Abstract
ObjectivesVietnam has significantly scaled up its national antiretroviral therapy (ART) program since 2005. With the aim of improving Vietnam’s national ART program, we conducted an outcome evaluation of the first five years of the program in this concentrated HIV epidemic where the majority of persons enrolled in HIV care and treatment services are people who inject drugs (PWID). The results of this evaluation may have relevance for other national ART programs with significant PWID populations.DesignRetrospective cohort analysis of patients at 30 clinics randomly selected with probability proportional to size among 120 clinics with at least 50 patients on ART.MethodsCharts of patients whose ART initiation was at least 6 months prior to the study date were abstracted. Depending on clinic size, either all charts or a random sample of 300 charts were selected. Analyses were limited to treatment-naïve patients. Multiple imputations were used for missing data.ResultsOf 7,587 patient charts sampled, 6,875 were those of treatment-naïve patients (74.4% male, 95% confidence interval [CI]: 72.4–76.5, median age 30, interquartile range [IQR]: 26–34, 62.0% reported a history of intravenous drug use, CI: 58.6–65.3). Median baseline CD4 cell count was 78 cells/mm3 (IQR: 30–162) and 30.4% (CI: 25.8–35.1) of patients were at WHO stage IV. The majority of patients started d4T/3TC/NVP (74.3%) or d4T/3TC/EFV (18.6%). Retention rates after 6, 12, 24, and 36 months were 88.4% (CI: 86.8–89.9), 84.0% (CI: 81.8–86.0), 78.8% (CI: 75.7–81.6), and 74.6% (CI: 69.6–79.0). Median CD4 cell count gains after 6, 12, 24, and 36 months were 94 (IQR: 45–153), 142 (IQR: 78–217), 213 (IQR: 120–329), and 254 (IQR: 135–391) cells/mm3. Patients who were PWID showed significantly poorer retention.ConclusionsThe study showed good retention and immunological response to ART among a predominantly PWID group of patients despite advanced HIV infections at baseline.
Highlights
Vietnam has a population of more than 84 million and an estimated 2011 adult (15–49 years) HIV prevalence of 0.45% [1]
Of 7,587 patient charts sampled, 6,875 were those of treatment-naıve patients (74.4% male, 95% confidence interval [confidence intervals (CI)]: 72.4–76.5, median age 30, interquartile range [IQR]: 26–34, 62.0% reported a history of intravenous drug use, CI: 58.6–65.3)
The epidemic is primarily concentrated in most-at-risk populations, including people who inject drugs (PWID), commercial sex workers (CSW), and men who have sex with men (MSM)
Summary
Vietnam has a population of more than 84 million and an estimated 2011 adult (15–49 years) HIV prevalence of 0.45% [1]. The epidemic is primarily concentrated in most-at-risk populations, including people who inject drugs (PWID), commercial sex workers (CSW), and men who have sex with men (MSM). There were an estimated 248,500 people living with HIV/AIDS in Vietnam in 2011. Among PWID the HIV prevalence was 25.5%; among CSW, 6.8%; and among high-risk MSM, 11.2% [2]. National size estimates of those high-risk populations were as high as 336,000 for PWID, 101,000 for CSW, and 393,000 for MSM [2]. In 2005, in response to the epidemic, the Ministry of Health (MOH) established the Vietnam Administration for HIV/AIDS Control (VAAC) to coordinate HIV response activities. The MOH developed guidelines for diagnosis and treatment of HIV/AIDS and established outpatient clinics (OPC) where HIV-infected patients have been offered free care and treatment services
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