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Scaling-up ARV therapy in Vietnam

HAIVNHAIVNHarvard Medical School AIDS

Initiative in Vietnam

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Learning Objectives

At the end of this lecture, each trainee should understand: - the Care and Treatment situation in Vietnam: management and technical aspects

- Current ARV therapy in Vietnam and role of international agencies in the treatment program.

- The challenges of the ART program in Vietnam

- The future plan for the ARV program in Vietnam

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Contents

1. Review the HIV/AIDS situation in Vietnam

2. Introduce the current care and treatment situation

3. Update on the ARV therapy program

4. List the challenges of ART program

5. Draft coordination plans in the next few years

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HIV/AIDS situation in Vietnam

HIV cases reported nationwide*: - HIV infections: 185,623

- AIDS cases: 44,701 - Deaths due to AIDS: 49,912Infections have been detected in**: - 96% of districts - 66% of wards/communes

0

20000

40000

60000

80000

100000

120000

140000

160000

93 94 95 96 97 98 992000

2001

2002

2003

.2004.

2005

2006

2007

2008

AIDS patient Death HIV infection

*Data up to 03/2011- MOH source.**The third country report on following up the implementation to the Declaration of commitment on HIV/AIDS, Socialist Republic of Vietnam, 2008

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Estimates of HIV/AIDS epidemic in Estimates of HIV/AIDS epidemic in Vietnam between 2004 - 2012Vietnam between 2004 - 2012

20042004 20062006 20082008 20102010 20122012

HIVHIV 179,244179,244 208,403208,403 231,422231,422 254,387254,387 280,113280,113

AIDS AIDS DeathsDeaths 5,2365,236 7,2587,258 7,7947,794 7,6537,653 8,2398,239

Need Need ARVARV 24,10224,102 39,10239,102 56.87056.870 77,82677,826 100,547100,547

Viet Nam HIV/AIDS Estimates and Projections 2007-2012, VAAC, 2009

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Characteristics of HIV epidemic in Vietnam• The epidemic is spreading and is still concentrated in the

high risk groups. Blood transmitted HIV cases account for (45%) but sexually transmitted HIV cases also are increasing (43%).

• Most PLWHA are men (73.5%) and young, between 20-39 years old.

• The epidemic is spreading out to the community: Transmission by sex, both heterosexual and homosexual, is increasing.

• There is a growing need for HIV/AIDS care and treatment due to the increase of number of patients with HIV/AIDS.

• To date, the drug supply doesn’t meet the needs of ARV treatment.

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Number of persons on ARV in low and middle income Number of persons on ARV in low and middle income countries, December 2008countries, December 2008

(estimated need in 2008: 9,500,000)(estimated need in 2008: 9,500,000)

WHO, Towards Universal Access Progress report, 2009

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Care and Treatment Objectives by 2010

1. 70% of AIDS patients are on ARV treatment2. 100% HIV/AIDS infected & affected children receive

care, treatment and management3. At least 50% of provincial AIDS clinics are

equipped with diagnostic & treatment facilities4. 70% of Districts establish outpatient clinics (OPC)

and comprehensive care, treatment and support systems for HIV/AIDS patients

5. 100% of technical staff receive adequate training

(Source: National strategy on HIV/AIDS control till 2010 and a vision 2020– MoH,2005)

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HIV/AIDS Care & Treatment in Vietnam

• VAAC was established in August 2005• Health system provides care and treatment services:

– Central level: 3 Centers– Provincial level: care & treatment of in-patient & out-

patient– District level: QCT Program (Management, Care and

Counseling)• ARV treatment support from International Organizations

(GFATM, PEPFAR, WB, ESTHER,...)

Source: MOH-Bases for Building up the Action Plan 3

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ARV Programs in Vietnam • Vietnam MOH:

- delivers ARV to all 63 provinces, • PEPFAR (President Emergency Plan for AIDS Relief):

- delivers a Comprehensive model of Treatment and Care for PLHA including ART and referral network in 18 provinces (Ha Noi, Hai Phong, Quang Ninh, Cao Bang, Bac Ninh, Son La, Hoa Binh, Thai Binh, Nam Dinh, Nghe An, Da Nang, Ho Chi Minh, Can Tho, An Giang, Vinh Long, Long An, BR-VT, Soc Trang).

• Global Fund:- supplies OI drugs and supports ART program in 20 provinces.

• Bill Clinton Foundation:- supplies ARV for HIV infected children.

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PEPFAR support: 7 Focus Provinces and 11 additional ARV provinces

Hai Phong

Quang Ninh

Ha Noi

Can Tho

An Giang

TP Ho Chi Minh

Nghe An

Ba Ria-Vung Tau

Soc Trang

Cao Bang

Nam Dinh

Son La

Hoa Binh

Thai Binh

Bac Ninh

Da Nang

Long An

Vinh Long

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Global Fund Supported 20 provinces/cities Qu¶ng Ninh

Hải Phòng

TP HCMAn Giang

Hà Nội

Lạng Sơn

Cao Bằng

Khánh Hòa

Thanh HóaNam Định

Th¸i Nguyªn

Phú Thọ

Đắc Lắc

Tây Ninh

Kiên Giang

Cà Mau Sóc TrăngCần Thơ

Nghệ An

Hải Dương

100 districts/578 communes

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Number of patients receiving ARV

28,00024,500

7242

3400500100/year50/year

0

5000

10000

15000

20000

25000

30000

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ART program in Vietnam(as of 2/2009)

Project Number of ART sites Number of patients(approximations)

MOH National program

94 sites/63 prov. 2,500

GF on AIDS 64 sites/20 prov. 5,200

PEPFAR 39 sites/7 prov. 19,000

Clinton Foundation and National Program for children

8 sites/6 pro. 1,300

Total 28,000

(Source: Vietnam Administration of HIV/AIDS Control – MoH)

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• Current ART regimens: (at PEPFAR sites)- 97% patients on the 1st line regimens- 3% patients on the 2nd line regimens

• Treatment target reported by MOH: – 70% of adults needing treatment on ARV by 2010

~ 49,000 adults (70% X 70,000)– 100% of children needing treatment on ARV by 2010

~ 2,200 Children

ART program in Vietnam

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Successes of ARV Treatment program in Vietnam

• Rapid scale –up of ARV treatment from 2005 to 2010

• ARV now available in every province in Vietnam.

• Expansion of treatment for children and availability of pediatric drug formulations.

• Expansion of new OPC’s in districts in many provinces

• Second-line ARV available in many provinces through the PEPFAR program.

• Expansion of capacity for CD4 testing in many provinces.

• Coordination between national programs and international donors by VAAC.

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• ARV are still not yet universally available for all patients who need it in Vietnam.

• The major limitation in providing ARV is the infrastructure to deliver care and treatment to patients: the number of clinics and trained medical staff.

• Many staff in OPC to not yet have adequate training.• OPC staffing is not stable: many staff turn over, work

part-time, have responsibilities in other clinical sites, and leave to work in other departments.

• The referral system and coordination between services at the local and provincial level needs to be improved

Challenges in the scale-up of ARV Treatment in Vietnam

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• Most HIV patients in Vietnam are also IDU and have many social, economic, and legal problems as a result of drug use.

• Adherence is difficult for patients who take ARV for long periods of time, especially for IDU.

• Lab capacity for OI diagnosis remains very limited in the hospitals.

• No Third-line or salvage ARV available in Vietnam yet

• PLWHIV support groups have few resources and limited capacity in most provinces.

Challenges in the scale-up of ARV Treatment in Vietnam

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Thank you

Questions?