With financial support from the Global Fund and technical support from WHO, an innovative digital health programme is helping people at risk of HIV to test themselves and receive care, moving Viet Nam closer to ending the AIDS epidemic and bringing hope on World AIDS Day on 1 December 2024 and beyond.
Viet Nam has a well-established HIV programme, including an essential package of services delivered through community-based organizations.
However, some of the estimated 250,000 people living with HIV in Viet Nam struggle to access services for several reasons, including stigma and discrimination (for example against transgender women or men who have sex with men (MSM)), limited availability of services, and barriers such as fear of coming forward for help as sex workers or injecting drug users.
“An HIV test is the first step towards care. If the result is negative, we can prevent HIV with pre-exposure prophylaxis (PrEP). If it’s positive, we can treat someone with antiretroviral therapy (ART).
“But we knew not everyone had access to the test, so we needed to give them more options,” Associate Professor Phan Thi Thu Huong, Director General of the Viet Nam Administration of HIV/AIDS Prevention and Control at the Ministry of Health said.
“So, in 2019, we began developing an online platform that became absolutely crucial during the emergency phase of the COVID-19 pandemic, when it was even more difficult for people to have in-person health care.”
From November 2020, the Ministry of Health, with support from WHO, piloted a web platform where people could go online and request HIV tests, condoms, lubricants and needles and syringes; start or continue to use PrEP to reduce the risk of getting HIV if they tested negative; and link to services that offer ARV if they tested HIV positive. Users could choose to pick up the free self-testing kits, have them sent by courier or delivered by a peer educator.
The World Health Organization (WHO) supported the project with funding from the Global Fund to Fight AIDS, TB and Malaria (GFATM), the Unified Budget, Results and Accountability Framework (UBRAF) of the Joint United Nations Programme on HIV/AIDS (UNAIDS), and UNITAID, a health initiative hosted by WHO. The project aligns with WHO recommendations to use virtual interventions to help people in risk groups access HIV testing. Viet Nam is one of very few countries to offer HIV self-testing through a virtual platform.
The pilot began in Can Tho Province and was expanded to Ha Noi and Nghe An Province in April 2021. Participants in the three pilot areas gave very positive feedback, saying the programme was easy to use, confidential and friendly. Participants suggested the programme should be rolled out around the country, and that they would recommend it to others.
“This service is very helpful,” one participant said. “Sometimes, I am very shy to go to the health facilities to do regular tests. Thanks to this service, I don't hesitate to get a test anymore. It was very fast and the counsellor was enthusiastic.”
Dr Huong said, “We found the website was a safe and effective way to reach people who may not test otherwise, including young MSM and other people from key populations. We were especially pleased that nearly half of participants were testing for the first time. If they tested positive, nearly all of them went on to receive health care, which is an excellent result.”
Thanks to its success, the pilot was scaled up, starting in April 2022, to 25 additional provinces, a total of 28 of the country’s 63 provinces, with support from the Global Fund and the US President's Emergency Plan for AIDS Relief (PEPFAR) and WHO.
An evaluation of the pilot by WHO and the Ministry of Health was published in the Journal of the International AIDS Society.
Dr Huong said community-based organizations played a crucial role in the pilot’s success.
“No matter how clever or clear our digital platform was, we could not have helped these hard-to-reach groups without the active involvement of community networks.
“Clinics that are led by MSM and transgender communities can understand and reach out to the communities through their networks. Their skills and commitment are essential if we want to close the gaps in testing, treatment and care for HIV.”
Dr Huong said, “The project’s success is a reminder that we can end AIDS – if we ensure everyone can access testing and care if needed.”
The theme of Viet Nam AIDS Day for 2024 is “Equity and equality in accessing HIV/AIDS services to end AIDS by 2030”.
WHO Representative in Viet Nam Dr Angela Pratt said the project showed how digital health can help reach the unreached.
“Digital health platforms are amazing tools for improving equity and access. By closing gaps in access to HIV testing like this, we can reach and engage everyone who is living with, at risk of or affected by HIV – especially people who are the most excluded and marginalized.”
Dr Pratt had a message for anyone unsure of their HIV status:
“We want everyone to stay healthy and keep others safe by getting tested. You can choose to get an HIV test in person at your preferred health-care facility or, depending on your home province, order a home self-test delivered to your door.”
With funding support, the programme could be further expanded where it is most needed.
The telehealth initiative will help Viet Nam reach targets from its National Strategy to End the AIDS Epidemic by 2030 and from UNAIDS of achieving 95% of people living with HIV being aware of their status, 95% of people aware of their status accessing treatment, and fostering wider access to prevention services.
The global theme for World AIDS Day 2024 is Take the Rights Path.