Challenges and Lessons Learned in Establishing a Successful CD4 Count System using FACSCount in Viet...
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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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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 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).