NGUYEN Van KinhNGUYEN Van Kinh11, Ritu SHRIVASTAVA, Ritu SHRIVASTAVA22, VU Duc Canh, VU Duc Canh11, Marvin COULDWELL, Marvin COULDWELL33, David KUHL, David KUHL33, LUU , LUU Ho Thanh TuanHo Thanh Tuan33, TRAN Phuong Thuy, TRAN Phuong Thuy33, Grace HAFNER, Grace HAFNER33

1 Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam, 2 Centers for Disease Control and Prevention (CDC), Hanoi, 1 Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam, 2 Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam, 3 Supply Chain Management System (SCMS), Hanoi, Vietnam. Correspondence: Ritu Shrivastava, Vietnam, 3 Supply Chain Management System (SCMS), Hanoi, Vietnam. Correspondence: Ritu Shrivastava, shrivastavar@vn.cdc.govshrivastavar@vn.cdc.gov

3. Surprises in implementation3. Surprises in implementation•1.5 years to import and install 1.5 years to import and install FACSCountsFACSCounts

•Most FACSCounts had broken pump Most FACSCounts had broken pump in the first monthin the first month

•First shipment of reagents took 7 First shipment of reagents took 7 months to import resulting in nearly months to import resulting in nearly expired reagents (USG regulations for expired reagents (USG regulations for VAT and duty waivers)VAT and duty waivers)

•Difficulty in fore-casting, resulting in Difficulty in fore-casting, resulting in under and over-ordering suppliesunder and over-ordering supplies

2. Background2. Background•17,000 patients on ART by 17,000 patients on ART by September 2008: MOH/PEPFAR goalSeptember 2008: MOH/PEPFAR goal

•103 patients, initiated ART in 103 patients, initiated ART in September 2005September 2005

•Vietnam National Program supported Vietnam National Program supported 1 FACSCount and 1 FASCALIBUR, 1 FACSCount and 1 FASCALIBUR, 19941994

•Given geographically scattered sites, Given geographically scattered sites, PEPFAR ordered FACSCount for 5 PEPFAR ordered FACSCount for 5 key provinces.key provinces.

5. Critical steps to set up a 5. Critical steps to set up a reliable CD4 systemreliable CD4 systemWith support from MOH, PEPFAR, With support from MOH, PEPFAR, SCMS, CHAI, CDC Thailand and SCMS, CHAI, CDC Thailand and Atlanta, WHO, BD and Delta we Atlanta, WHO, BD and Delta we eventually facilitated eventually facilitated

•Training for equipment operation Training for equipment operation and maintenanceand maintenance

•Stock management systemStock management system

•Cold chain distributorCold chain distributor

•Hired appropriate staffHired appropriate staff

•CD4-related guidelines CD4-related guidelines

•CD4 EQA system CD4 EQA system

•Specimen referral networkSpecimen referral network

6. Next steps6. Next stepsSeveral donors are offering different brands of CD4 equipment in VietnamSeveral donors are offering different brands of CD4 equipment in Vietnam•Additional co-ordination among partners is required to maximize program Additional co-ordination among partners is required to maximize program effectiveness.effectiveness.

•Conduct a review of demand curve and respond by adjusting the capacity Conduct a review of demand curve and respond by adjusting the capacity (example replacing FACSCount with FACSCalibur).(example replacing FACSCount with FACSCalibur).

•Location: South East Asia. Location: South East Asia. Land area: 331,114 sq kmLand area: 331,114 sq km

•64 provinces 64 provinces

•Population: 84 million Population: 84 million

•Pop. growth rate: 1.33% Pop. growth rate: 1.33%

•GDP per capita: $639 GDP per capita: $639

•HIV prevalence 0.44% HIV prevalence 0.44%

Source: Source: Health Statistics Health Statistics Year Book 2006, UNDP Year Book 2006, UNDP March 05)March 05)

Challenges and Lessons Learned in Establishing a Challenges and Lessons Learned in Establishing a Successful CD4 Count System using FACSCount in Successful CD4 Count System using FACSCount in

VietnamVietnam

1. Socialist Republic of Vietnam1. Socialist Republic of Vietnam 4. Lessons learnt4. Lessons learnt•Not to start a CD4 system without Not to start a CD4 system without establishing a back-up specimen establishing a back-up specimen referral system, early onreferral system, early on

•Import equipment only via a Import equipment only via a specialist experienced partnerspecialist experienced partner

•Establish a reliable stock Establish a reliable stock management system in laboratoriesmanagement system in laboratories

•Ensure a quality cold chain Ensure a quality cold chain distributordistributor