Combining Cohort Analysis and Monitoring of HIV Early-Warning Indicators of Drug Resistance to Assess Antiretroviral Therapy Services in Vietnam

Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
Clinical Infectious Diseases (Impact Factor: 8.89). 05/2012; 54 Suppl 4(suppl 4):S306-12. DOI: 10.1093/cid/cir1045
Source: PubMed


Antiretroviral therapy (ART) retention and 5 early-warning indicators (EWIs) of HIV drug resistance (HIVDR) were abstracted
at 27 adult and 4 pediatric clinics in Vietnam in 2009. Of 4531 adults and 313 children, 81.2% and 84.4% respectively were
still on ART at 12 months. More than 90% of the clinics monitored achieved the World Health Organization (WHO) targets for
lost-to-follow-up (LTFU), ART prescribing practices, and ARV supply continuity. Only 83.9% of the clinics met the target for
first-line ART retention and 79.3% met the target for clinic appointment-keeping. Clinic factors (i.e. number of patients,
administrative level, and geographical region) were associated with ART retention and LFTU. Data were useful in guiding public
health action to optimize ART services.

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    • "The economic impact of the ART programme is still modest: firstly, because of its moderate coverage, which was 50% by 2010. Secondly, patients usually seek health care and initiate ART very late, when their immune system has deteriorated with severe comorbid diseases (Do et al. 2012). Thirdly, as the majority of HIV/AIDS patients engaged in high-risk behaviours such as drug injection and sex work, they often lack stable jobs and steady incomes, and are less capable to pay for health-care services (Tran et al. 2011, 2012a,b). "
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    ABSTRACT: Objective: To assess the out-of-pocket (OOP) payments for health-care services of HIV/AIDS patients, and identify associated factors in Vietnam. Methods: Cross-sectional multisite survey of 1016 HIV/AIDS patients attending 7 hospitals and health centres in Ha Noi, Hai Phong and Ho Chi Minh City in 2012. Results: HIV/AIDS patients used inpatient and outpatient care on average 5.1 times (95% CI = 4.7-5.4) besides ART services. Inpatient care cost US$ 461 on average and outpatient care US$ 50. Mean annual health-care expenditure for HIV/AIDS patients was US$ 188 (95% CI = 148-229). 35.1% of households (95% CI = 32.2-38.1) experienced catastrophic health expenditure; 73.3% (95% CI = 70.6-76.1) of households would be affected if ART were not subsidised. Being a patient at a provincial clinic, male sex, unstable employment, being in the poorest income quintile, a CD4 count of <200 cells/mL and not yet receiving ART increased the likelihood of catastrophic medical expense. Conclusions: HIV/AIDS patients in Vietnam frequently use medical services and incur OOP payments for health care. Scaling up free-of-charge ART services, earlier access to and initiation of ART, and decentralisation and integration of HIV/AIDS-related services could reduce their financial burden.
    Full-text · Article · Dec 2012 · Tropical Medicine & International Health
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    ABSTRACT: The HIV drug resistance (HIVDR) prevention and assessment strategy, developed by the World Health Organization (WHO) in partnership with HIVResNet, includes monitoring of HIVDR early warning indicators, surveys to assess acquired and transmitted HIVDR, and development of an accredited HIVDR genotyping laboratory network to support survey implementation in resource-limited settings. As of June 2011, 52 countries had implemented at least 1 element of the strategy, and 27 laboratories had been accredited. As access to antiretrovirals expands under the WHO/Joint United Nations Programme on HIV/AIDS Treatment 2.0 initiative, it is essential to strengthen HIVDR surveillance efforts in the face of increasing concern about HIVDR emergence and transmission.
    Full-text · Article · May 2012 · Clinical Infectious Diseases
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    ABSTRACT: Objective: This study assessed health-related quality of life (HRQOL) and its related factors in HIV/AIDS patients taking antiretroviral treatment (ART) in Vietnam. Methods: A cross-sectional study was conducted with 1016 patients (36.2% women, mean age = 35.4) in three epicenters of Vietnam, including Hanoi, Hai Phong, and Ho Chi Minh City. HRQOL was assessed using the Vietnamese version of the WHOQOL-HIV BREF. Factor analysis classified measure items into six HRQOL dimensions, namely Physical, Morbidity, Social, Spirituality, Performance, and Environment. Tobit censored regression models were applied to determine associations of patient’s characteristics and HRQOL domain scores. Results: Internal consistency reliability of the six domains ranged from 0.69 to 0.89. The WHOQOL-HIV BREF had a good discriminative validity with patient’s disease stages, CD4 cell counts, and duration of ART. In a band score of (4, 20), six domains were moderate; “Environment” had the highest score (13.8±2.8), and “Social” had the lowest score (11.2±3.3). Worse HRQOL were observed in patients at provincial and district clinics. Those patients who were male, had higher educational attainment, and were employed, reported better HRQOL. In reduced regression models, poorer HRQOL was found in patients who had advanced HIV infection and had CD4 cell count <200 cells/mL. Patients reported significantly poorer Physical and Social in the 1st year ART, but moderately better Performance, Morbidity, Spirituality, and Environment from the 2nd year ART, compared to those not-yet-on ART. Conclusion: Strengthening the quality of ART services at the provincial and district levels, gender-specific impact mitigation, and early treatment supports are recommended for further expansion of ART services in Vietnam. Regular assessments of HRQOL may provide important indicators for monitoring and evaluating HIV/AIDS services.
    Full-text · Article · Jul 2012 · PLoS ONE
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