1. NGUYEN Van Kinh 1, Ritu SHRIVASTAVA 2, VU Duc Canh 1, Marvin COULDWELL 3, David KUHL 3, LUU Ho Thanh Tuan 3, TRAN Phuong Thuy 3, Grace HAFNER 3 1 Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam, 2 Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam, 3 Supply Chain Management System (SCMS), Hanoi, Vietnam. Correspondence: Ritu Shrivastava, shrivastavar@vn.cdc.gov 3. Surprises in implementation 1.5 years to import and install FACSCounts1.5 years to import and install FACSCounts Most FACSCounts had broken pump in the first monthMost FACSCounts had broken pump in the first month First shipment of reagents took 7 months to import resulting in nearly expired reagents (USG regulations for VAT and duty waivers)First shipment of reagents took 7 months to import resulting in nearly expired reagents (USG regulations for VAT and duty waivers) Difficulty in fore-casting, resulting in under and over-ordering suppliesDifficulty in fore-casting, resulting in under and over-ordering supplies 2. Background 17,000 patients on ART by September 2008: MOH/PEPFAR goal17,000 patients on ART by September 2008: MOH/PEPFAR goal 103 patients, initiated ART in September 2005103 patients, initiated ART in September 2005 Vietnam National Program supported 1 FACSCount and 1 FASCALIBUR, 1994Vietnam National Program supported 1 FACSCount and 1 FASCALIBUR, 1994 Given geographically scattered sites, PEPFAR ordered FACSCount for 5 key provinces.Given geographically scattered sites, PEPFAR ordered FACSCount for 5 key provinces. 5. Critical steps to set up a reliable CD4 system With support from MOH, PEPFAR, SCMS, CHAI, CDC Thailand and Atlanta, WHO, BD and Delta we eventually facilitated Training for equipment operation and maintenanceTraining for equipment operation and maintenance Stock management systemStock management system Cold chain distributorCold chain distributor Hired appropriate staffHired appropriate staff CD4-related guidelinesCD4-related guidelines CD4 EQA systemCD4 EQA system Specimen referral networkSpecimen referral network 6. Next steps Several donors are offering different brands of CD4 equipment in Vietnam Additional co-ordination among partners is required to maximize program effectiveness.Additional co-ordination among partners is required to maximize program effectiveness. Conduct a review of demand curve and respond by adjusting the capacity (example replacing FACSCount with FACSCalibur).Conduct a review of demand curve and respond by adjusting the capacity (example replacing FACSCount with FACSCalibur). Location: South East Asia.Location: South East Asia. Land area: 331,114 sq km Land area: 331,114 sq km 64 provinces64 provinces Population: 84 millionPopulation: 84 million Pop. growth rate: 1.33%Pop. growth rate: 1.33% GDP per capita: $639GDP per capita: $639 HIV prevalence 0.44%HIV prevalence 0.44% Source: Health Statistics Year Book 2006, UNDP March 05) Challenges and Lessons Learned in Establishing a Successful CD4 Count System using FACSCount in Vietnam 1. Socialist Republic of Vietnam 4. Lessons learnt Not to start a CD4 system without establishing a back-up specimen referral system, early onNot to start a CD4 system without establishing a back-up specimen referral system, early on Import equipment only via a specialist experienced partnerImport equipment only via a specialist experienced partner Establish a reliable stock management system in laboratoriesEstablish a reliable stock management system in laboratories Ensure a quality cold chain distributorEnsure a quality cold chain distributor