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Title: A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam
Authors: Masami, Fujita
Krishna, C Poudel
Nhan, Do Thi
Duong, Bui Duc
Kinh, Nguyen Van
Kimberly, Green
Thu, Nguyen Thi Minh
Masaya, Kato
David, Jacka
Thuy, CaoThi Thanh
Long, Nguyen Thanh
Masamine, Jimba
Keywords: HIV
Health services
Health care systems
Developing countries
Abstract: -- Background: The global initiative 'Treatment 2.0' calls for expanding the evidence base of optimalHIV 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 frameworkof 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 This was accomplished by reviewing related published and unpublished documents including existing service delivery data.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 districtssupported 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 strengthsand 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.
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