1. THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Situation of transportation of samples for HIV serology testing and time for releasing HIV confirmatory test results in Yen Bai province, 2013-2014 Level-2 specialized doctor Phan Duy Tieu Director of Yen Bai Provincial Center of HIV/AIDS Control

2. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Outline 1.Introduction 2.Research objectives 3.Research objects and methods 4.Results and discussion 5.Conclusions 6.Recommendations

3. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI I. Introduction Yen Bai is one of the 10 provinces with the highest HIV prevalence rate in the country. Since the first HIV case detected in September 1997, by 31 December 2014 the epidemic is present in 9/9 districts/towns/city and 155/180 communes of the province. By December 2014, there are 3,619 HIV+ people alive. The prevalence rate is 0,43% and Yen Bai ranks 8 out of 10 provinces with the highest HIV prevalence rate nationwide.

4. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI I. Introduction (continued) Early detection of HIV+ people and early treatment for them will help reduce HIV transmission, consequently reduce HIV prevalence rate in the community Over the last years, various HIV prevention and control programs have been implemented but there has never been any research conducted to assess HIV testing activities and time to release HIV test results. Therefore we carried out this research on “Situation of transportation of samples for HIV serology testing and time for releasing HIV confirmatory test results in Yen Bai in 2013-2014”.

5. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI II. Research objectives 1.To assess the situation of transportation of samples for HIV confirmatory testing and time for releasing test results (since the reception of samples to the release of HIV confirmatory test results to clients). 2.To compare the time for sending samples and releasing HIV test results before and after the implementation of interventions to enhance HIV testing in the province.

6. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI III. Research objects and methods -Research objects: log books and reports relating to HIV testing at the confirmatory laboratory of Yen Bai Provincial Center of HIV/AIDS Control. -Research design: descriptive cross-sectional study, using retrospective data. -Research time and site: March 2013 – December 2014 in Yen Bai province. -Sample size: information of 507 cases with HIV+ screening results collected from 13 HIV screening testing facilities from March 2013 to December 2014, which is sent to the confirmatory laboratory of Yen Bai Provincial Center of HIV/AIDS Control.

7. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI III. Research objects and methods (continued) Research indicators: 1. Time since the HIV screening test to the transportation of sample for the HIV confirmatory test. 2. Time since the reception of the sample by the confirmatory laboratory to the confirmatory test. 3. Time since the confirmatory test to the release of test result. 4. Total time since the HIV screening test to the release of HIV confirmatory test result.

8. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI III. Research objects and methods (continued) Data analysis: Data are collected from log books at the HIV confirmatory laboratory and are entered in Excel. Descriptive statistical method is used to analyze the frequency, percentage and average time of research indicators.

9. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI IV: Results and discussion 1. Situation of transportation of samples for HIV serology testing and time for releasing HIV confirmatory test results in 2013

10. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Table 1. Percentage of screened samples sent to the confirmatory laboratory by time In 2013, in general the percentage of samples from 13 facilities sent to the confirmatory laboratory within 7 days accounted for 40%. And there was no difference in the time of sending samples by a facility located in the city which is 5km away and by one located in a district which is 100km away from the confirmatory laboratory.

11. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI In 2013, the average time since the HIV screening test to the release of HIV confirmatory test result is 37 days. The time since the HIV screening test to the transportation of sample for the HIV confirmatory test is the longest – 20 days. Table 2. Time for sending samples, performing confirmatory tests and releasing test results in 2013 TimeAverage time (days) 13 HIV screening testing facilities in general (n=203) HIV screening testing facilities in the city which are 5km away from the confirmatory laboratory (n=85) HIV screening testing facilities in districts which are 100km away from the confirmatory laboratory (n=31) Time since the HIV screening test to the transportation of sample for the HIV confirmatory test 20 (0-113) 25 (0-84) 38 (3-113) Time since the reception of the sample by the confirmatory laboratory to the confirmatory test 8 (1-26) 5 (1-12) 10 (3-14) Time since the confirmatory test to the release of test result 9 (0-40) 13 (5-20) 7 (4-12) Total time since the HIV screening test to the release of HIV confirmatory test result 37 (6-131) 43 (7-78) 55 (18-131)

12. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI 2. Interventions and solutions in 2014 - The Provincial Center of H IV/AIDS Control collected and analyzed data in order to promptly propose interventions; - The Provincial Department of Health held a workshop to disseminate research findings, discuss on solutions and issue Decision No. 39/QD-SYT dated 17/2/2014 on “Process of performing HIV serology tests, counting TCD4 cells and linking services"; - The Provincial Center of HIV/AIDS Control enhanced its supervision and support, increased the number of times to perform confirmatory tests from 2 times/month to 4 times/month. - The Provincial Center of HIV/AIDS Control strengthened confirmatory testing with 3 rapid tests to confirm HIV status of pregnant women and VCT users.

13. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Transportation of samples for HIV serology testing in 2014 and comparison with 2013 The percentage of samples sent within 7 days has increased considerably from 38% in 2013 to 87% in 2014.

14. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Transportation of samples in 2014 and comparison with 2013 in a facility located in the city -The percentage of samples sent to the confirmatory laboratory within 7 days has increased considerably to 92% in 2014 from 22% in 2013. - Especially, the percentage of samples sent after >7 days has reduced and there are no samples sent after >14 days

15. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI -The percentage of samples sent to the confirmatory laboratory within 7 days has increased considerably to 72% in 2014 from 12% in 2013. - Especially, the percentage of samples sent after >7 days has reduced from 89% in 2013 to 28% in 2014. Time since the collection of sample to the transportation of sample for confirmatory test at a district facility which is 100km away from the laboratory

16. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Time for sending samples, performing confirmatory tests and releasing test results in 2013 and 2014 The total time since the collection of sample to the release of test results has reduced from 37 days in 2013 to 8 days in 2014

17. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Reduced time for releasing test results The time from the collection of sample to the availability of test result has been reduced from 37 days to 8 days (a reduction of 78%) The time from the reception of samples by the laboratory to the release of test result to facilities has been reduced from 7 days to 2 days (in application of 3 rapid tests) 2 days Within the day 1 day (0-3) 1 day (0-1 ) 8 days (3 – 41 days) 3 days (0-36) 4 days (0-8) 1 day (0-2) Reception of sample  confirmatory test Completion of confirmatory test  test result sheet 2 days (0-6) Completion of test result sheet  release of result Screening test  send sample for confirmatory test Confirmed by Elisa tests Confirmed by 3 rapid tests

18. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Discussion HIV testing activities in Yen Bai province before 2013 had many limitations -The time since the collection of samples to the release of test results to HIV screening testing facilities was long - 37 days. -Analysis of causes and shortcomings of each step: + Time since the collection of sample to the transportation of sample to the confirmatory laboratory + Time since the reception of sample to the confirmatory test + Time for releasing test results to clients Understanding of the situation and causes of the delay of releasing HIV test results is essential for developing effective interventions to improve the situation.

19. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Discussion (continued) - In 2013, the time since the collection of sample by HIV screening testing facilities to the transportation of sample to the confirmatory laboratory was very long (20 days). Reasons include: + The number of samples was small, so facilities waited until they have more samples and sent them in batches, + Health workers did not pay enough attention to the transportation of samples, more over, due to far distance and difficult travelling conditions, they only took samples to the Provincial Center of HIV/AIDS Control when they went there for business… - The time since the reception of sample by the laboratory to the confirmatory test was 8 days. Reasons include: + Since the number of samples was small for ELIST testing, the confirmatory laboratory waited until they have more samples in order to save biological products. They only performed confirmatory testing twice a month. - Signing and release of test results also took 9 days: there are many procedures, sometimes health staff go on business, etc.

20. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Discussion (continued) Interventions of Yen Bai Department of Health (DoH) and Provincial Center of HIV/AIDS Control: -In December 2013, the DoH held a workshop to disseminate findings of HIV testing situation in the province -The DoH issued Decision No. 39/QD-SYT on “Process of performing HIV serology tests, counting TCD4 cells and linking services“. - The Provincial Center of HIV/AIDS Control enhanced its supervision and support to facilities. - Using 3 rapid tests to confirm the HIV status of pregnant women and VCT users. - Increasing the number of times to perform confirmatory tests from 2 times/month to 4 times/month from 2 times/month to 4 times/month. For pregnant women, test results are released during the day. - Organizing training on HIV testing; biological safety, laboratory quality management for testers in the province.

21. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI Discussion (continued) -HIV screening testing facilities: enhanced the management of HIV testing quality and transportation of samples as prescribed by Decision 39/QD-SYT of the DoH. - Results of interventions: + Reduced time since the collection of samples to the transportation of them to the confirmatory laboratory: from 20 days in 2013 to 3 days in 2014. + The total time since the collection of samples to the release of test results by the confirmatory laboratory has been decreased from 37 days (in 2013) to 8 days (in 2014). + Use of 3 rapid tests to confirm HIV status and release of test results within the day was also a solution to improve HIV testing activities in Yen Bai in 2014.

22. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI V. Conclusions According to the research, it is realized that in 2013 there were many limitations in HIV serology testing in Yen Bai. The Provincial Center of HIV/AIDS Control has explored the actual situation of HIV testing in the province in order to work out prompt solutions, especially we got specific instructions from the DoH in the implementation of solutions and HIV testing guidelines from the Ministry of Health (MoH). These interventions have produced effectiveness in 2014, reducing considerably the time since the collection of samples for HIV screening testing to the release of HIV confirmatory test results to clients, contributing to reducing the time for retuning test results to HIV testing service users.

23. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI VI. Recommendations - DoH’s close direction plays a very important role in the issuance of guiding documents. - Provincial Centers of HIV/AIDS Control should be active in exploring the situation of HIV testing and providing advice to DoHs to issue guiding documents for facilities in the province to comply with MoH regulations. - To maintain and expand confirmatory laboratories at district level in order to reduce the time for releasing HIV test results. -To perform HIV screening testing at commune level; to enhance community-based VCT in order to increase the access to services and detect HIV+ people early so that they can be managed, care and treated promptly.

24. Hội nghị Khoa học Quốc gia về Phòng, chống HIV/AIDS lần thứ VI