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

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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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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, [email protected]

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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