HIV Care in Ho Chi Minh City

Holly and I spent yesterday getting our bearings and visiting the VCHAP (Vietnam-CDC-Harvard Medical School AIDS Partnership) Clinic in District 5 of Ho Chi Minh City (HCMC). The office is housed at the Infectious Disease Hosptial in HCMC. We met with their staff and saw three HIV case presentations, and in doing so, discovered a gap in our respective strengths. I know more Vietnamese than Holly, and she likewise knows more medicine, but my already tenuous ability to piece together meaning starts to break down when words like "Zidovudine" are thrown in there. The situation was made all the more difficult by the presence of Dr. Donn Colby, Medical Director of VCHAP-HCMC, who speaks Vietnamese as fluently as the guy that sold you pho at the street corner. Only he also knows the medicine.

In addition to the case presentations, we were lucky enough to also get a general overview of VCHAP's role in the national HIV management strategy. The Vietnamese Ministry of Health partners with non-governmental organizations like VCHAP to provide anti-retroviral (ARV) drugs and ARV therapy training to HIV care providers across the country. In the past 5 years, VCHAP has conducted numerous seminars throughout the country, training hundreds of doctors and nurses about HIV management and drug regimines.

HIV mangagement in Vietnam revolves around a set of guidelines set by the World Health Organization (available at this link), and employs a anti-retroviral drug regimine that is no longer used in most developed nations. This particular three-drug combination has quite a few side effects, but is both cheap and effective. A year of medication for a single patient costs $90. The next least expensive option costs $1200, a price that puts nationwide implementation far beyond the resources of a developing nation like Vietnam.

Treatment and management of care occurs at the province level. There are 59 provinces in Vietnam and 5 municipalities that have province-level status. Doctors and nurses at the local level receive training and drugs from the Ministry of Health and NGO's like VCHAP, which are then distributed in the home province or city. If a patient does not respond to the frontline ARV therapy, the case is brought to an advising HIV specialist, who are mostly in the larger cities. Upon consultation with the specialist, the patient can then be prescribed the second-line ARV therapy if the case warrants that treatment. While visiting the VCHAP office, which acts as the consulting body for the southern region of Vietnam, we saw three such case presentations from visiting doctors.

Our overall impression of the VCHAP role in the national HIV management strategy is that it increases efficiency and, most importantly, builds capacity amongst Vietnamese providers to manage HIV at the local level.