 Good afternoon everyone. My name is Wenlei. I'm from the MSF OCG and today I'm going to present about the fisherman study that we have done in the Nindari project. It's a pleasure for me to be able to present on behalf of the authors as mentioned on the slide. So as I did the fisherman study I would like to briefly mention about the fishermen. So as all of you are aware, fishermen is regarded as a high-risk population because of their highly mobile and professional and they are close session that work in their community and assess to cash and income and also as they walking away from their family the frequency of using commercial assess is high and that the HIV the HIV status of fishermen hasn't monitored yet closely monitor yet by the Ministry of Health and Sport and also by the INGO. In our the web project we found that 25% of our HIV co-operation are fishermen because because the Nindari is one of the most productive fishing region in Myanmar in 2010 650,000 tons of fish produced from the Nindari region. So this is just showing our coastal region our coastal line of Myanmar which is about more than 3,000 kilometer. So MSF in Myanmar MSF OCG has studied in 2000, yeah year 2000 but in 2000 studying from 2003 we have implemented the HIV project in the Nindari region. So Myanmar is HIV epidemic is the concentrated, concentrated epidemic among the high-risk group men who have sex with men, sex worker and the injection drug user. So at the time of 2015 nearly 88% of our ART in the Nindari region are provided by the MSF clinic but right now we are sharing half by half with the Ministry of Health because we are in the transition period. Operational research was integrated in 2013 in our OCG project so we did a cross-section a retrospective analysis of routinely collated FUSHA data and this study met the exemption from the MSF ethical review because it is a retrospective analysis. So we have identified in our Go-Hong May HIV positive fisherman 1,172 a debt compared to a debt made Go-Hong 1,626 patients as a comparison group. And descriptive analysis were done to compare the clinical character-arrested and the demographic character-arrested between fishermen and the May Adel Go-Hong and also the generalized linear model was assessed to identify the odds of the rigs behavior. In addition the fisherman was disaggregated into three subgroups the local subsistence fishermen, Myanmar fishermen and the international fishermen. So local subsistence fishermen are fishermen who own their own boat and they spend some time in the sea but not longer than other two groups. Myanmar fishermen are the boat owned by the Myanmar citizen but they spend longer time than the local fishermen. International fishermen are owned by the boat are owned by the foreigner and they spend much more time in the sea compared to other two subgroups and they are walking in in the international water. So this is the patient character-arrested comparison of between fishermen and the non-fishermen. So from this slide you can see the baseline CD4-MN2 groups main times on the ART is not too much different. Lost refollower rate is not much different statistically not different but fishermen have a higher rigs of using the high rigs behavior like using a commercial sex and also the injured in drug user compared to the non-fishermen group. And we also compare the second line ARV proportion among the non-fishermen and the other sub-3 groups of the fishermen. So as you can see here the proportion of second line ARV is not different between non-fishermen and the fishermen. HEPSEA... sorry. So not all patients of our fishermen and non-fishermen haven't test with the hepatitis C but a non-screen patient we compare the proportion between the non-fishermen and the other subgroups of the fishermen. We can see that is a high proportion of HEPSEA co-infection in the fishermen group compared to the non-fishermen group especially in the international fishermen. This is an odd ratio of having sex with men who have sex with men, commercial sex use and also injured in drug user among the fishermen compared to the non-fishermen group. So international fishermen have high use of commercial sex and injured in drug practice compared to the non-fishermen group. So in summary we found that there is a high use, high odd of commercial sex and injured in drug among the fishermen population and we found that fishermen are good patients. They are successful patient in terms of their mobile nature. Their mean duration on the ART treatment is also good and lots to follow it is also low in the fishermen group. So we found that the fishermen has successful treatment compared to the non-fishermen and there is a higher risk of using commercial sex and also drug use. So counseling service is highly needed for the disfishermen group and also we found that the infusion is also high in the fishermen. So we'll be interested to advocate to the Ministry of Health or the other organization for the hemorrhagic program and as Ministry of Health is now start rolling the hepatitis C treatment program nationwide so it will be interested for them to see the result that fishermen will be a high risk group to systematically screen for the hepatitis C. So we have some limitation in the analysis because this data use the retaining collected data and the fishermen's data was at the time of the end rule in our go home so that might change over time and the type of the desegregation between the fishermen was maybe slightly different depending on the interviewer at the time of admission and risk information is self-reported so maybe and are estimated. I would like to thank all the I would like to relay the thanks message to the MSF staff on behalf of the order. Thank you. Thank you very much for your nice presentation. Now I'd like to open for questions and clarifications please. So I would like to ask a question maybe when people are thinking more. Did you also assess their knowledge about the risks factors for acquiring Hep C and any other diseases? Do they have any what is the knowledge of these populations? Is there anybody has done such type of an assessments on these people because? Not yet. This is just the rooting color data analysis but we are thinking to do in the future to find out. It would be interesting to know that even if knowingly if they still are not changing their behavior so then there needs to be other interventions that yes yes please. Hi I'm just curious to know like did you only study fishermen or this includes includes like fisher women also and was there a difference in like them having HIV and co-infection? Sorry can you repeat a question? So I'm just asking that the group that you studied fishermen did that also include women or these are just men you're talking about? It's only men or even females are in. No men because in our group because we are studying the fishermen in our HIV cohort so not all the fishermen population in the way so in our HIV cohort most of the fishermen are male. Any questions? I would like to also you know understand you said that the government is planning to start treatments for hepatitis C. I guess it's with the new directly you know this DA is right. So what is the availability and cost of these treatments in Myanmar? Do you have any idea? So Ministry of Health was that the treatment already started studying from May the target is 2000 so and so right now they are fine vending for the father increase men in the target right now for the 2000 treatment they are using the donation from the BMS. Okay they're getting a donation from the BMS. Yes please. The last question is then you move on. I'm Dr. Santosh from the Bersara Board. Yeah it's like can you actually provide that how much is how much the prevalence is from sexual sexual intercourse and how much is from intravenous drug use and if it's possible if it's like more of the patients have acquired this evidence see and also this HIV from sexual route is possible that we need to intervene on the prevention like quantum use of condoms and so on. Have we actually thought about that? Myanmar so most of the you were talking about the hepatitis C prevalence right? Yes. So in Myanmar the hep C prevalence is the highest among the injection drug user in our study we found that the international fishermen has a high prevalence of the hep C infection and they are also high risk to use the drug injecting drug and then so we found we control this injecting drug user in order to find out the risk to hep C infection as well so still the risk of getting hepatitis C is higher even after control the injection drug user so that might be interesting to find out other risks that are in addition to the injection drug user might be you are mentioning about this promoting the sexual protection would be interesting. Okay right so it's the the question and the comments have been on has there been any advocacy for using condoms to these group of people you know that would in itself prevent many of these sexually transmitted? Yes we have this kind of activity in our project because as we found that the fishermen 25% of our goal we have community testing activity targeting to the fishermen village and giving a health education as well. Thank you very much.