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3. Surprises in implementation 1.5 years to import and install FACSCounts

Challenges and Lessons Learned in Establishing a Successful CD4 Count System using FACSCount in Vietnam. NGUYEN Van Kinh 1 , Ritu SHRIVASTAVA 2 , VU Duc Canh 1 , Marvin COULDWELL 3 , David KUHL 3 , LUU Ho Thanh Tuan 3 , TRAN Phuong Thuy 3 , Grace HAFNER 3

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3. Surprises in implementation 1.5 years to import and install FACSCounts

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  1. Challenges and Lessons Learned in Establishing a Successful CD4 Count System using FACSCount in Vietnam NGUYEN Van Kinh1, Ritu SHRIVASTAVA2, VU Duc Canh1, Marvin COULDWELL3, David KUHL3, LUU Ho Thanh Tuan3, TRAN Phuong Thuy3, Grace HAFNER3 1 Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam, 2 Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam, 3 Supply Chain Management System (SCMS), Hanoi, Vietnam. Correspondence: Ritu Shrivastava, shrivastavar@vn.cdc.gov 1. Socialist Republic of Vietnam • 4. Lessons learnt • Not to start a CD4 system without establishing a back-up specimen referral system, early on • Import equipment only via a specialist experienced partner • Establish a reliable stock management system in laboratories • Ensure a quality cold chain distributor • Location: South East Asia. • Land area: 331,114 sq km • 64 provinces • Population: 84 million • Pop. growth rate: 1.33% • GDP per capita: $639 • HIV prevalence 0.44% • Source: Health Statistics Year Book 2006, UNDP March 05) • 2. Background • 17,000 patients on ART by September 2008: MOH/PEPFAR goal • 103 patients, initiated ART in September 2005 • Vietnam National Program supported 1 FACSCount and 1 FASCALIBUR, 1994 • Given geographically scattered sites, PEPFAR ordered FACSCount for 5 key provinces. • 5. Critical steps to set up a reliable CD4 system • With support from MOH, PEPFAR, SCMS, CHAI, CDC Thailand and Atlanta, WHO, BD and Delta we eventually facilitated • Training for equipment operation and maintenance • Stock management system • Cold chain distributor • Hired appropriate staff • CD4-related guidelines • CD4 EQA system • Specimen referral network • 3. Surprises in implementation • 1.5 years to import and install FACSCounts • Most FACSCounts had broken pump in the first month • First shipment of reagents took 7 months to import resulting in nearly expired reagents (USG regulations for VAT and duty waivers) • Difficulty in fore-casting, resulting in under and over-ordering supplies • 6. Next steps • Several donors are offering different brands of CD4 equipment in Vietnam • Additional co-ordination among partners is required to maximize program effectiveness. • Conduct a review of demand curve and respond by adjusting the capacity (example replacing FACSCount with FACSCalibur).

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