Transcript Session 2 - Teaching Slides

Scaling-up ARV
therapy in Vietnam
HAIVN
Harvard Medical School AIDS
Initiative in Vietnam
1
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
2
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
3
HIV/AIDS situation in
Vietnam
HIV cases reported nationwide*:
- HIV infections:
185,623
- AIDS cases:
44,701
- Deaths due to AIDS: 49,912
Infections have been detected in**:
160000
140000
120000
100000
80000
60000
- 96% of districts
40000
- 66% of wards/communes
20000
99
20
00
20
01
20
02
20
0
.2 3
00
4.
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05
20
06
20
07
20
08
98
97
96
95
94
93
0
AIDS pa tient
Dea th
*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
HIV infection
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Estimates of HIV/AIDS epidemic in
Vietnam between 2004 - 2012
HIV
AIDS
Deaths
Need
ARV
2004
2006
2008
2010
179,244
208,403
231,422
254,387
280,113
5,236
7,258
7,794
7,653
8,239
24,102
39,102
56.870
77,826
100,547
Viet Nam HIV/AIDS Estimates and Projections 2007-2012, VAAC, 2009
2012
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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 2039 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.
6
Number of persons on ARV in low and middle income
countries, December 2008
(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 treatment
2.
100% HIV/AIDS infected & affected children receive
care, treatment and management
3.
At least 50% of provincial AIDS clinics are
equipped with diagnostic & treatment facilities
4.
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 & outpatient
– 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
9
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:
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- supplies ARV for HIV infected children.
PEPFAR support: 7 Focus Provinces and
11 additional ARV provinces
Son La
Cao Bang
Hoa Binh
Bac Ninh
Quang Ninh
Thai Binh
Ha Noi
Nghe An
Hai Phong
Nam Dinh
Da Nang
TP Ho Chi Minh
Ba Ria-Vung Tau
An Giang
Long An
Can Tho
Vinh Long
Soc Trang
11
Global Fund Supported 20 provinces/cities
Qu¶ng Ninh
Cao Bằng
Hải Dương
Lạng Sơn
Hải Phòng
Th¸i Nguyªn
Hà Nội
Phú Thọ
Nam Định
Nghệ An
Thanh Hóa
Khánh Hòa
Đắc Lắc
100 districts/
578 communes
Tây Ninh
An Giang
Kiên Giang
Cà Mau
TP HCM
Cần Thơ
Sóc Trăng
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Number of patients
receiving ARV
28,000
30000
24,500
25000
20000
15000
7242
10000
3400
5000
50/year100/year
500
Fe
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20
08
20
06
20
05
20
04
19
93
-2
00
0
20
01
-2
00
3
0
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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 8 sites/6 pro.
and National
Program for children
1,300
Total
28,000
(Source: Vietnam Administration of HIV/AIDS Control – MoH)
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ART program in Vietnam
• 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
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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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Challenges in the scale-up of ARV
Treatment in Vietnam
• 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
18 to
be improved
Challenges in the scale-up of ARV
Treatment in Vietnam
• 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.
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Thank you
Questions?
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