Đào Việt Tuấn Trung tâm Phòng, chống hiv/aids hải Phòng

1. Phạm Minh An (2011), “Tỉ lệ tuân thủ điều trị ARV và các yếu tố liên quan ở bệnh nhân HIV/AIDS người lớn tại tỉnh Bà Rịa- Vũng Tàu năm 2010”, Luận án chuyên khoa II Quản lý y tế.

2. Nguyễn Hữu Đức (2007), “Tác hại của ma túy và chất gây nghiện”, Trường ĐHYD - TP. HCM, http://www.medinet.hochiminhcity.gov.vn/data/news/2003/12/1830/xxxtachaicuamatuyvachatgaynghien.htm, accessed on 14 may 2012.

3. Hà Thị Minh Đức (2009), “Kiến thức thực hành về tuân thủ điều trị bênh nhân HIV/AIDS tại phòng khám ngoại trú quận 10 thành phố Hồ Chí Minh năm 2009”.

4. Ministry of Public Security, "Vietnam National Report on Situation of Illicit Drugs in 2011 and the first 6 months on 2012”.

5. Osterberg L, Blaschke T(2005), “Drug therapy: Coherence to medication”, NEJM, 487-94

6. Xiao L, Wu Z et al (2011), “Quality of life of outpatients in Methadone Maintenance Treatment clinics” J.J Acquir Immune Defic Syndr, 53(1), 116-20.
FANSIPAN CHALLENGE: AN INNOVATIVE MODEL

TO INCREASE HIV TESTING AND COUNSELING UPTAKE

AMONG KEY AFFECTED POPULATIONS IN HO CHI MINH CITY

Authors: Son, Vo Hoang ¹; Ban, Le T. ¹; Hanh, Nguyen Thu¹; Hue, Nguyen Thi²; Hai, Nguyen Van²; Cong, Bui Khanh³; Hai, Nguyen Quoc³; Deen Gu¹, Caroline Francis<sup>1

1</sup> Family Health International (FHI 360)

² Provincial AIDS Committee of Ho Chi Minh City

³ MMT patients
SUMMARY

Keywords: Challenge, expedition leaders, Information Communication Technologies, peer-driven, PWID, HIV, Vietnam.

Issue: The traditional Peer education outreach model is expensive, coverage of the prevention program was 29% of PWIDs in HCMC and referrals PWIDs to HIV testing Counseling (HTC) uptake is limited (22% in 2012). External donor funding declines across many health-related areas nationwide and the Government of Vietnam takes on greater ownership. Cost-effective and sustainable outreach innovative to increase HTC uptake and link to care & treatment among PWID networks in HCMC is critical.

Project: HCMC-PAC with technical and financial support from USAID/ SMARTA has implemented the Fansipan Challenge, which part game, part interpersonal communications intervention, uses peer- driven approach to reach PWID and their sexual/injecting partners to promote HTC uptake and link to care &treatment services. Those reached by the expedition leaders become members of his team, with points awarded for successful testing uptake and enrollment in HIV care & treatment. Contacts, testing and HIV care & treatment enrollment are recorded by ICT system with data inputs via mobile telephones by leaders after a contact and by members themselves after being tested. SMS messages are provided weekly as the challenge promotional strategy and various prizes are awarded for team/individuals who first “reach the peak”. The Challenge started on May 31^st with 14 expedition leaders in 7 teams.

Results: Status Report (June 3 – September,31, 2013).

425 people were reached

306 or 72% individuals were assessed as "high risk"

249 or 58.58% of people- tested for HTC

 181 or 42.58% of these individuals were first time testers

Ho Chi Minh City (HCMC) is located in the south region of Viet Nam. It is described by the World Health Organization and others as a high burden area for HIV and concentrated among most-at-risk-population groups including people who inject drugs (PWID), men who have sex with men (MSM) and female sex workers (FSW)). Although the number of newly HIV infected people identified each year is declining, it remains as high as 4,000 -5,000 new infections identified each year. HIV prevalence among MARPs ranges from 47.8% (IBBS 2009) among people who inject drugs (PWID) [although according to the HIV sentinel surveillance among PWID trends are decreasing from 51.8% to 29.3% (2008 – 2012)], 16.7% (IBBS 2009) among men who have sex with men (MSM), and 16% (IBBS – 2009) among both street and EE based female sex workers (FSWs).

Vietnam moves into middle-income country status, it is clear that external funding for HIV prevention and care is declining. Programs now must be more economical – to foster Government and civil society ownership - more impactful - to avert HIV infections – and more sustainable than ever before. As the traditional Peer education outreach model is expensive, coverage of the prevention program was 29% of PWIDsⁱ in HCMC. Besides that, PEs have reached “current clients”, however it has not expanded to new/hidden client networks and referrals PWIDs to HIV testing Counseling (HTC) uptake is limited (22% in 2012). Moreover, the need for increasing the participation, ownership and responsible shared from target population such as MMT patients help themselves & their friends. Cost-effective and sustainable outreach innovative to increase HTC uptake and link to care & treatment among PWID networks in HCMC is critical.

Project:

HCMC AIDS Committee (PAC) with technical and financial support from USAID/ SMARTA has implemented the Fansipan Challenge, which was initiated for extending and strengthening prevention efforts among high risk drug use networks by involving active MMT patients in district 8 and Binh Thanh District to reach unexposed drug use/their sexual partner networks to increase HIV testing and counseling uptake among PWIDs networks as link care and treatment service as well in Ho Chi Minh city. Part game, part interpersonal communications intervention, the Fansipan challenge uses peer- driven approach with MMT patients as the first and second seeds to reach PWID and their sexual/injecting partner networks with HIV testing and counseling service promotional messaging. Those reached by the expedition leaders become part of his team, with points awarded for successful testing uptake and enrollment in HIV care & treatment. Teams strive to reach 3143 points over a six-month period, or the height of Fansipan Mountain (3143 meters). Contacts, testing and HIV care & treatment enrollment are recorded by Information Communication Technology (ICT) system with data inputs via mobile telephones by leaders after a face to face contact and by members themselves after being tested. SMS messages are provided biweekly as the challenge promotional strategy and various prizes are awarded for team/individuals who first “reach the peak”.

Fansipan Challenge tests assumptions about outreach methodologies in Vietnam and responds to challenge that influence who we reach and how we reach them. The Challenge strives to:

Go beyond traditional outreach networks by using methadone maintenance treatment clients to access drug users and their partners who are not regularly exposed to HIV prevention and care services. The Challenge uses peer-driven approaches to expand coverage across a variety of hard-to-access drug use networks. Peers receive no monthly stipend for their efforts and just one day of orientation before the Challenge begins.­

Test the utility of mobile technologies as a critical and cost-effective component of a country-owned response. In the Challenge, mobile technologies are used to follow up clients; record HIV testing uptake; and provide promotional messaging in place of continuous (and expensive) face-to-face contacts. The Fansipan ICT system tracks coverage, illustrates networks, and verifies service uptake. Can mobile technologies replace some labor-intensive components of outreach, particularly follow up contacts and monitoring? Are digital channels “safe spaces” for key affected populations to share private information? Fansipan Challenge wants to find out...

Engage vulnerable people and mobilize demand for services through creative communications. It’s clear that information alone is not enough to promote positive behaviors. Gamification – where game thinking and mechanics leverage people’s natural desires for competition, achievement and status – rewards players who accomplish desired tasks, like being tested for HIV.

Who will reach the summit?

Seven teams

Three “expedition leader” rounds

Up to 406 persons reached

1 in 3 individuals assessed as “high needs or focus” category

70% - or 284 individuals - test for HIV

Accumulating points helps teams “move up the mountain”

The Fansipan Challenge awards points for the following behaviors:

15 points per contact

60 points for HIV testing uptake

250 points for HIV care/treatment enrollment

The goal: 3143 point or the height of Fansipan mountain (3143 meters)

Points are awarded to teams, not individuals. To accumulate enough points, “expedition” leaders build up their teams and encourage individuals to test for HIV and enroll in care and treatment services if they are HIV positive. Uptake is verified through Fansipan system linkages with the National HIV Testing database and care and treatment clinic enrollment records.

“What’s in it for expedition Leaders”? Fansipan Challenge rewards

The Fansipan Challenge rewards positive behaviors. Individuals who provide their HIV testing code to the Fansipan ICT system automatically receive a mobile telephone top up credit. “Climbers” also have the opportunity to win Fansipan merchandise and gift certificates during Fansipan Challenge special events that take place over the 6- month period. Summit Awards for expedition leaders and team members include Samsung smartphones, HCMC Certificates of Contribution, and restaurant/travel vouchers.

Fansipan’s focus on behaviors – particularly testing for HIV – is reaping positive results (see expedition Update in text box and graphics next page). Of the 425 individuals reached, 306 persons (or 72%) were assessed as high risk or “focus”. 249 persons – 58.58% - tested for HIV after contact with the expedition leader and used the Fansipan ICT system to text in their HTC codes.

Fansipan strives to access those who may not be served by traditional outreach programming. Of individuals testing for HIV, 42.58% indicated that this was the first time they had been tested. The overall HIV positivity rate stands at 23.29%, suggesting that Fansipan is indeed targeting highest risk individuals. Four persons, who were lost to follow up and have currently been enrolled in HIV care and treatment services by peer expedition leader efforts.

Results: Status Report (June 3 – September 31, 2013)

The Fansipan Challenge records program progress in real-time. Here’s initial results:

425 people were reached

306 or 72% individuals were assessed as "high risk"

249 or 58.58% of people- tested for HTC

 181 or 42.58% of these individuals were first time testers

58 or 23.29% of HIV overall positivity rate recorded

15 enrolled in care/treatment

4 LTFUs enrolled in care/treatment

Note: 19 people enrolled in Care and treatment including 4 people, who lost to follow up & 15 new infected people.

Team	Reach	H+	Percentage
Bao Lua	99	9	9.09%
Bao Tuyet	15	2	13.33%
Gio Loc	30	1	3.33%
Mua Bao	50	5	10.00%
Thac Lu	114	27	23.68%
Tia chop	100	14	14.00%
Sam Set	17	0	0.00%
Total	425	58

Fansipan’s focus on behaviors – particularly testing for HIV – is reaping positive results. Comparable data from 12 HIV testing sites in Ho Chi Minh City indicate that just 20 HIV tests are performed among people who inject drugs each month. Fansipan will conduct further analyses of uptake data to illustrate the number of persons re-testing for HIV, newly testing positive, etc. as we continue the climb to the summit

Lessons learnt:

Strong support and smooth coordination between MMT, HTC, OPC at district & city level from PAC.

Timely supportive supervision from the technical team (MMT counselors, PAC coordinator, USAID, SMARTTA) to expedition leaders.

MMT counselors’ role is very important as directly management & support to expedition leaders.

The new model has implemented and adapted a little bit based on needs and issues of expedition leaders.

Recruiting “right expedition leaders”, who are committed, enthusiasm and patient to take part in the Fansipan Challenge are successful initial steps of the program.

A challenge keeps “ expedition leaders’ willing” in recruiting new team members and refer them to HTC uptake and enroll in care treatment.

Regularly shared experience between expedition leaders & documented & shared the implementation steps.

Good ICT system and IT administrator.

Conclusion - Mountain climbing in other locales

USAID/SMART TA will continue to support the HCMC PAC to implement, monitor and refine the Fansipan Challenge over the coming two months. The Challenge will then be expanded to Hai Phong (and selected North provinces) as per the lessons learned in Ho Chi Minh City.

Fansipan’s ICT system will be adapted for use with other vulnerable populations, particularly MSM and FSWs. Here the system will be linked to USAID/SMART TA’s social media engagement strategy that strives to increase demand and uptake of critical HIV services through a variety of media and interpersonal channels.

The initial success of Fansipan suggests that alternative outreach models are feasible in Vietnam. Even more importantly, these models can be monitored and revised to meet the changing needs of clients through the creative use of mobile technologies. USAID/SMART TA looks forward to “climbing more mountains” as it trials different approaches for positive health impact in Vietnam.

Theo cơ quan phòng chống ma tuý và tội phạm của Liên hiệp quốc (UNODC), tình trạng sử dụng các chất kích thích dạng amphetamine (ATS) đang gia tăng một cách đáng lo ngại trong nhóm thanh thiếu niên tại tất cả các quốc gia châu Á, trong đó có Việt Nam [7]. Nghiên cứu gần đây ở một số quốc gia châu Á gồm Thái Lan và Campuchia cho thấy việc sử dụng ATS rất phổ biến trong nhóm thanh thiếu niên, đặc biệttrong các nhóm có hành vi nguy cơ lây nhiễm HIV là nữ mại dâm (FSW) và nam quan hệ tình dục đồng giới (MSM), trong khi nghiên cứu tại Mỹ cho thấy ATS được sử dụng rất phổ biến trong nhóm MSM [4], [5]. Nghiên cứu IBBS tại Việt Nam cho thấy tỷ lệ MSM sử dụng các chất gây nghiện trong nhóm MSM ở Hà Nội (HN) tăng từ 22,8% (2006) lên 31,8% (2009) và thành phố Hồ Chí Minh (HCM) từ 21,0% lên đến 25,3% trong cùng thời gian này [1], [3]. Năm 2010 – 2011, trung tâm Nghiên cứu và Đào tạo HIV/AIDS, trường Đại học Y Hà Nội với sự tài trợ của Văn phòng liên hiệp quốc phòng chống ma túy và tội phạm (UNODC) đã tiến hành một điều tra về tình hình sử dụng ATS xuất hiện ở Việt Nam là hồng phiến, thuốc lắc và đá nhóm trong nhóm MSM, FSWs và nam sử dụng ma túy. Bài viết này sử dụng một phần kết quả của nghiên cứu trên với hai mục tiêu nghiên cứu:1. Mô tả thực trạng sử dụng các chất ma túy tổng hợp dạng amphetamine trong nhóm nam bán dâm đồng giới tại Việt Nam. 2. Xác định mối liên quan giữa sử dụng ma túy tổng hợp dạng amphetamine với hành vi tình dục có nguy cơ.