Suchergebnisse

AbstractIntroductionThe HIV epidemic in Vietnam is concentrated in key populations and their partners – people who inject drugs, men who have sex with men, sex workers and partners of people living with HIV. These groups have poor access to and uptake of conventional HIV testing services (HTS). To address this gap, lay provider‐ and self‐testing and assisted partner notification (aPN) were introduced and delivered by the community. We explored the feasibility and effectiveness of implementing aPN as part of community testing services for key populations.MethodsLay provider testing and self‐testing was started in January 2017, and targeted key populations and their partners. Since July 2017, aPN was introduced. HTS was offered at drop‐in houses or coffee shops in Thai Nguyen and Can Tho provinces. All self‐testing was assisted and observed by peer educators. Both in‐person and social network methods were used to mobilize key populations to test for HIV and offer HTS to partners of people living with HIV. Client‐level data, including demographic information and self‐reported risk behaviour, were collected on site by peer educators.ResultsBetween January 2017 and May 2018, 3978 persons from key populations were tested through community‐led HTS; 66.7% were first‐time testers. Of the 3978 clients, 3086 received HTS from a lay provider and 892 self‐tested in the presence of a lay provider. Overall, 245 (6.2% of tested clients) had reactive results, 231 (94.3%) were confirmed to be HIV positive; 215/231 (93.1%) initiated antiretroviral therapy (ART). Of 231 adult HIV‐positive clients, 186 (80.5%) were provided voluntary aPN, and 105 of their partners were contacted and received HTS. The ratio of partners who tested for HIV per index client was 0.56. Forty‐four (41.9%) partners of index clients receiving HTS were diagnosed with HIV, 97.7% initiated ART during the study period. No social harm was identified or reported.ConclusionsIncluding aPN as part of community‐led HTS for key populations and their partners is feasible and effective, particularly for reaching first‐time testers and undiagnosed HIV clients. Scale‐up of aPN within community‐led HTS for key populations is essential for achieving the United Nations 90‐90‐90 targets in Vietnam.

AbstractIntroduction: In Vietnam, HIV testing services had been available only at provincial and district health facilities, but not at the primary health facilities. Consequently, access to HIV testing services had been limited especially in rural areas. In 2012, Vietnam piloted decentralization and integration of HIV services at commune health stations (CHSs). As a part of this pilot, a three‐rapid test algorithm was introduced at CHSs. The objective of this study was to assess the performance of a three‐rapid test algorithm and the implementation of quality assurance measures to prevent misdiagnosis, at primary health facilities.Methods: The three‐rapid test algorithm (Determine HIV‐1/2, followed by ACON HIV 1/2 and DoubleCheckGold HIV 1&2 in parallel) was piloted at CHSs from August 2012 to December 2013. Commune health staff were trained to perform HIV testing. Specimens from CHSs were sent to the provincial confirmatory laboratory (PCL) for confirmatory and validation testing. Quality assurance measures were undertaken including training, competency assessment, field technical assistance, supervision and monitoring and external quality assessment (EQA). Data on HIV testing were collected from the testing logbooks at commune and provincial facilities. Descriptive analysis was conducted. Sensitivity and specificity of the rapid testing algorithm were calculated.Results: A total of 1,373 people received HIV testing and counselling (HTC) at CHSs. Eighty people were diagnosed with HIV infection (5.8%). The 755/1244 specimens reported as HIV negative at the CHS were sent to PCL and confirmed as negative, and all 80 specimens reported as HIV positive at CHS were confirmed as positive at the PCL. Forty‐nine specimens that were reactive with Determine but negative with ACON and DoubleCheckGold at the CHSs were confirmed negative at the PCL. The results show this rapid test algorithm to be 100% sensitive and 100% specific. Of 21 CHSs that received two rounds of EQA panels, 20 CHSs submitted accurate results.Conclusions: Decentralization of HIV confirmatory testing to CHS is feasible in Vietnam. The results obtained from this pilot provided strong evidence of the feasibility of HIV testing at primary health facilities. Quality assurance measures including training, competency assessment, regular monitoring and supervision and an EQA scheme are essential for prevention of misdiagnosis.

AbstractIntroductionMonitoring the population‐level emergence and transmission of HIV drug resistance (HIVDR) is necessary for supporting public health programmes. This study provides a nationally representative prevalence estimate of HIVDR in people initiating antiretroviral therapy (ART) and estimates of acquired HIVDR and viral load (VL) suppression in people who have received it for 12 or ≥48 months in Vietnam.MethodsThe study was conducted between September 2017 and March 2018 following World Health Organization guidance. Thirty ART clinics were randomly sampled using probability proportional to size sampling from a total of 367 ART clinics in the country.Results and DiscussionIn total, 409 patients initiating ART were enrolled into the survey of pre‐treatment HIVDR. The prevalence of any pre‐treatment HIVDR was 5.8% (95% CI 3.4–9.5%), and the prevalence of non‐nucleoside reverse transcriptase inhibitor resistance was 3.4% (95% CI 1.8–6.2%). Four hundred twenty‐nine patients on ART for 12±3 months and 723 patients on ART for ≥48 months were enrolled into the surveys of acquired HIVDR. The prevalence of VL suppression (defined as <1000 copies/ml) in patients on ART for 12±3 and ≥48 months was 95.5% (95% CI 91.3–97.8%) and 96.1% (95% CI 93.2–97.8%), respectively. Among individuals with viral non‐suppression, any HIVDR was detected in 11/14 (weighted prevalence 74.3%) of those on ART for 12±3 months and in 24/27 (weighted prevalence 88.5%) of those receiving ART for ≥48 months.ConclusionsThis nationally representative study of HIVDR found high levels of VL suppression among those on ART for 12 and ≥48 months. Overall, high levels of VL suppression at both time points suggested good adherence among patients receiving ART and quality of treatment services in Vietnam.Clinical Trial NumberNot applicable