Vietnam’s innovative testing model for viral hepatitis

Minh Quang* is a 53-year-old drug user from Hanoi. Last year, he learned of a local community-based organization (CBO), “Lien Minh Ve Nha,” which offers support group sessions and provides free HIV, hepatitis B (HBV), and hepatitis C (HCV) testing and counseling; condoms; and clean syringes to people who inject drugs and other key populations at high risk for these infections.

Upon attending one of these sessions, Quang tested positive for both HIV infection and HCV antibodies. “I felt confused and worried. Because I was still using drugs at that time, I didn't have any money and didn't know how to treat [HIV and HCV]. I was also concerned that I could infect my family members and that the disease could not be cured,” he said.

Lien Minh Ve Nha CBO staff immediately made an appointment with Quang to support him in navigating his next steps. They provided him with information on HIV and HCV, a list of nearby facilities where he could receive further testing to confirm his HIV and HCV diagnoses, and next steps for receiving treatment should his diagnoses be confirmed.

CBO staff accompanied Quang to a nearby outpatient clinic for confirmatory testing. Here, he received a chronic HCV diagnosis and was immediately enrolled in direct-acting antiviral treatment, fully covered by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Given the high cost of HCV direct-acting antivirals (which range from US$500–$1,000 per month), this support was essential for Quang, enabling him to receive the three-month treatment regimen that might have otherwise been unaffordable. At the outpatient clinic, Quang was also confirmed to have HIV and immediately enrolled in free antiretroviral treatment covered through Vietnam’s social health insurance scheme.

Today, Quang is HCV-free and continues to receive sterile needles, syringes, and harm reduction counseling at Ve Nha CBO, as well as opioid agonist therapy alongside his HIV care and treatment at the outpatient clinic.

Quang is one of over 20,000 individuals in Hanoi and Ho Chi Minh City who have learned their viral hepatitis status through the HepLINK project. A joint two-year initiative between PATH and The Hepatitis Fund (EndHep2030), HepLINK integrated HBV and HCV screening into community sites and health facilities, including methadone maintenance treatment centers, HIV outpatient clinics, and private primary care clinics that are led by key population individuals. PATH’s HepLINK team worked closely with the Vietnam Ministry of Health’s Administration of Medical Services to strengthen providers’ skills in counseling and referral systems and secure financing to ensure individuals like Quang could receive free or low-cost diagnostic and treatment services.

“I am grateful for the health providers that tested and treated me for free, as well as the CBO staff who accompanied and encouraged me throughout my whole treatment. I urge other people who belong to the drug injecting community to get tested early, be patient during treatment, and use other safety measures like condoms and clean syringes to protect your loved ones.”

HBV and HIV share common transmission routes as well as a common treatment method: an antiviral medication called tenofovir. As the tenofovir drug regimen is effective for both treating HBV and preventing and treating HIV, the hepatitis-HIV integrated model can create a unique opportunity for people to access HBV and HIV services at the same time.

40-year-old Nam Anh*, a gay man from Hanoi, is one individual who has benefitted from this lifesaving treatment.

Since 2020, Anh has visited Glink Hanoi, a private clinic that primarily services gay men, transgender women, and female sex workers, where he receives periodic HIV testing and pre-exposure prophylaxis (PrEP) a daily oral pill to prevent HIV infection. At Glink, Anh was counseled to test for HBV and HCV alongside his HIV prevention care.

When he received a positive result for HBV, he immediately discussed his options with a Glink counselor who had been trained by the HepLINK project on counseling and evaluating clients for HBV treatment:

“I was very worried and quite anxious. I was hoping to be treated as soon as possible so that the disease would not affect my health as much. Staff from Glink helped to counsel me on my treatment options right away.”

Glink staff provided counseling to Anh and indicated that the PrEP treatment he receives to prevent HIV infection (using a tenofovir and emtricitabine regimen) also effectively acts to treat HBV. Today, Anh continues to receive PrEP for HIV prevention and HBV treatment services at Glink, and he advocates for those in his community to seek testing like him: “The best message I could give is to encourage people to seek hepatitis B and C testing as soon as possible and at all ages. The earlier the disease is detected, the more effective the treatment will be.”

From April 2021 through August 2022, more than 20,000 people were screened for HBV and HCV at HepLINK project sites, of whom approximately 900 received treatment for HCV infection and 500 enrolled in HBV treatment. Building on learnings and successes from HepLINK, PATH and the Ministry of Health are assessing ways forward for financing integrated viral hepatitis services and ensuring continuation of the HepLINK model.

PATH is also championing innovative new tools and models of care in Vietnam and globally to speed up progress and ensure greater action for all those living with viral hepatitis. Through the United States Agency for International Development STEPS project, PATH and partners are advancing differentiated models of community-based, integrated primary health care that span a number of health areas, including HIV, viral hepatitis and sexually transmitted infections, and mental health. Later this year, PATH will also pilot HCV self-testing through STAR, a Unitaid-funded program that aims to catalyze markets for HIV, HCV, and COVID-19. This pilot will provide new proof points on the best ways to expand access to HCV testing in the community.

“Resources for a viral hepatitis program are limited, so integrating viral hepatitis into HIV services that have been built up and offered in the community and primary health care health facilities for decades is a great starting point. We are continuing our work with the Ministry of Health to expand HepLINK’s decentralized and integrated care approach by exploring new models such as HCV point-of-care viral load testing and self-testing,” said Vu Ngoc Bao, MD, Senior Technical Director, HIV/TB and Viral Hepatitis at PATH, who oversaw the HepLINK project.

*Editor’s note: All client names have been changed to protect confidentiality.