1. A model for integrating family- centered care into HIV clinical and community services in Vietnam Kimberly Green Family Health International August 11, 2009

2. Background Concentrated epidemic Approximately 45% of PLHIV in care have children GoV & FHI with PEFPAR/USAID support 18 Continuum of Care (COC) sites –District coordination committee –District hospital HIV out-patient clinics (ART, palliative care, OI rx, nutrition support, etc) –Linked community and home-based palliative care (CHBC) services and PLHIV support groups –Support for children affected by HIV through routine family case management

3. Low uptake: challenges to family- centered care - 2006 Enrollment of children living with and affected by HIV was much lower than expected given estimates –~470 children enrolled in support services (16% of adults) Rapid assessment identified the following issues: –Lack of pediatric HIV care services in rural areas: adults bringing their children into adult HIV clinics seeking care –CHBC teams more focused on care for adults –High levels of stigma, major barrier to enrolling children/families into govt social welfare programs and other services

4. 5-pronged approach Goal: Increase OVC access to care using a family-centered care case management approach focused on minimizing stigma and integrating OVC and families in existing social welfare services 1. Active but discrete identification of OVC in need of care 2. Family case management: routine assessment and care 4. Partnership with local social welfare services 5. Addressing barriers to services: work with local leaders to address problems and improve community acceptance 3. Enhanced package of services incl family clinic

5. Lab TB Services District Hospital -IPC and OPD COMMUNITY/HOME OTHER CBOs PLHIV SUPPORT GROUPS PLHIVFamilies Family Centered Care Family Maternity Tertiary Health Facilities CHBC/OVC services Pediatric OPD Adult and Pediatric HIV Clinic – includes PMTCT

6. Results Mid 2009: –Number of children enrolled approaching original estimate –Quality of pediatric care and treatment reported high by external QA/QI –No LTFU of infected/exposed children –Majority children successfully enrolled/re-enrolled in school –Adoption of family centered approach in GoV National Plan of Action for Children and HIV Mid-2006Mid-2009 Adults3,0007,200 OVC470 (16%) 2,922 (41%) Table 1. Number and percentage of children receiving care versus adults: 2006 vs 2009

7. Challenges and way forward Child communication and counseling…an area that needs strengthening Support roll-out of the NPA –Work towards institutionalizing family-centered care approaches within the GoV social welfare system

8. Key resources Scaling up the Continuum of Care for PLHIV in Asia and the Pacific: A Toolkit for Implementers –Establishing systems of care for adults and children in concentrated and low level epidemics HIV Counseling Resource package (UNICEF/FHI/WHO) –Counseling guide for adults and children The Way We Care: A Guide for Managers of Programs for Vulnerable Children and Youth –Program guide: family centered care case management www.fhi.org

9. Acknowledgements MoH/VAAC PEPFAR USAID HHS-CDC UNICEF WHO PACT Clinton Foundation FHI – Drs. Rachel Burdon, Vu Ngoc Phinh, Phan Thu Phuong, Nguyen Thi Thanh Ha, Vu Ngoc Son Viet Nam PAC/DHs – Hanoi, Hai Phong, Quang Ninh, Dien Bien, Lao Cai, Nghe An, HCMC, Can Tho, An Giang

10. Thank You!

11. The Numbers… Vulnerable groupsNumbersSource Estimated number of children living with HIV 3,818 (Range: 2,536-6,110) MoH, 2009 Estimated number of children affected by HIV 283,667MOLISA, 2003 Orphans from all causes - Double orphans - Maternal orphans - Paternal orphans 143,000 25% 43% 34% MOLISA, 2007 1,276,000GSO, 2007 Children orphaned by AIDS68,874 (Range: 36,695-138,570) UNAIDS, 2007

12. Package of Care Cognitive Development: Children Play and educational opportunities by age and stage; training parents/caregivers in parenting skills and child development; schooling support Social Support and Protection: Adults & Children Link to government social welfare funding Link families to IGA (eg Womens Union) Preventing abuse; identifying and caring for abused children Physical Care: Adults & Children OI treatment and prophylaxis, palliative care, ART, adherence support CT, PMTCT, prevention counseling growth monitoring, nutrition support immunizations, primary health care Emotional Support: Adults & Children Assessment of emotional well-being and lay counseling and support Succession planning Support group