WHO recommends oral Pre-Exposure Prophylaxis (PrEP) containing Tenofovir Disoproxil Fuma¬rate (TDF) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches (strong recommendation, high quality evidence). PrEP is encompassed as one of the innovative prevention strategy in coun¬try’s third National Strategic Plan for HIV/AIDS, 2016-2020 (NSP-III) to further strengthening of Myanmar’s commitment to fast track the HIV response and to end the AIDS epidemic as a public health threat by 2030.
As per guidance from the HIV Technical Strategy Group (TSG), “Standard Operation Procedures on provision of Pre-Exposure Prophylaxis (PrEP) for HIV infection in Myanmar” is developed in accordance with the global recommendations which tailored to the Myanmar context in consultation with concerned key stakeholders in the country. Throughout the process of SOP development, a number of consultations with leading HIV clinicians, UN agencies and technical partners, implementing Partners and community Groups have been conducted.
PrEP is the use of antiretroviral (ARV) drugs by people who do not have HIV infection in order to prevent the acquisition of HIV. This SOP recommends daily oral PrEP containing TDF as an additional prevention tool for people at substantial risk of HIV infection as part of the combi-nation HIV prevention approaches with the drug of choice option of using either TDF/3TC or TDF/FTC. It provides information about how PrEP is safe and effective. Myanmar PrEP SOP em¬braces key technical information required for successful PrEP demonstration and implementa¬tion; eligibility criteria for PrEP including ruling out of HIV infection before PrEP initiation and assessing the substantial risks; procedures and services to be provided on initial and follow up visits including laboratory testing; monitoring and management of PrEP side effects and other special situations such as co-infection with Hepatitis B, Creatinine elevation, seroconversion, discontinuation of PrEP; key counselling messages about PrEP safety and effectiveness. The im¬portance of community involvement and how to minimize the potential stigma around PrEP are also discussed. Algorithms and job aids are included to promote the users’ friendliness to the SOP. Therefore, this SOP will serve as a technical reference to provide PrEP services in Myan¬mar as part of the combination prevention and build up additional momentum of National HIV response by reducing new infection.