On October 20 and 21, 2018, the B. K. Kee Foundation hosted the second Myanmar Liver Symposium in Yangon, Myanmar, in collaboration with the Myanmar Ministry of Health and Sports, the Myanmar Liver Foundation, Stanford University School of Medicine’s Center for Innovation in Global Health and Community Partners International (CPI). Dr. Thet Khaing Win, Permanent Secretary of the Ministry of Health and Sports, Dr. Tin Myo Win, Chairman of the Union Peace Commission and U.S. Ambassador to the Republic of the Union of Myanmar Scot Marciel gave the welcoming remarks.
The Symposium gathered together more than 200 local and international experts and other health professionals to exchange best practices, treatment protocols and known data of chronic hepatitis B (HBV), C (HCV), cirrhosis, end stage liver disease and liver cancer. Chaired by Mindie Nguyen MD, MAS, AGAF, FAASLD, Professor of Medicine (Gastroenterology and Hepatology) at the Stanford Medical Center and Faculty Fellow, Stanford Center for Innovation in Global Health, delegates included leading liver disease specialists from world-renowned medical and research institutions, Myanmar Ministry of Health and Sports policy makers and representatives, Myanmar liver specialists, academicians and researchers, representatives from international and local non-governmental organizations working in health, and general practitioners (GPs) from Myanmar's states and regions.
Liver disease is a significant and neglected health issue in Myanmar. In 2015, the Myanmar Liver Foundation, in cooperation with the Department of Medical Research and the Central Epidemiological Unit of the Department of Public Health, carried out a survey of HBV and HCV infection (leading causes of liver diseases) in Myanmar. Of those surveyed, 10% tested positive for HBV, HCV or both, indicating that as many as 5 million people in Myanmar may be infected. Chronic HBV and HCV are leading causes of cirrhosis and liver cancer. Myanmar has a significant liver cancer incidence (11/100,000), more the double the regional incidence in Southeast Asia (5.1/100,000).
In his opening remarks, Dr. Tom Lee, Board Chair of CPI, emphasized the need to train and empower GPs to conduct routine screening, treatment and care for viral hepatitis in Myanmar. Myanmar currently has a small number of specialist hepatologists based at hospitals in the country’s main urban centers, Yangon and Mandalay. There is an urgent need for countrywide screening and treatment initiatives, and GPs can play a pivotal role in hepatitis control and elimination.
Divided into six sessions over two days, the Symposium first examined the current situation of hepatitis in Myanmar. On Day One, core sessions addressed chronic HBV and HCV respectively, considering epidemiology, diagnosis, evaluation, natural history, treatment initiation and monitoring. These sessions were followed by parallel workshops that discussed screening, testing, evaluation, treatment and monitoring of HBV and HCV.
On Day Two, the Symposium examined special population and advanced liver disease, with presentations and parallel workshops on the management of chronic HBV during pregnancy, the management of co-infections including HBV/HCV and HCV/HIV, and cirrhosis, end-stage liver disease, and hepatocellular carcinoma. In the final session, delegates discussed public health and outreach for viral hepatitis. The session included presentations on Myanmar’s National Hepatitis Control Program and updates on the Myanmar Liver Foundation’s hepatitis projects.
Additionally, researchers attending the Symposium were invited to submit abstracts on viral hepatitis and liver disease as a way to showcase research on this topic in Myanmar, share findings, and foster potential research collaborations. Posters summarizing their abstracts were displayed during the Symposium.
The second Myanmar Liver Symposium provided a forum for stakeholders to explore practical ways forward to better manage and eventually eliminate viral hepatitis in Myanmar. Options discussed during the Symposium included expanding point-of-care screening for hepatitis, simplified treatment guidelines to support increased access to screening and treatment for the general population in Myanmar, and continuing medical education for GPs focused on hepatitis and other liver diseases.
CPI will continue to work with Myanmar’s National Hepatitis Control Program, the Myanmar Liver Foundation, the B. K. Kee Foundation and all stakeholders to help control and eliminate viral hepatitis in Myanmar.
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