Lay provider HIV testing in Vietnam offers new model to connect at-risk populations with antiretroviral therapy
Hanoi, Vietnam, January 1, 2019—One in three people living with HIV in Vietnam remain undiagnosed, according to recent estimates. New strategies and models of HIV testing are urgently needed to reach undiagnosed populations and help them enroll in antiretroviral therapy (ART), in Vietnam and throughout the world.
Results from an evaluation study now published in PLOS ONE demonstrate that HIV testing by lay providers can serve as a critical addition to efforts to achieve the United Nations’ 90-90-90 global HIV targets by 2020 and help to cover the “last mile” of HIV services to at-risk populations in Vietnam.
Evidence from the study—conducted by PATH in partnership with the Vietnam Ministry of Health, the United States Agency for International Development (USAID), and the Center for Creative Initiatives in Health and Population in Hanoi—suggests that community-based HIV testing is an effective approach to reach people at risk of HIV who have never been tested or test infrequently. Key at-risk populations include people who inject drugs, men who have sex with men, female sex workers, and first-time HIV testers.
A cross-sectional survey of 1,230 individuals tested by lay providers found that 74 percent of clients belonged to at-risk populations, 67 percent were first-time HIV testers, and 85 percent preferred lay provider testing to facility-based testing. Furthermore, lay provider testing yielded a higher HIV positivity rate compared to facility-based testing and resulted in a high ART initiation rate of 91 percent.
“PATH is committed to achieving the global 90-90-90 goals by 2020 and to ending AIDS by 2030,” said Dr. Kimberly Green, PATH HIV & TB Director. “Innovation in HIV testing is absolutely critical to meet these ambitious targets, and community-based HIV testing offers a promising solution to connect undiagnosed people with the services they need.”
Lay providers participating in the study belonged to community-based organizations led by at-risk populations in urban areas and to village health worker networks in rural mountainous areas. Providers used a single rapid diagnostic test in clients’ homes, at the offices of community-based organizations, or at any private place preferred by the client. This approach helped to overcome barriers that had prevented key populations from seeking facility-based testing services, such as a perceived lack of confidentiality, fear of stigma and discrimination, inconvenient service opening times and distance, and long waiting times for test results.
Clients who had an HIV-reactive test were referred to the nearest health facility for HIV confirmatory testing, and those who received a confirmed HIV-positive result were referred to a public or private clinic for enrollment in ART. Clients with non-reactive test results received counseling to re-test after three or six months and were referred to a local health facility for HIV prevention services.
The study provides new evidence on the effectiveness of HIV testing administered by non–health care workers representing key populations and frontline village health volunteers. The results also support findings from community-based HIV testing approaches in other regions, including sub-Saharan Africa, that have demonstrated comparatively high rates of HIV testing uptake, high HIV positivity yields, and high success rates in linking people to care.
Based on the results of the study, the Vietnam Ministry of Health developed and approved national guidelines on community-based HIV testing and counseling in April 2018, and wider adoption of lay provider HIV testing was included in the 2018–2020 Global Fund concept note and in programming from the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Lay provider HIV testing services are now available in 32 of Vietnam’s 63 provinces.
For more information, please contact the Vietnam Administration for HIV/AIDS Control, Ministry of Health or USAID/PATH Healthy Markets.
The Vietnam Administration for HIV/AIDS Control (VAAC)
The Vietnam Administration for HIV/AIDS Control (VAAC) is a department within the Ministry of Health that assists the Minister of Health in government management and implementation of legal policies, specifically to supervise planning, directing, and managing the implementation of HIV programs across the country. Please visit http://vaac.gov.vn/ for more information.
The United States Agency for International Development (USAID)
USAID leads the U.S. Government’s international development and disaster assistance through partnerships and investments that save lives, reduce poverty, strengthen democratic governance, and help people emerge from humanitarian crises. Following over 50 years of improving lives through development and humanitarian assistance, USAID continues to support partners to become self-reliant and capable of leading their own development journeys. Please visit www.usaid.gov or follow https://www.facebook.com/USAID/ for more information. Vietnam-specific sites are https://www.usaid.gov/vietnam and https://www.facebook.com/USAIDVietnam.
PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world’s most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions—including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. Learn more at www.path.org.
USAID/PATH Healthy Markets
The Healthy Markets project is a five-year initiative that aims to grow a viable market for HIV-related goods and services capable of meeting the needs of populations facing the greatest risks. Healthy Markets aims to improve the environment for private-sector and social-enterprise engagement and investment; increase demand for HIV-related goods and services; and generate a sustainable supply of quality HIV commodities and services that are accessible and affordable. By growing a market for HIV-related goods and services, Healthy Markets (1) contributes to improved sustainability and country ownership of the HIV response and (2) supports efforts to reduce the HIV incidence, including 90-90-90. Healthy Markets is funded by USAID and implemented by PATH in partnership with the Center for Creative Initiatives in Health and Population and T&A Ogilvy. PATH works closely with manufacturers, distributors, private health care providers, pharmaceutical and diagnostics companies, national- and local-level governments, social enterprises, and community-based organizations.