improving the hiv cascade if services in vietnam
TRANSCRIPT
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Improving the HIV Cascade of Services
in VietnamICAAP BangkokNovember 2013
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Response to HIV epidemic in Vietnam
• Nearly 72,000 on ART
• More than 14,500 on MMT (Target 80,000 by 2015)
• Number of newly reported HIV diagnoses has declined
• New generation of well trained, experienced leaders emerging
• Country leadership on HIV/AIDS is gaining in strength
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Concerning trends in Vietnam (and in other countries)
1. Substantial, local HIV epidemics occurring in underserved areas.
2. Many PLHIV often not seeking testing or not linked to care after testing positive.
3. Number newly initiating ART not growing or declining in many sites.
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Concerning trends in Vietnam
4. Many clients are dying, dropping out of treatment or lost to follow‐up
5. Donor resources declining and service system costs too high to be sustained by the GVN.
6. Epidemic of injection drug use continues with >215,000 estimated PWID.
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Late Entry to ART
“At present, 51% of people start treatment at a CD4 cell count below 100 cells/mm3, underlining the urgency of expanding access to treatment, regardless of its prevention benefit.”
Dr Bui Duc Duong, Deputy Director‐GeneralViet Nam Authority of HIV/AIDS Control
7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, Malaysia (July 2013)
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The Cascade Frameworkin Vietnam
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The Cascade framework is…
• Old, but new• Improvement on older methods for presenting data &illustrating program performance
• Simple, easy to communicate with powerful impact• Easily adaptable to different programs, strategies and populations
• Promotes different interventions targeted to different phases of ‐ or gaps in ‐ the cascade
• Based on a set of available core indicators
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The Cascade is…
• A logic model that links prevention outreach, testing & treatment services across a continuum of care (CoPC)
• Reveals how individuals move, don’t move, through the CoPC or are lost to follow‐up
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The Cascade Framework: Patching a Leaky Pipe
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‐ Extension of life‐ Reduce transmission
The Cascade Framework
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Cascade of HIV diagnosis, care and treatment in Vietnam, December, 2012
138166
53979 47926
63537
28262 24785
0
50000
100000
150000
200000
250000
Diagnosed PLHIV In care at OPC On ART
Person
Female Male
39%
44%
87%
88%
Source: VAAC report, D28
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Rapid Assessments and Responses
• Four provinces assessed: Nghe An, Lao Cai, Dien Bien and An Giang (three more scheduled)
• Cascade framework coupled with service mapping used to assess CoPC performance and needs.
• Targeted, time limited assistance plan rapidly implemented (in phases)
• Cost assessment and analyses being added
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Cascade for Nghe An, Dec 2012
3088
1234 1176
1583
562 538
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Diagnosed PLHIV In care On ARV
Person
Female Male
35%95%
40% 95%
Source: Nghe An PAC, 2012
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Cascade for Lao Cai, 6/2013
1778
477 381
1390
276 232
0
500
1000
1500
2000
2500
3000
3500
Diagnosed PLHIV In care On ARV
Person
Female Male
20%84%
27% 80%
Source: Lao Cai PAC, 10/2013
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7782
6364
1741 1616
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Accumulative HIVreported cases
PLHIV still alive Retain in care Currently on ARV
27.36% 92.82%
Cascade for Dien Bien, 6/2013
81.78%
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Tua Chua District, Aug 2013
57
38
6
35
0
10
20
30
40
50
60
70
80
90
100
H+ cumulative HIV+ Managed on ARV
Death
PLHIV
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Muong Bang Commune, Aug 2013
28
16
2
20
0
10
20
30
40
50
60
H+ cumulative HIV+ Managed on ARV
Death
PLHIV
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Potential for Other Cascades
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
IDU's MMT ART
ARV 71.4%
13,000
121‘06 Centers
25‐35,000
60MMT Clinics
13,000HIV+ 22.5%
HIV‐Negative77.5%
2,925
Data Source: VAAC 2012
MMT Retention:Haiphong1 Year 90%2 Years 80%
Drug Users
Estimated:217,000
Recorded:171,000
Methadone Maintenance
MMT – HIV – ART Cascade, Dec 2012
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Implications for planning and investment
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The Cascade Framework in Vietnam…
• A useful planning/diagnostic tool,
• Easily used at the provincial level
• Rapid assessments/responses can lead to closing of service gaps/leaks
• Useful Evaluation tool
• Can monitor success in introducing new tools (i.e., Treatment for Prevention)
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Investments in ….
• Use of the cascade framework coupled with service mapping and cost assessment can be very effective.
• Addressing targeted gaps and leaks will substantially Improve system performance.
• Supporting local use of the cascade framework can increase sustainability.
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Thank you!