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Access to ARV in Vietnam: Current situation and challenges

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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Access to ARV in Vietnam: Current situation and challenges

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  1. Access to ARV in Vietnam: Current situation and challenges

  2. Outline • HIV epidemic situation and ARV treatment • Treatment orientations • Current ARV drug supply sources • Challenges in access to ARV drug • Issues under debates

  3. 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

  4. 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

  5. HIV infection: from diagnosis to treatment Many PLHIV have not yet accessed to treatment

  6. Distribution of patients on ART by drug supply sources – 12/2012 95% ARV drugs for HIV treatment in Vietnam supported by international organizations

  7. Financial structures for care and treatment 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

  8. Budget for ARV drugs by 2016* 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

  9. Estimated patients interrupted and not accessed to ART # of patients with interrupted treatment and not access to treatment according plan # of patients retained in treatment

  10. ARV reporting and quantification chart Monthly report to VAAC National Program supported sites Procurement team meets quarterly to quantify Monthly report to PAC GF supported sites PEPFAR supported sites

  11. Three procurement mechanisms from three financing sources 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

  12. ARV treatment orientations • Continue to expand ART provision for PLHIV • Supply ARV drugs with ensured quality, continuity and reasonable costs • Gradually socialize HIV/AIDS treatment

  13. Optimal solutions for ARV sustainable supply? 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

  14. Issues under debates • 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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