Voluntary Counseling and Testing in Viet Nam, 2003

1
Voluntary Counseling and Testing in Viet Nam,
2003

• Mary Kamb
• CDC Viet Nam Office

2
What is Voluntary Counseling Testing (VCT)?

• An HIV prevention intervention w/ several
  components
• 1) Voluntary individual freely chooses test
  (no coercion)
• 2) Counseling on how to avoid acquiring or
  transmitting HIV,
• with a trained counselor
• 3) HIV test and receiving the test results
• 4) Referral to additional HIV prevention
  and/or care services

3
Why is VCT a prevention intervention?

• Knowledge is Power Through voluntary
  counseling and testing
• HIV-uninfected persons with HIV risk can receive
  help in reducing their risk for acquiring a new
  HIV infection through counseling referral
• HIV-infected persons can learn their HIV status
  receive help in reducing transmission to their
  sex/ needle - sharing partners unborn children
  receive help in disclosing their status to
  partners and be referred to clinical and other
  support services
• Foundation for referral to other HIV
  prevention/care services

4
VCT as part of comprehensive HIV prevention and
care services in the community
MTCT
Community Outreach
VCT
HIV Treatment
STD, TB, Drug Abuse
Support Services
Planning for future
5
Voluntary Counseling and TestingMethods of
Delivery

• How test is offered
• Voluntary Testing
• - Anonymous testing (no personal
  identifiers) high risk
• - Confidential testing (personal identifiers
  collected)
• - Client driven high risk
• - Recommended screening test (opt out)
• How test is delivered
• Standard (results return in 7 10 days)
• Rapid testing (results on site)
• How counseling is delivered
• Education, focused on providing information
  (e.g., PMTCT)
• Client-centered tailored to clients own
  risk/situation
• particularly acceptable for IDU

6
Voluntary Counseling and TestingModels of
delivery

• Physical Models
• - VCT part of traditional medical facility
• - Integrated Service model
• - linked to other health care TB, STD, drug
  abuse treatment, ANC, FP, etc.
• - Free-standing VCT site located in hot
  zone
• - Mobile services (e.g., van, daily vendor)
• - VCT linked to community outreach
• - Private practice
• particularly acceptable to hidden
  populations/ IDU

7
Viet Nam Systems barriers to national VCT
program

• 2000 UNAIDS assessment little high quality
  counseling or clarity about the role and purpose
  of counseling as prevention intervention
• Lack of perceived risk among community leaders
• Issues of confidentiality (name on a list) and
  stigma
• No role of counselor in current vertical system
  (health care provider?) few trained counselors
  unclear pay scale
• Acceptance of VCT still unknown (what benefit?)
• No risk reduction counseling model (support
  models existed)
• Lack of emphasis on partner notification

8
Systems barriers to initiating national VCT
program2001 Provincial Assessment

• New concept, almost all HIV testing mandatory
• Concerns on testing for safety of health provider
  gt HIV prevention concerns
• Testing strategy difficult costly
• 2 confirmatory tests required not all provinces
• Long waits for those who get test results (most
  do not)
• Ambivalent concerns about confidentiality
• Who receives test results?
• No infrastructure for referral or partner
  notification

9
Voluntary Counseling and TestingVCT Services in
Vietnam

• ? Prior to 2001, Preventive Medicine Centers
• - VCT available but not utilized with some
  exceptions
• - No separation of voluntary vs. other HIV
  tests
• - Confirmatory tests required by MOH, lab
  available in lt 1/2 of provinces so required
  send-out
• ? 2001, first anonymous VCT site opened in HCMC
  (CAPS)
• - Community setting, free standing/integrated
  service
• - Many high risk persons tested
• - CDCs client-centered counseling model
• - Thus far, gt 2000 persons tested, 18 HIV

10
Voluntary Counseling and TestingVCT Services in
Vietnam

• ? 2002, hospital-based VCT site in Hanoi (Bach
  Mai)
• - Confidential HIV testing (?) in out-patient
  clinic
• - Client-centered prevention counseling model
• ? 2002, MOHs national VCT program through
  LIFE-GAP
• - Anonymous VCT services aimed at high risk
  persons
• - Several models services currently without
  charge
• - Scale up project services in 18 provinces (
  ? 40 provinces)
• - gt 4500 HR clients counseled/tested,
• 94 return for test results, 22 HIV (range
  18-35)
• - Test results return within 7 10 days
• - Linkages to other prevention clinical
  programs (TB)

11
(No Transcript)
12
LIFE-GAP VCT Activities5 yr GOAL VCT
in 40 provinces

• Progress/activities
• MOH support for anonymous testing (2002)
• Counseling model piloted w/ previously trained
  counselors
• Found acceptable, adapted for Vietnam, translated
• Developed pilot-tested prevention counseling
  curricula
• Training, Participant, and Training of Trainer
  (TOT) manuals
• Procedure manual
• Quality assurance tools
• Data collection tools for monitoring progress
• Data entry/ management system

13
LIFE-GAP VCT Progress/Activities

• Provincial assessments of sites, develop
  proposals
• Checklist
• Anonymous testing, free of charge
• Site easily accessible to/services focused on
  high risk persons
• Test results (including confirmatory) within 7
  days
• Laboratory uses universal precautions, safe
  disposal
• Sites open business and off- hours
• Full time counselors trained, apply
  confidentiality at all times
• Referral notebook developed, used, emphasis on
  integrating
• Training provided to counselors/ laboratory staff
  (4 day course)
• Training of trainers April 2003
• Monitoring (on site/external quality assurance,
  and data)

14
Voluntary Counseling and TestingVCT Services in
Vietnam

• Future Plans
• ? 2003 - 2004, VCT sites at reproductive health
  clinics (MSI)
• - Confidential vs. anonymous HIV testing ?
• - Counseling model ?
• ? Others? (Global Fund)

15
(No Transcript)
16
VCT strategies vary in different populations