1. THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS THE INITIAL RESULTS OF INTEGRATED ARV-MMT IN PREVENTIVE MEDICINE CENTERS IN HCMC Tieu Thi Thu Van, Nguyen Thi Thuy Nga, Đinh Quoc Thong, Le Thi Ngoc Diep, Mai Thi Hoai Son, Nguyen Thi Thu Thao, Van Hung HCMC AIDS Committee

2. The 6 th National Scientific Conference on HIV/AIDS Outline 1.Background 2.Objectives 3.Methods 4.Results & Discussions 5.Conclusions 6.Recommendations

3. The 6 th National Scientific Conference on HIV/AIDS 1. Background Dec., 2014, HCMC has: –33 OPC for ARV (24 OPC located in PMC at 24 districts, 5 OPC located in hospitals and 4 OPC in 06 Centers) with 24,638 ARV patients; –8 MMT clinics in district PMC with 2,013 MMT patients. By 2012, most of activities and services in MMT clinics and OPCs were funded by NGOs (PEPFAR, Global Fund, DEFID, World Bank…).

4. The 6 th National Scientific Conference on HIV/AIDS 1. Background Since 2012, the funding is decreasing  starting transferring process to the local (activities and budget).  Need to integrate all HIV related services in the clinics, streamline the system to improve working efficiency and ensure to remain the program results and the program sustainable development.  Need to do assessment to identify the effectiveness and feasibility of the integrated model, then provide suitable solutions and orientation for the program development in HCMC in the future.

5. The 6 th National Scientific Conference on HIV/AIDS 1. Background By Oct.,2013, the MMT clinics and the OPC had separately facilities, equipment, budget and staff. OPC Admin Medical Counseling Testing Medicine delivery MMT Clinic Admin Medical Conseling Testing Medicine delivery D. COUNSELING AND COMMUNITY SUPPORT

6. The 6 th National Scientific Conference on HIV/AIDS 1. Background The diagram of patient classification in integrated model Admin (reception, patient classification) Medicine (MMT, ARV) Counseling (HTC, MMT, ARV) Medical (MMT, ARV) 4 5 1 2 4 Testing (urine, blood) 3 76

7. The 6 th National Scientific Conference on HIV/AIDS 2. Objectives “Assess the results of integrated ARV-MMT treatment in Preventive Medicine Centers in HCMC” Specific: 1.Comparing working efficiency of clinic staff before and after integrated 2.Comparing cost of clinic’s operation before and after integrated. 3.Comparing the program monitoring results of ARV and MMT treatment before and after integrated.

8. The 6 th National Scientific Conference on HIV/AIDS 3. Methods Research design: Cross sectional study Time: Before integrating: From Mar. to Sep., 2013; After integrating: from Jul. to Dec., 2014 Research place: OPC and MMT clinics in D.6 and Binh Thanh. Research population: MMT and ARV staff and patients of the clinics in the 2 districts..

9. The 6 th National Scientific Conference on HIV/AIDS 3. Methods Research sample:  Working efficiency:  Cost: All operation cost by cash for the clinics activities in 6 months before and after the integration  Activity results: ARV: 5 HIVQUAL indicators; MTD: 6 monitoring indicators integrationWorking time (staff)Service used time (patients) Before40 casesARV = 165; MTD = 160 After23 casesARV = 156; MTD = 163

10. The 6 th National Scientific Conference on HIV/AIDS 3. Methods Analysis methods: Descriptive statistic and then used comparing analysis to understand about the data (excel, SPSS sata 13.)

11. The 6 th National Scientific Conference on HIV/AIDS 4. Results & Discussions After integrated, the number staff was cut down in both program, particularly ARV. Clinic staff before and after integrating model

12. The 6 th National Scientific Conference on HIV/AIDS 4. Results & Discussions Working time of the clinic staff before and after integration After integrated, staff’s working time was increased quite high because of the staff was trained to work with multiduties.

13. The 6 th National Scientific Conference on HIV/AIDS 4. Results & Discussions Waiting and receiving the service of ARV/MMT patients ARV patients: after integrated, time for waiting and receive the the service (ARV/MMT) were decreased but ART patients have to spend more time to wait.

14. The 6 th National Scientific Conference on HIV/AIDS 4. Results & Discussions Thời gian chờ và nhận DV của BN Methadone trước và sau lồng ghép MMT patients: after the integration, patient time for waiting and receiving the service was reduced.

15. The 6 th National Scientific Conference on HIV/AIDS 4. Results & Discussions Summary of cost and number of enrolled patients before and after the integrated After integrated: -Cost was go down -The number of patients was go up

16. The 6 th National Scientific Conference on HIV/AIDS MMT indicators Before (4-9/2013) After (7-2/2014) P-value (CI) Patients who enroll into the MMT program 37,8% (28/74) 84,5% (93/110) p<0,001 (0,270-0,491) Patients who remain in the treatment at least 12 months 92,1% (488/563) 83,1% (490/606) p<0,001 (0,053-0,127) Patients with HIV (-) were screened every 6 months 20,3% (63/311) 52,5% (170/324) p<0,001 (0,250-0,390) Heroin (+) among patients who were in the treatment at least 6 months 8,3% (44/530) 3,5% (19/537) p=0,006 (0,012-0,068) Patients who stop treatment for 5 days continuously 8,2% (46/563) 5,3% (32/606) p=0,037 (0,003-0,058) Patients who leave the program 8,9% (47/563) 3,4% (20/606) p<0,001 (0,016-0,044) 4. Results & Discussions

17. The 6 th National Scientific Conference on HIV/AIDS 4. Results & Discussions ARV indicators BeforeAfter P-value Cases/total patient-year (%) Loss follow-up before treatment 12/1.535 (8,4)14/1.232 (17,0)0,174 Death before treatment 7/1.535 (5,86)1/1232 (0,75)0,038 Loss follow-up during the treatment 40/17090 (2,95)37/17211 (2,8)0,356 Death during the treatment 26/17090 (1,77)22/17211 (1,57)0,275 Patients meet the criteria treatment for ARV but did not get the treatment 223/356 (60,75)59/168 (33,35)<0,001 All most of the indicators did not show any affected by the integrated ARV-MMT services

18. The 6 th National Scientific Conference on HIV/AIDS 5. Conclusions The limitation of integrated model: The staff was put at risk of workload. The service quality was put at risk of go down because doctors and staff did not have enough time for patients to support their needs.

19. The 6 th National Scientific Conference on HIV/AIDS 5. Conclusions Benefical of the integrated model: Improve staff effective working Save cost for operation and staff through restructured system and have reasonable allocative jobs. In generally, the integrated model has not any affective to the results of the 2 clincs.

20. The 6 th National Scientific Conference on HIV/AIDS 6. Recommendations The integrative model was cost saving, Mô hình lồng ghép hiệu quả, tiết kiệm, giúp đảm bảo được sự bền vững của CT vì tận dụng được các nguồn lực sẵn có cần được xem xét nhân rộng. The integrative model should incorporative, streamlined, professional and appropriate assignment to ensure both quality cost and effectiveness expenditure.

21. The 6 th National Scientific Conference on HIV/AIDS QUESTION? THANK YOU!