Access to arv in vietnam current situation and challenges
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Access to ARV in Vietnam: Current situation and challenges. Outline. HIV epidemic situation and ARV treatment Treatment orientations Current ARV drug supply sources Challenges in access to ARV drug Issues under debates. HIV epidemics in Vietnam. By end of 2012: Estimated:

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Outline
Outline

  • HIV epidemic situation and ARV treatment

  • Treatment orientations

  • Current ARV drug supply sources

  • Challenges in access to ARV drug

  • Issues under debates


Hiv epidemics in vietnam
HIV epidemics in Vietnam

By end of 2012:

  • Estimated:

    • PLHIV nationwide 256,400

  • # detected

    • HIV prevalence among IDUs 11,6%

    • HIV prevalence among CSW 2,7%

    • HIV prevalence among MSM: 2,3%

    • HIV prevalence among pregnant women: 1,9%

    • HIV reported cases 208,866

  • Key HIV transmission path in Vietnam is via drug injection, however MSM transmission was seen

  • Uneven distribution


Arv treatment for plhiv
ARV treatment for PLHIV

Number of PLHIV on treatment by year

ART coverage *

  • Objective by 2015: 105,000 persons

Adult

Children

*: - Before 2009: CD4 count threshold for initiating ART ≤ 250

- Since 2009: CD4 count threshold ≤ 350


Hiv infection from diagnosis to treatment
HIV infection: from diagnosis to treatment

Many PLHIV have not yet accessed to treatment


Distribution of patients on art by drug supply sources 12 2012
Distribution of patients on ART by drug supply sources – 12/2012

95% ARV drugs for HIV treatment in Vietnam supported by international organizations


Financial structures for care and treatment
Financial structures for care and treatment 12/2012

Bilateral organizations

Multilateral organizations

State budget

Households

State budget allocation for ARV procurement is presently at 8% - 11%/year, equal to 1.1 mill. USD/year

Source: NASA 2008-2010


Budget for arv drugs by 2016
Budget for ARV drugs by 2016 12/2012*

State budget

PEPFAR

GF

Total committed budget

*: Data provided by PEPFAR, GF Round 9 notification and planned state budget for ARV drugs increasing by 20% per annum


Estimated patients interrupted and not accessed to art
Estimated patients interrupted and not accessed to ART 12/2012

# of patients with interrupted treatment and not access to treatment according plan

# of patients retained in treatment


ARV reporting and quantification chart 12/2012

Monthly report to VAAC

National Program supported sites

Procurement team

meets quarterly to quantify

Monthly report to PAC

GF supported sites

PEPFAR supported sites


Three procurement mechanisms from three financing sources 12/2012

GF Quarterly Order

International procurement

Procurement team

meets quarterly to quantify

PEPFAR Quarterly Order

National Program Annual Order

Procurement from local pharma companies*

Drug prices offered by international suppliers much lower than locally procured

*: small quantities locally manufactured, some procured from foreign pharma companies, redistributed


Arv treatment orientations
ARV treatment orientations 12/2012

  • Continue to expand ART provision for PLHIV

  • Supply ARV drugs with ensured quality, continuity and reasonable costs

  • Gradually socialize HIV/AIDS treatment


Optimal solutions for arv sustainable supply
Optimal solutions for ARV sustainable supply? 12/2012

State budget

Health insurance

Self-payment

Financial sources

- High prices

- Low prices

Supply sources and procurement mechanisms

Drug prices

International procurement

Local procurement

Local manufacturing


Issues under debates
Issues under debates 12/2012

  • Stable financial sources for appropriate ARV supply in Vietnam:

    • State Budget

    • Health insurance

    • NTP

    • Self-payment

  • Appropriate measures to reduce drug prices in Vietnam:

    • International procurement via bilateral cooperation:

      • VPP

      • Cooperation with CHAI

    • Procure from local drug suppliers

    • Centralized or decentralized procurement

    • Expand ARV local manufacturing


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