Outcomes of Antiretroviral Therapy in Vietnam: Results from a National Evaluation

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.

Substance use disorders and HIV in Vietnam since Doi Moi (Renovation): An overview

“…Currently, an estimated 26% of the IDU population is infected with HIV. Data among people initiating ART showed that 62% of them reported a history of intravenous drug use [12]. Drug users have been more likely to be infected with the hepatitis C virus (HCV) and hepatitis B virus (HBV) than other high-risk groups [13].…”

“…Drug users have been more likely to be infected with the hepatitis C virus (HCV) and hepatitis B virus (HBV) than other high-risk groups [13]. IDUs who are HIV seropositive also have a higher rate of active tuberculosis and HCV than do non-IDUs [12]. Clatts et al, using a cohort of young male heroin injectors in Hanoi, addressed the issue of time since first drug injection as being a risk factor for HCV infection among IDUs.…”

“…A national evaluation of the outcomes of antiretroviral therapy in Vietnam found that people who reported a history of IDU have lower CD4 cell counts, are at a higher (more severe) WHO stage of HIV disease, and had poorer retention on ART than non-IDUs. Retention of IDUs in treatment is 81.5% at 12 months and 63.3% at 60 months, whereas retention of non-IDU groups at 60 months was 85.7% [12]. …”

Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

“…69 An analysis of the new HIV diagnosis and the clinic enrolment data at national 70 and provincial levels 70 suggests that a substantial number of people diagnosed with HIV infection are lost to follow-up and are not effectively linked to care. People are also starting ART late, 70,71 with a median CD4 count of 93 cells mm -3 in 2010, associated with a higher attrition rate. 72 Attrition was defined as discontinuation of ART due to death or loss to follow-up, or discontinuation of ART medications while remaining in care.…”

HIV Patients' Preference for Integrated Models of Addiction and HIV Treatment in Vietnam

“…Since the first diagnosed case of HIV in 1990, Vietnam has scaled up a free antiretroviral therapy (ART) program, nationwide, that began in 2005 through a network of outpatient HIV clinics and has greatly expanded access to HIV care (Nguyen et al, 2013). International momentum is building to reach the World Health Organization 90–90–90 goal of closing gaps in the HIV continuum by 2020: 90% of people living with HIV know their HIV status; 90% of people who know their status are on HIV treatment; and 90% of people on treatment will have undetectable levels of HIV, known as viral suppression (UNAIDS, 2014a).…”