Viet Nam WHO Western Pacific Regional Office Health Sector Response to HIV P.O
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For more information, please contact: Joint Review of the HIV/AIDS and STI Viet Nam WHO Western Pacific Regional Office Health Sector Response to HIV P.O. Box 2932 1000 Manila 2014 Philippines Email: [email protected] http://www.wpro.who.int/hiv Joint Review of the Health Sector Response to HIV in V iet Nam 2014 Joint Review of the Health Sector Response to HIV in Viet Nam 2014 WHO Library Cataloguing in Publication Data Joint review of the health sector response to HIV in Viet Nam 2014. 1. HIV infections - prevention and control. 2. National health programs. 3. Vietnam. I. World Health Organization. Regional Office for the Western Pacific. ISBN 978 92 9061 742 6 (NLM Classification: WC 503) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications–whether for sale or for non-commercial distribution–should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines (fax: +632 521 1036, email: [email protected]). 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However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Table of Contents Acknowledgements v Executive summary vi Acronyms and definitions x 1. Introduction 1 1.1 Background 1 1.2 Methods 2 2. Status and trends of the epidemic 3 2.1 Overview of the epidemic and disease burden 3 2.2 People who inject drugs (PWID) 6 2.3 Female sex workers (FSW) 8 2.4 Men who have sex with men (MSM) 9 2.5 Geographical concentration of the HIV epidemic 10 3. Policy, strategy and structure of the health sector response to HIV 12 3.1 Organizational structure for the health sector response to HIV 12 3.2 Laws and regulations supporting HIV-associated policies 13 3.3 The national strategy, plans and target programme on HIV/AIDS 14 4. Review findings and recommendations 15 4.1. High-impact health sector interventions 15 4.1.1 Condom programmes 15 4.1.2 Harm reduction for people who inject drugs 17 4.1.3 Community outreach 22 4.1.4 HIV testing and counselling 24 4.1.5 HIV treatment and care 31 4.1.6 Prevention of mother-to-child transmission (PMTCT) of HIV and congenital syphilis 40 4.1.7 Linking high-impact interventions: towards a functional continuum of prevention, diagnosis and care 44 4.2 Systems to support the health sector response to HIV 47 4.2.1 Strategic information 47 4.2.2 Laboratory 49 4.2.3 Procurement and supply management 50 Joint Review of the Health Sector Response to HIV in Viet Nam 2014 4.3 HIV services and health systems 57 4.3.1 Current situation of the HIV programme in the health system 57 4.3.2 Governance and capacity-building for local authorities 60 4.3.3 Organization of services 60 4.3.4 Human resources for HIV 65 4.3.5 Financing 68 4.3.6 Towards a sustainable supply of ARV medicines 73 4.4 Enabling environment 75 4.4.1 Civil society and key populations: greater openness and participation 75 4.4.2 Considerations for MSM and transgender populations 76 4.4.3 Considerations for female sex workers 78 4.4.4 Addressing gender inequality 79 4.4.5 Towards zero stigma and zero discrimination 80 4.4.6 Administrative violation and detention 81 4.5 Potential impact of the health sector response to HIV 82 4.5.1 Potential impact of the health sector response to HIV on health 82 4.5.2 Potential impact of the health sector response to HIV on society and household economy 85 5. Way forward: towards ending AIDS 87 References 88 Annex 1 External review team, WHO secretariat, local members and steering committee 94 Annex 2 Schedules for review team and field trips 98 Annex 3 Product flow mapping 104 Annex 4 Human resources for HIV/AIDS 105 Annex 5 List of recommendations and action points 107 iv Acknowledgements The members of the joint review team wish to express their gratitude to Professor Nguyen Thanh Long, Vice Minister of Health, for the invitation to assess the national health sector response to HIV in Viet Nam. The review team would like to thank Dr Nguyen Hoang Long, the Director General, and other senior staff and personnel of the Viet Nam Authority of HIV/AIDS Control (VAAC) for their partnership and guidance throughout the review process, and the time and effort they devoted to provide the team with quality information and feedback on the review report. The VAAC staff facilitated all interviews and communication and, in general, ensured smooth implementation of the review activity. The review team wishes to thank warmly other entities within the Ministry of Health, other ministries and institutions for providing it with excellent information, and welcoming its visits to their offices and facilities. The review team members express their gratitude to the members of the Steering Committee who provided direction for the review, as well as to governmental and nongovernmental partners who have been contributing in a major way to the Viet Nam response to HIV. A special note of encouragement goes to the thousands of health workers who are doing a fabulous job across the country, often with insufficient means and little or no personal incentive. Finally, the team acknowledges the resilience, courage, kindness and openness of the members of HIV-affected communities in the country, in particular, people living with HIV and key affected populations, and wishes them more power in their bold confrontation with the HIV epidemic. The first draft of the report was written by Daniel Tarantola, consultant to WHO, with contributions from members of the international and national review team and secretariat under the oversight of the Steering Committee and the VAAC director and staff. The document was finalized with additional contributions from Xu Ke and Annie Chu, Health Care Financing; Gulin Gedik, Human Resource for Health, Division of Health Sector Development of the WHO’s Regional Office for the Western Pacific, and Linh-Vi Le from the HIV, Hepatitis and STI unit, Division of Communicable Diseases, Manila and staff from the Department of HIV/AIDS, WHO, Geneva. The HIV team of the World Health Organization (WHO)’s country office and VAAC ensured accuracy of the data and review findings, and provided essential administrative and logistic support during the review and for preparing this report. The report was finalized by Ying-Ru Lo, WHO Regional Office for the Western Pacific; Masaya Kato, Socorro Escalante, Van Thi Thuy Nguyen, Nguyen Thi Kim Phuong, Benedicte Pascale Galichet and Amitabh Suthar from the WHO Viet Nam country office. The review, development and publication of this report were supported by financial contributions from the Global Fund to Fight AIDS, Tuberculosis and Malaria. v Joint Review of the Health Sector Response to HIV in Viet Nam 2014 Executive summary Overview A joint review of the health sector response to HIV in Viet Nam was conducted from 14 to 26 September 2014 by a team of national and international experts. The purpose of the review was to document progress in the health sector response to HIV in Viet Nam, and to inform optimization of the national programme towards the national strategy targets and the vision of ending AIDS by 2030. The methods included a desk review of primary and secondary data, the published and grey literature, and interviews with key informants and observations during field visits. The estimated HIV prevalence (age 15–49 years) in Viet Nam is 0.36%, with an estimated 256 000 people living with HIV (adults and children) as of 2014. Although the overall prevalence is low, Viet Nam’s epidemic is diverse, and consists of localized epidemics concentrated primarily among people who inject drugs (PWID), men who have sex with men (MSM) and female sex workers (FSW). A substantial proportion of new transmission also occurs between members of key risk populations and their sexual partners. There has been a considerable expansion of prevention, care and treatment interventions since 2005. In 2013, national aggregate data suggested that key populations are generally adopting safe behaviours, with 98% of PWID reporting the use of clean needles at their last injection, 66% of MSM reporting condom use at last anal sex, and 92% of FSW reporting the use of a condom with their most recent client.