Doing it for themselves: Communities pioneer new HIV testing approach in Vietnam
A community-based HIV testing pilot set up in Vietnam in 2016 by the World Health Organization (WHO) and the Viet Nam Authority for HIV/AIDS Control is empowering communities and changing lives.
On Tuesday nights, Dang Quoc Phong and his friends get together at a café in Can Tho, Vietnam. They’re not just there to drink coffee and catch up – some are getting tested for HIV. “Guys like coming here because they feel more comfortable, and it’s convenient to be able to pass by after work or classes,” says Phong, a peer leader among men who have sex with men.
A few blocks away, on Wednesday mornings, female sex workers Le Thi Phung and Duong Ho Hue Tam welcome other FSW to their house to drink tea, talk and, if they want, test for HIV.
Duong Ho Hue Tam does an HIV test for a female sex worker in Can Tho, Vietnam.
Free HIV testing has been available in hospitals and clinics across Vietnam for some time, but getting those at highest risk of infection to come to a facility has proven difficult.
Data from 2016 revealed that just 36% of people who inject drugs, 41% of men who have sex with men, and 43% of female sex workers had ever tested for HIV. But as Vietnam focuses on reaching the global target of 90% of people living with HIV knowing their status by 2020, getting people the health services they need, where and when they need them, and without financial hardship is now a priority.
To help with this goal, the Vietnam Authority for HIV/AIDS Control partnered with the World Health Organization (WHO) in 2016/17 to pilot community-based HIV testing in two provinces. This makes Vietnam one of the first countries to adopt WHO recommendations targeting those not testing in traditional facilities.
In the pilot, people from the men who have sex with men, female sex workers and people who inject drug communities were trained to use HIV test kits and to counsel their peers to take a test. Last year, 2520 people at risk of HIV in Thai Nguyen and Can Tho provinces were supported by a peer to get tested. Among those, 140 people were found to be HIV-positive and 94% (131/140) started antiretroviral therapy.
The community-led approach has enabled more people with HIV to be diagnosed and start lifesaving treatment. This is important both for their health and for preventing others from becoming infected, as treatment reduces the amount of virus in a person’s body, dramatically cutting the risk that they will pass it on.
In 2017, peer testing identified 60% of all new HIV cases in Thai Nguyen and 30% of new cases in Can Tho. Nearly 70% of those who took an HIV test in the pilot were first-time testers, suggesting that this community-based approach is achieving its goal of “reaching the unreached”.
As a result of the pilot success, partner testing is now also being implemented – where partners of people who test positive are encouraged to also get tested. Of the 68 partners tested, 27 (40%) were also confirmed to be HIV-positive and 93% (25/27) started treatment.
“The peer leaders in Thai Nguyen and Can Tho are helping people within their communities to find out their HIV status and get started on treatment when necessary. They’re also helping gather evidence for the development of national guidelines on community-based HIV testing,” said Dr Kidong Park, WHO Representative in Vietnam. “This innovative approach is essential to ensuring the people who really need access to HIV testing get it.”
WHO has worked closely with the government to support provincial AIDS centres in training, monitoring and supporting peer educators so that they can provide high-quality services. Financial support from the local government has been mobilized to ensure peer educators receive an allowance to cover their costs. This is essential to the sustainability of community-based HIV testing, ensuring it can continue after the pilot is completed.
Vietnam is aiming to end transmission of HIV, in line with global goals. While there is still a long way to go, the commitment of peer leaders like Phong, Phung and Tam is changing lives, and showing how enabling communities to take the lead can make a difference.
This story was developed by Avert and the World Health Organization (WHO) Department of HIV/AIDS and Global Hepatitis Programme.