title: A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam.
abstract: BACKGROUND
  The global initiative 'Treatment 2.0' calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam.
  
  
  METHODS
  We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data.
  
  
  RESULTS
  Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services.
  
  
  CONCLUSIONS
  Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the 'Treatment 2.0' initiative.
authors.affiliation: World Health Organization Cambodia Office, No, 177-179 Pasteur (St,51) (corner 254) Sangkat Chak Tomouk, Phnom Penh, Cambodia. fujitam@wpro.who.int
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Poudel
authors.forename: Thi Nhan
authors.initials: TN
authors.lastname: Do
authors.forename: Duc Duong
authors.initials: DD
authors.lastname: Bui
authors.forename: Van Kinh
authors.initials: VK
authors.lastname: Nguyen
authors.forename: Kimberly
authors.initials: K
authors.lastname: Green
authors.forename: Thi Minh Thu
authors.initials: TM
authors.lastname: Nguyen
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.forename: David
authors.initials: D
authors.lastname: Jacka
authors.forename: Thi Thanh Thuy
authors.initials: TT
authors.lastname: Cao
authors.forename: Thanh Long
authors.initials: TL
authors.lastname: Nguyen
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D003376:Counseling; D019033:Delivery of Health Care, Integrated; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D011314:Preventive Health Services / Q000331:legislation & jurisprudence / Q000592:standards*; D011785:Quality Assurance, Health Care; D014744:Vietnam
chemical_list: D044966:Anti-Retroviral Agents