Thanh Hoa Province Mid-term Review Meeting of Treatment 2.0 Implementation

Dr. Bui Duc Duong, Deputy Director General of Viet Nam Administration for AIDS Control,

Leaders of Thanh Hoa Provincial Health Department and Thanh Hoa Provincial AIDS Centre,

Colleagues and friends,

Good morning:

I would like to start by sharing with you how excited I am to be here in Thanh Hoa, to see with my own eyes the expansion of the Treatment 2.0 initiative, and the user-friendly HIV services it brings to people living with HIV, and people at risk of infection with HIV, here in Thanh Hoa.

We just heard Dr. Duong describe the cutting edges of this innovation, and let me add to that and tell you why I think Treatment 2.0 is so important. Because it is all about people. It means making HIV services more accessible for people in need, helping people living with HIV better adhere to treatment requirements so they can stay healthy, and empowering people living with HIV and people at risk of HIV to take leadership in responding to HIV.

I just arrived in Thanh Hoa, but I’ve already heard about Hai, a young woman living with HIV in Quan Hoa District, who successfully persuaded twenty people at risk of HIV in her commune to take an HIV test at the commune health station within only a few months of the beginning of Treatment 2.0. Thanks to her devoted time, patience and effort, four people living with HIV have become aware of their HIV status and are now receiving the treatment they need. I haven’t met you, young and courageous Hai, but I hope to see you in person soon and learn more about your wonderful work to mobilize your community’s participation in the response to HIV and to help people in need of support.

Colleagues and friends,

With Treatment 2.0 expansion, more and more Vietnamese people are getting the benefit of early HIV testing and early treatment. On behalf of the Joint UN Team on HIV in Viet Nam, I would like to recognize and express our great appreciation of the leadership that VAAC, and in particular Dr. Duong, have taken in embracing this innovative HIV treatment service delivery model. I would also like to express a special thanks to Thanh Hoa provincial leaders, in particular leaders of Thanh Hoa Provincial AIDS Centre, for your substantial support. WHO and UNAIDS are proud of the early but very encouraging Treatment 2.0 results in Thanh Hoa.

After more than six months of implementation, the new way of delivering HIV services has become fully operational. A working team has formed at each commune comprising of commune health workers, hamlet health workers and key populations (who are those people most at risk of acquiring HIV infection). Grass-roots health workers have learned to engage key populations in their work, and members of key populations have also learned to do HIV outreach, counselling and referral.  As a result, the numbers of people taking up voluntary HIV counseling and testing has clearly increased. By November 2014, the introduction of mobile HIV testing services has further boosted HIV testing.  The response among key populations is particularly encouraging. Members of key populations taking HIV tests at commune health stations has increased by two fold in the first month and by nearly three fold in the second month. Between July and December 2014, there were a total of 27 new HIV infections diagnosed, and these people have all now been enrolled in care.

Colleagues and friends,

These are encouraging initial results of our collective efforts thus far in Thanh Hoa, but these results also raise some questions for us to think about: how can we do this work even better than we are doing it now, and importantly, how can we sustain what we have started?

First, have we done enough in making HIV services easily accessible and user-friendly? Maybe not. We need to continue thinking boldly and doing differently. HIV mobile testing can be brought even closer to people in need at the hamlet level. The time lag between testing and enrolment in care can be further shortened to reduce the drop-out rate, using three quick tests at commune health station for confirmatory testing. Methadone can and should be dispensed at commune health stations, just like we are dispensing ARVs at commune health stations. Trying to further decentralize service delivery will bring immediate benefits to those most at risk of HIV in Thanh Hoa, and will allow us to learn important lessons for moving forward.

Second, as the Ministry of Health takes system strengthening measures to integrate HIV services in the mainstream public healthcare, there will be no more stand-alone HIV clinics and no more doctors and nurses who only care for people living with HIV. This integration is a good move for sustaining the response to HIV, but it also poses the question of how to make sure our health workers will be able to fulfil these additional responsibilities over the long term. I believe the answers are not only with national health managers in addressing system and human resource issues, but also with provincial leaders in finding local solutions for any new challenges faced by local health workers.

Finally, we need to think harder about how we can encourage more people living with HIV like our courageous Ms. Hai to take leadership in responding to HIV, and to become active agents of change for their own communities. We all know that international funding for HIV in Viet Nam is diminishing, and there will be fewer big HIV projects. Peer outreach and education as the result of an empowered and mobilized community of people living with HIV and those who are at risk of HIV will be the way to go, and they will need recognition and appreciation from both leaders and the larger community.

I believe Thanh Hoa is heading in the right direction with Treatment 2.0, and with the continued support from VAAC and provincial leaders will gain even more impressive results than the ones we are hearing about today. Please continue to push harder. The lessons you are learning will help other provinces as they start to build strong community responses to the epidemic. Thanh Hoa and other provinces will need determination and commitment to take bold action in order for Viet Nam to achieve the goal of Ending AIDS by 2030. The United Nations is committed to continue supporting you in this very important effort.

But let me finish where I began: this initiative is important because it is about people. It is about the people of Thanh Hoa, and the people of this country. It is our collective responsibility to assure that all Vietnamese people receive the care and support they need to lead happy and healthy lives.

Let me stop here by thanking you for your invitation to be with you today, and for all the good work you are doing. I very much look forward to a fruitful discussion.

Thank you and chuc suc khoe.

 

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