- Treatment with antiretroviral drugs (ART), can control the virus and help patients to enjoy healthy and productive lives. ART also helps to prevent the spread of HIV.
- Despite the increasing of coverage of ARTs in Viet Nam, half of the people at need of their saving life medicines stills do not have access to them.
- Besides ART, the use of condoms in all sexual relations and the use of clean needles for the injection of drugs are still the more effective way to prevent the spread of HIV.
- Viet Nam has a concentrated HIV epidemic in most affected populations such as people who inject drugs, commercial sex workers and men who have sex with men.
- Viet Nam is piloting treatment 2.0 since 2011, a national efficient, cost-effective and sustainable way of halting the HIV epidemic.
- The HIV epidemic in Vietnam is concentrated in most at-risk populations (people who inject drugs, sex workers and men who have sex with men. The spread of HIV to females is mainly to sexual partners of these populations.
- An HIV sentinel surveillance system began in 1994, with 10 provinces reporting HIV prevalence among six sentinel populations.
- In 1996, the system expanded to 20 provinces, in 2001 to 30 provinces and in 2003 to 40 provinces. In 2009, Ha Tay province merged with Ha Noi, leaving 39 provinces with sentinel sites.
- Surveyed populations included men who inject drugs, female sex workers, patients of sexually transmitted infection (STI) and tuberculosis (TB) clinics, pregnant women attending antenatal care clinics and military recruits. Other populations are added at the discretion of local authorities.
- In 2011, men who have sex with men were formally added as a sentinel population.
- The distribution of free needles and syringes was sustained at around 30 million in 2011 , (sufficient to provide around 80 000 IDUs with one per day).
- In 2011 more than 28.7 million free condoms were distributed across 57 provinces and cities.
- These results were achieved predominantly through the activities of more than 3,500 peer outreach workers employed by district and provincial health authorities working with private sector entertainment establishments, hotels and guest houses.
- WHO continues to collaborate with VAAC and International partners in the provision of key support to the expansion of the National Programme on OST with Methadone. From the pilot six clinics in 2008 there were 45 clinics by the end of Aug 2012.
- WHO together with the ONE UN Viet Nam is also contributing to paviment the environmental helping in changing the Law on Administrative Detention and advocating for the closure of the “forced drug treatment” or 06 centers.
Care and treatment
- In 2011, an estimated 248,500 people in Viet Nam were living with HIV, among whom some 112,800 were in need of ART.
- Viet Nam has achieved a rapid scale-up of ART. At the end of 2011, 57,663 adults and 3,261 children were receiving ART, a 22-fold increase over 2005. The coverage of ART reached 53% in adults and 83% in children in 2011
- The average retention rate on ART at 12 months has been 80% among both adults and children since 2007, indicating that ART is having a positive health impact.
- Despite these achievements, considerable challenges remain. Nearly half of all people in need of treatment do not have access to it. People are also starting ART late. 52.7% of them with a CD4 count < 100 cells/mm3 at ART initiation is a probable factor in high mortality, morbidity and cost, and possibly contributing to HIV transmission in the community.
- Earlier diagnosis and a better continuum of care from diagnosis, linkage to and retention in care are needed.
- Also, a better responses is needed to address the high burden of co-morbidities. Tuberculosis remains the main cause of mortality and morbidity in people living with HIV/AIDS (PLHIV). However, only an estimated 30.1% of HIV positive incident TB cases received both ART and TB treatment in 2011.
- The prevalence of viral hepatitis is high, especially that of hepatitis C virus infection in HIV-infected people who inject drugs.
- Earlier HIV diagnosis during pregnancy, and an expansion of efficacious ARV intervention is needed in order to minimize new HIV infection in infants.
- WHO Viet Nam works in close collaboration with the Viet Namese government to support the conduct of high-quality surveys, help prioritize surveillance activities in a crowded survey environment, and assure that data are well-analyzed and disseminated for programmatic action.
- WHO promoted the development of brief behavioural surveys with the sentinel surveillance system. WHO continues to support this activity technically.
- The project grew from two pilot sites to seven to 12 to 36 participating provinces in four years.
- The programme was adopted by the Government and, beginning in 2013, will be wholly funded by the Government.
- The data are analyzed by the provinces, creating a sense of ownership, and then are synthesized and analyzed further by national surveillance staff in close collaboration with WHO.
- The Government has responded to the HIV/AIDS epidemic. The Law on HIV/AIDS Prevention and Control in 2006, an associated Decree in 2007 and the National HIV Strategy in 2012 all call for harm reduction interventions such as needle syringe programmes, condom use programmes and opioid substitution therapy for key affected populations.
- Under this legal structure, the Ministry of Health is the designated lead government agency for executing and coordinating the HIV prevention, diagnosis and treatment response, including harm-reduction activities.
- WHO has been a principal provider of technical assistance for HIV prevention harm reduction interventions.
- In 2004, the first large donor-funded HIV prevention project (Preventing HIV in Viet Nam Project) started in 19 provinces and 2 cities. This project’s successes were achieved with financial support from the UK Department for International Development (DFID) and the Norwegian Agency for Development Cooperation (NORAD), with technical and initial adminstrative support from WHO.
- WHO also support from 2012 onwards the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) prevention component.
Care and treatment
As part of One UN Viet Nam, WHO provides technical assistance to the Ministry of Health, relevant institutes and other partners in their efforts to achieve universal access to HIV prevention, treatment, care and support.
- WHO promotes strategic use of antiretrovirals (ARVs) to maximize their survival and preventive benefits.
- WHO advocates for closer collaboration among HIV prevention, diagnosis and treatment services and better continuum of care to achieve earlier ART initiation and better outcomes.
- WHO supports development of national strategy, policy, plans and normative guidelines on: antiretroviral therapy (ART); HIV/TB; prevention of mother to child transmission of HIV (PMTCT); HIV testing and counseling and HIV care and support.
- WHO also facilitates monitoring of HIV drug resistance.
- WHO works in the development of point-of-care testing algorithm and strengthening laboratories to support HIV services.
- WHO is also working with the Ministry of Health and partners to enable diagnosis and treatment for chronic viral hepatitis.
- Treatment 2.0 is a global initiative proposed by WHO and UNAIDS to catalyze the next phase of HIV treatment scale-up through rapid simplification.
- It consists of five priority areas: 1) Optimize drug regimens, 2) Provide point-of-care (POC) and simplified diagnostic and monitoring tools, 3) Reduce costs, 4) Adapt service delivery, and 5) Mobilize communities.
- In 2011, the Government of Viet Nam decided to pilot Treatment 2.0 in two provinces, i.e. Dien Bien and Can Tho.
- WHO and UNAIDS in collaboration with other partners are supporting the planning, training and implementation of the pilot.
HIV treatment as prevention (TasP)
- There is growing amount of evidence that supports that ART given to PLHIV prevents HIV transmission and development of active tuberculosis (TB).
- ARV has been used in the past decades to prevent mother-to-child transmission.
- In collaboration with partners, WHO supports Ministry of Health to operationalize TasP in serodiscordant couples, and to identify cost-effective strategy and targets to apply TasP in Viet Nam’s epidemic through a mathematical modelling study.