STRATEGIC INFORMATION FOR ACTION IN VIET NAM 6 th Viet Nam National Scientific Conference 24 November 2015 Ha Noi, Viet Nam Amitabh Bipin SUTHAR, PharmD, MPH Epidemiologist World Health Organisation Viet Nam Country Office

Global consensus to end AIDS Global leaders agreed to new development agenda at UN General Assembly in September 2015 Includes goal of ending AIDS: “By 2030, end the epidemics of AIDS, tuberculosis, malaria…” Countries will need to use strategic information to reach this goal

Policies Action Epidemic Outline Tailor technical package of interventions to epidemiological situation Estimate coverage and quality of services Measure HIV burden and transmission in different populations and regions through surveillance

Epidemic

Burden Approximately 0.5% of Vietnamese estimated to have HIV ~250,000 people total Burden highest in key populations PWID (2014)10.5% MSM (2014)6.7% FSW (2014)2.5%

Transmission Approximately 15,000 new infections in 2014 Injection drug use and transmission in serodiscordant couples driving national transmission (2013)

Morbidity and mortality AIDS and death rates peaked in mid 2000s Reductions likely attributable to national HIV/AIDS response Programme data on cause of death limited; studies indicate TB, liver failure, mycobacterium avium complex, drug overdose play important role (Cuong et al, 2011)

Policies

Baseline CD TasP Using data to guide national policy TasP (Early diagnosis through testing expansion and immediate ART) provides value for money

Recent policy developments New 3 rapid test algorithm recommended by NIHE (2015) –Reduces time/visits required prior to receiving treatment Decision 3047 (2015) -> HIV treatment guidelines –All key pops, CD4 < 500, coinfections (TB/HBV/HCV) –Decentralisation of treatment to commune level Circular 12 (2015) -> Methadone guidelines –District and commune level provision

Action

90 Global cascade framework WHO 2015 Consolidated SI Guidelines

# PLHIV = Annual estimates and projections National technical working group develops estimates and projections for PLHIV on annual basis based on modelling –Annual HIV sentinel surveillance, programme data (treatment, PMTCT, etc.), and surveys used to update results –EPP provides national and cluster data –AEM only provides national data KP behavioural data and service coverage also used to update results –Case reporting and testing data used to triangulate and verify results PRIORITY = SUBNATIONAL USE

# Diagnosed = HIV case reporting system HIV/AIDS has been reportable disease since 1987 Health facilities, HTC sites (community- and facility-based), and closed settings routinely report Basic demographic and behavioural information included PRIORITY = IMPROVE ACCURACY (E.G. REMOVE DEATHS AND DUPLICATES) District Prevention and Medicine Centres (~1,100) Commune health stations (> 10,000) Paper-based reporting E-report Viet Nam Administration of HIV/AIDS Control (MOH) Provincial AIDS Centre (63)

# on treatment = Health information system Previously, mix of electronic and paper reporting for HTC, case reporting, HIV care and treatment, mobile health, PAC Moving toward electronic HIS with interoperability across databases –Variables synchronised across databases –Two-way information exchange –Web-based platform PRIORITY = NATIONAL EXPANSION

# achieving viral suppression = Surveys Viet Nam in process of implementing routine viral load monitoring During this transition information needed to guide programme action Drug resistance surveillance requires monitoring of viral suppression rates through acquired drug resistance surveys VAAC has successfully implemented 5 rounds of DR surveys Viral load suppression rates from ADR survey is a nationally representative number that can be considered in the absence of national programme data

Using the cascade at sub-national levels Geographical differences in magnitude of HIV/AIDS epidemic across regions Health system, financing, and programming also differs –Some provinces have stronger economy and more independent decision-making Central government starting to promote use of cascade at sub- national levels In the future, PAC and district can use cascade framework to guide action Viet Nam 2014 HIV Estimates and Projections

Conclusions Strategic information needed to guide programme action Priority is to minimise and define indicators and standardise reporting procedures Simple and powerful indicators can enable use of cascade at national and sub-national levels

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