Helping more at-risk people know about their HIV infections

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UNONE-467Striving toward the global goal of ending the AIDS epidemic by 2030, in late 2014 Viet Nam committed to achieve the "90-90-90" targets in HIV testing and treatment by 2020.

In other words by 2020, 90% of all people living with HIV in Viet Nam will know their status, 90% of those diagnosed with HIV will be on treatment and 90% of those on treatment will have sustainable viral suppression.

To achieve these ambitious targets, Viet Nam must first address significant obstacles within a short five-year window, especially the first testing target. To underscore the challenges ahead, the country entered 2015 with only one-in-three key HIV affected people – people who inject drugs (PWID), female sex workers and men who have sex with men (MSM), taking HIV tests and knowing their results. In addition, access to traditional health facility-based HIV testing was limited for key populations, with the national average positive rate of the traditional testing approach at just 2% in 2015 according to the Viet Nam Authority for AIDS Control (VAAC).

In response, the UN in 2015 assisted VAAC to introduce an innovative community-based HIV testing and counselling approach with test-for-triage using lay providers to better encourage key affected people to take regular HIV tests.

To introduce this ground-breaking approach in Viet Nam, UNAIDS support and technical inputs from WHO helped VAAC first hold a stakeholder consultation meeting on community-based HIV testing and counselling. This key meeting sensitized relevant stakeholders on the need to diversify testing approaches and the feasibility of community-based lay provider testing. UNAIDS also supported a multi-stakeholder study visit to Cambodia in mid-2015 to facilitate learning about community-based HIV testing and lay providers. As a result, this UN-supported approach took a significant step towards becoming a reality in Viet Nam with the setting up of a VAAC-chaired Steering Committee to direct the pilot of community-based testing to optimize available resources and the sharing of information. Meanwhile, WHO was active on the ground to introduce two new lay provider testing models in Thanh Hoa and Thai Nguyen provinces. In Thanh Hoa, village health workers were trained to reach out and offer HIV testing services in remote villages. In total 606 people, including key populations and partners of people living with HIV received HIV testing and counselling at their own villages. Some 36 were confirmed HIV+ and 34 started antiretroviral therapy (ART). In Thai Nguyen, community-based HIV testing services were provided in collaboration with the network of people who inject drugs. This resulted in 19 PWID for the first time, from four self-help clubs, trained to perform HIV testing using finger prick and rapid tests to provide pre-test information and post-test counselling. A month later in August to December 2015, some 132 people from the key at-risk populations received HIV testing and counselling at the four self-help clubs. Eleven were diagnosed HIV+ and nine started ART.

"Community-based HIV testing benefits us a lot. It is available at the community and is very convenient, comfortable and friendly. Therefore, our peers like to come to us for HIV tests. We also support peers to take confirmatory tests and get treatment," said Dinh Thi Thuy Hang, a lay provider and member of the Belief and Dream self-help group of people who inject drugs in Dong Hy district, Thai Nguyen province.

These initial results show how UN-backed community-based lay provider HIV testing is feasible and can better reach hard-to-reach key affected people for HIV tests as well as ensure a progression from testing to care and treatment. Intensive UN advocacy, coordination and technical support throughout 2015 resulted in a national plan for the official pilot of community-based HIV testing and counselling and the Ministry of Health's Decision 4306/QD-BYT to approve the pilot plan.

"We now have much-needed support at all levels to roll out community-based HIV testing and counselling," said Dr. Phan Thi Thu Huong, Deputy Director General of VAAC. "Evidence shows that key affected people can perform HIV tests with reliable results."

Based on the initial pilot results and within the framework of the national pilot plan of community-based HIV testing, WHO will continue to support the pilot's further expansion in Thai Nguyen and Thanh Hoa provinces, while UNAIDS will back lay provider HIV testing among MSM in Ho Chi Minh City. The lessons learned from these demonstration pilots will inform the development of national guidelines next year for community-based HIV testing.