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Open Access Research article

A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam

Masami Fujita1*, Krishna C Poudel2, Nhan Do Thi3, Duong Bui Duc3, Kinh Nguyen Van4, Kimberly Green5, Thu Nguyen Thi Minh6, Masaya Kato6, David Jacka6, Thuy Cao Thi Thanh4, Long Nguyen Thanh3 and Masamine Jimba7

Author Affiliations

1 World Health Organization Cambodia Office, No. 177-179 Pasteur (St.51) (corner 254) Sangkat Chak Tomouk, P.O. Box 1217, , Phnom Penh, Cambodia

2 Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, 316 Arnold House, 715 North Pleasant St, Amherst, MA, 01003-9304, USA

3 Vietnam Authority of HIV/AIDS Control, Ministry of Health Vietnam, 135/3 Nui Truc, Ba Dinh, Hanoi, Vietnam

4 National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam

5 FHI 360, Demmco House, 1st Dzorwulu Crescent, Accra, Ghana

6 World Health Organization Vietnam Office, 63 Tran Hung Dao, Hoan Kiem District, P.O. Box 52, Hanoi, Vietnam

7 Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan

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BMC Health Services Research 2012, 12:483  doi:10.1186/1472-6963-12-483

Published: 29 December 2012

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 This was accomplished by reviewing related published and unpublished documents including existing service delivery data.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.

Keywords:
HIV; Health services; Health care systems; Developing countries