1. Accessing to ARV in HIV/AIDS care and treatment programme in Vietnam Accessing to ARV in HIV/AIDS care and treatment programme in Vietnam Dr.Nguyen Van Kinh Head, Department of care and treatment

2. HIV/AIDS situation in vietnam First case of HIV infection reported:Dec.1990 First case of HIV infection reported:Dec.1990 First case of AIDS reported: 1993 First case of AIDS reported: 1993 As of Sept.30 th, 2003, cumulative reported cases of HIV/AIDS through out the country including: As of Sept.30 th, 2003, cumulative reported cases of HIV/AIDS through out the country including: –101,291 cases of HIV infection –16,528 AIDS patients; 9554 deaths by AIDS Estimated HIV/AIDS number in 2005: 263,000 Estimated HIV/AIDS number in 2005: 263,000 Projected HIV/AIDS in 2010 number: 311,000 Projected HIV/AIDS in 2010 number: 311,000 –

3. Estimated number of PLWHA need to accessing ARV treatment during 2005-2010 2005 : 14.775 2006 : 18.975 2007 : 23.040 2008 : 27.690 2009 : 33.075 2010 : 37.275

4. Accessing to ARV Started since 1995 1995-2003 : 50 patients/year (2 combination) 2004: 500 patients ( three combination) Current number of patients on treatment (2005) –Central level: 900 patients –Provincial level : 2,100 patients –District level: 140 patients Total : 3,140 patients At the end of this year: Estimated 5,600 patients

5. ARV accessing Treatment regime : - First line : d4T +3TC + NPV; d4T + 3TC + EFV ZDV + 3TC + NVP: ZDV + 3TC + EFV - Second line: TDF/ ABC + ddI + LPV/r or SQV/r or NFV Funding sources: Government Global fund ESTHER project PEPFAR

6. Current HIV/AIDS care and treatment system in Vietnam Provincial Health service -PMC; MCH Hospital/Center General Hospital/STD center/TB Hospital/Center District Health CenterCommune Health Station Task force PLWAs and their families Rehab. Centers NGOs/CBOs VAAC Subdivision for Treatment NIOTD/TB Hue General Hos. TDC -HCMC Subdivision for M&E NIHE Regional Pasteur Ins. Subdivision for PMCT CHOGO CHOC SubDivision for STIs NIDV

7. calculating needs for ARV drugs and regimens Main assumptions for planning: Following protocol of MOH 70% of adults weighed under 60kg Estimated 5% children patients Mean weigh of children patient :15kg About 10% of patient needs second line regimen Newborn weigh about 3.0 kg

8. Current situation MOHGFPEPFARESTHER ForecastingBased M&E Based on funds available Method in placeBased on funds available Procurement.Open bidding Decision 88, buffer stocks? UNICEF, buffers? Direct proc. brand, FDA approved, buffer incl. HCMC-Tender Hanoi-local market Storage/ Distribution Medinsco CPS1, Quart. Deliveries. Pharmacy in Hospital Patient M&E system Some sites (HCMC) have, As MOHSystem in placeWorking with PEPFAR Inventory control Exists in some facilities Not preparedSystem being developed Not prepared Buffer/minimal stock level at facility level 6 months?Yes/2months?

9. StandardReports Number of patients started in the Month with Weight and Age status and Age status Graph Patient Intake trend over months in a given year Number of patients Number of patients started in the Month with regimen and drugs Cumulative number Cumulative number of patients up to the date Current Active number of patients by regimen of patients by regimen Number of visits in the Month by regimen Weight status Adults Weight status Adults that visited Pharmacy in the month

10. more indicator Number of health workers trained to deliver ARV/palliative care Number of service outlets providing ARV and OIs Number of service outlets providing palliative care Number of patients change into second regimen Number of patients died during treatment

11. Next strategy Completed M&E system Completed ARV accessing action plan Set up indicators system for ARV using, procurement... ARV source Co-ordinating