PhD defence Ni Ni Tun

Supervisors

• Prof. dr. Tom Decroo (ITM)

• Prof. dr. Josefien van Olmen (University of Antwerp)

• Prof. dr. em. Lut baroness Lynen (former ITM)

• Prof. dr. Christopher P. Conlon (University of Oxford) 

Abstract

People who are most at risk of HIV—such as men who have sex with men (MSM), transgender women, sex workers, and people who inject drugs (PWID)—still face many challenges in getting HIV prevention, testing, and treatment. These groups often experience stigma, discrimination, and limited access to healthcare. In Myanmar, there is still little research on the best ways to improve HIV services for these communities.

This thesis examines several HIV and hepatitis C (HCV) programs run by Medical Action Myanmar between 2009 and 2024. The research includes studies on the first HIV pre-exposure prophylaxis (PrEP) program for MSM and transgender women, the use of near point-of-care viral load testing in poor urban communities, and HIV and HCV treatment for people who inject drugs in remote areas of northern Myanmar.

The findings show that HIV prevention services should be designed around the needs and preferences of individuals. For example, offering alternatives to taking a daily PrEP pill may encourage more people to use and continue PrEP. The research also suggests that promoting PrEP as a way to improve sexual confidence and wellbeing may be more appealing than focusing only on the risk of HIV infection.

The studies also found that providing viral load testing through laboratories located close to, but outside, HIV treatment clinics can help maintain testing services during times of political instability, conflict, or funding shortages.

For people who inject drugs, community-based services that combine HIV care, hepatitis C treatment, and harm reduction were shown to improve access to healthcare in remote areas. The research also demonstrated that hepatitis C treatment can be successfully provided by trained primary care teams with support from specialist doctors through telemedicine, together with peer educators, volunteers, and community health workers.

Although these findings come from a privately funded program and may not apply to all settings, they provide valuable real-world evidence from a resource-limited country. Because the studies were observational rather than randomized clinical trials, they cannot prove that the interventions directly caused the observed outcomes.

Overall, this thesis shows that HIV programs in Myanmar can better serve key affected populations by providing person-centred, community-based care that includes HIV prevention and treatment, hepatitis C services, and harm reduction. These approaches have the potential to improve access to care and health outcomes for some of the communities most affected by HIV.