NATIONAL COORDINATING MECHANISM OF THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA IN VIETNAM (CCM VIETNAM) CONDUCTED OVERSIGHT VISIT TO DONG THAP PROVINCE ON DECEMBER 19–20, 2024

On December 19 and 20, 2024, the Oversight Team of the National Coordinating Mechanism of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Vietnam (CCM Vietnam), led by Mr. Nguyen Anh Phong, Vice Chair of CCM, conducted a field visit to Dong Thap province to assess the implementation of HIV/AIDS  prevention and control activities and tuberculosis program under the Global Fund – supported project.

The team worked with project-implementing partners, including: Dong Thap Provincial Department of Health, Dong Thap Center for Disease Control, Dong Thap General Hospital, Dong Thap Lung Hospital, Tam Nong District Health Center, An Long Commune Health Station, Hong Ngu City Health Center, and An Lac Commune Health Station.

The province has proactively utilized Global Fund resources and achieved positive results in HIV and TB prevention and control. It met the 95-95-95 targets. Some indicators have met or exceeded targets, such as: HIV case detection: 95%, on ARV treatment: 94.6%, viral load suppression: 98%, HIV testing among high-risk groups: 100% of target. The public–private partnership model for PrEP treatment has been effective and convenient for patients, ensuring confidentiality. For TB prevention, detection, and treatment, the provincial TB program aims to detect 80% of estimated TB cases, treat over 85% of cases, and improve LTBI treatment. However, there is a reported upward trend in TB cases over time.

Despite these achievements, Dong Thap still faces significant challenges:

For the HIV program:

• In 2025, the Global Fund will no longer support health insurance card payments for HIV patients, leading to shortages.
• The provincial general hospital lacks a confirmatory HIV testing lab, causing difficulties for patients and reducing treatment linkage efficiency.
• Lack of CD4 testing services to assess and provide care for advanced HIV patients, which is also a criterion for urine LF-LAM TB diagnostic testing for HIV patients if implemented in the future.
• Shortages of drugs for TB/HIV co-infected patients (DTG 50 and/or TLE regimen).
• Condoms and lubricants are currently in short supply or near expiration at facilities.
• Challenges in reaching high-risk groups due to:
  1. No peer educators among female sex workers.
  2. Delayed support for case finding and treatment linkage.
  3. Decline in PrEP clients.
  4. Delays in Global Fund budget approval, causing activity delays.

For the TB program:

• Screening and LTBI treatment rates remain low (>3,300 TB patients in 2023 – about 45% of estimated cases, with 592 treated for LTBI).
• Limited capacity of health workers in TB infection control, counseling, screening, and treatment.
• Data management issues: only AFB and Xpert results are recorded in TB treatment registers; other results are not documented.
• TB program funding relies heavily on external sources; provincial budget accounted for only 4% of total TB funding in 2023.

Recommendations from CCM Vietnam:

For the province:

• Urgently work with HIV patients, the Department of Health, and the People’s Committee to maintain health insurance cards and ensure uninterrupted treatment.
• Consider establishing a confirmatory HIV testing lab at the provincial general hospital.
• Strengthen HIV case detection, focusing on MSM groups.
• Develop case-finding and referral procedures based on national guidelines.
• Improve TB patient information management at grassroots level.
• Enhance training for health workers on national guidelines for TB and HIV treatment, monitoring, and data management.
• Strengthen monitoring of multi-tier indicators: number of people at risk of TB, number screened in high-risk groups, number treated after screening.
• Proactively plan budgets for TB and HIV programs to ensure sustainability.

For the central level:

• Provide guidance for units to forecast and procure drugs for less commonly used regimens, such as DTG 50 mg and certain TB drugs for individualized treatment.
• Issue timely financial guidance to avoid delays in settlement and ensure activities for 2025.
• Support facilities to meet conditions for opening confirmatory testing labs.
• Support maintenance of private PrEP clinics to prevent treatment interruptions due to closures.

Field Oversight Report and List of Delegates (attached)
Reported by CCM Vietnam Secretariat