART sites and cross sectional analysis (Monthly
Report) in all ART sites. In order to have systematic, standardized and
qualitative indicators of program activities, Cohort Analysis Training was
conducted for National AIDS program (NAP) in June 2009 with the technical
support of WHO SEARO and WHO MMR.
Cohort analysis of patients on ART allow comparison of
treatment status/ outcome over time and between groups of patients who have
had equal duration of ART either from the same ART centre or between
different ART centers. The cohort analysis compares the baseline clinical
status of a group of ART patients who started treatment in the same month and
year (cohort) with their status at 6, 12 and 24 months. Thirty-eight
participants from 22 ART centers across Myanmar attended the 3 day
training. The participants included medical officers, specialists and
State/Division AIDS/STD officers, AIDS/STD team leaders involved in patient
care in hospitals.
Goals of Antiretrovial Therapy provided by
National AIDS Programme are reducing admitted
patient load with the targets of: 95% adherence to treatment, less than 20%
Lost to Follow Up after 1 year and at least 70 % alive and on treatment after
1 yr. The expected outcomes of ART programme are
extend life of PLHAs, improve the quality of life
of People Living with HIV/AIDS (PLHAs), reduce
opportunistic infections and minimize drug resistance.
During the training, participants discussed the indicators
used for ART provided by NAP and also the internationally used indicators,
including the early warning indicators for drug resistance. In addition, participants discussed the
difference between the monthly report and the cohort report. It was
highlighted that the monthly report does not provide qualitative information
about treatment outcomes. After demonstration of completing a simple cohort format (6 month outcome of
10 patients), participants conducted exercises and finally, extracted the
cohort data for 2007 and 2008 from their own ART enrollment registers.
National cohort outcomes for 2007 and 2008 were compiled from 6 respective
townships and the results of 6 month ART cohort analysis and 1 yr ART cohort
analysis of each year were presented.
ART of National AIDS Programme
cohort Analysis
 Total Cohort: 9 different
Centers, 763 patients
2007 Cohort:
 6 Centers (Waibagi,
Mandalay, Magwe, Taungyi, Mawlamyiang, Myitkyina)
460 patients at 6 and 12 months
279 patients at 24 months
2008 Cohort:
5 Centers (Waibagi,
Taungyi, Hpaan, Kyaing Tong, Pathein)
303 patients at 6 months
93 patients at 12 months
With regards to the training, standard pre and post
training assessment and training evaluation were conducted. Overall 50% of
participants felt that the training was ‘useful’ and another 50% felt that
the training was ‘very useful’. No participants felt that the training was
‘not useful’.
The session wise analysis of the training is provided in
the Fig 2.
The participants appreciated the following about the
training: exercises and practical training, the use of actual data/registers,
the attitude of the trainer, the place/facilities, the support, teaching
aids, discussions and the team work clinicians and the STD team.
The pre and post training assessment reveals a 100%
increase of participant’s knowledge and understanding (increase from 25% to
50%).
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Fig 1. 2008 Cohort
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Fig 2. ART
Cohort Training Assessment
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