ABSTRACT: BACKGROUND: The global initiative 'Treatment 2.0' calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. METHODS: We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. RESULTS: Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services. CONCLUSIONS: Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the 'Treatment 2.0' initiative.
BMC Health Services Research 12/2012; 12(1):483. · 1.66 Impact Factor
ABSTRACT: Health care workers (HCWs) in high TB burden countries bear significant risks of being
infected with Mycobacterium tuberculosis and developing TB disease through their work.
In recent years, an increasing number of people living with HIV (PLHIV) are taking part in
delivering HIV and other health services in resource-limited settings with high TB burden.
The greater involvement of PLHIV in health service delivery has many beneficial consequences
on individuals and health systems, however, the involvement creates considerable
opportunities for them to be exposed to patients with infectious TB disease. Due to their
immunodeficiency, PLHIV are far more likely to develop active TB following the infection.
Available evidence and recently revised WHO policy guidance on TB infection control suggest
simple, predominantly administrative control measures are feasible and effective in
reducing the infection. Nevertheless, many countries are still at the early stage of developing
infection control policies. We call for evidence-based infection control measures in
order to ensure a safe working environment for PLHIV in support of their greater involvement
in health care. More research is needed to strengthen knowledge on TB infection
risks amongst PLHIV through involvement in service delivery, and optimal interventions to
International Health 12/2011; 3(4):221-225.
The Lancet 06/2011; 377(9782):2004-5; author reply 2005. · 38.28 Impact Factor