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HIV/AIDS Prevention and Treatment

HIV/AIDS Prevention and Treatment

Health Systems 20/20 is collaborating with Family Health International (FHI) and several local partners to evaluate a number of programs related to HIV/AIDS prevention and treatment in Vietnam. Programs include discharge planning, access to HIV prevention, care, and treatment, substance abuse counseling, and relapse prevention interventions for individuals transitioning from drug rehabilitation centers back to their communities. Currently, with resources from PEPFAR, Health Systems 20/20 is evaluating a pilot transitional program with case management/drug counseling pre- and post-release focused on individuals returning from the Nhi Xuan drug rehabilitation facility to four target districts in Ho Chi Minh City (HCMC).

The pilot transitional program consists of two primary components: Nhi Xuan center-based pre-release interventions and community-based interventions in four target districts. Services offered in the Nhi Xuan facility include: peer education, case management and drug counseling; access to voluntary counseling and testing (VCT); peer education; anti-retroviral treatment (ART) treatment and care for people living with HIV/AIDS (PHA); and discharge planning and pre-release training which includes family visits, visits to community clinics that may serve them post-release, and assessments by case managers focusing on client risk of relapse following discharge.

Services offered in the communities include: continued case management and drug counseling; peer education; continued access to VCT; and continued ART treatment and care in outpatient clinics for PHA. Since case management and drug counseling are new to Vietnam, the scale-up and quality of these services will be gradual and expanded over time. Other services such as vocational training and job placement and different forms of drug relapse prevention and treatment will also be added. It is expected that methadone will be available to selected clients starting in May 2008.

The evaluation of the pilot transitional program has four components:

• Program monitoring data collection and analysis
• Qualitative assessment
• Cost analysis
• Cohort study of client-level outcomes

The program monitoring component will document the level and scope of services received by each client at Nhi Xuan Center and in the four districts of HCMC targeted by the PEPFAR-supported program as well as services provided in the four target districts to returnees from other centers and districts. The program monitoring data to be collected and analyzed will also contribute to the overall HCMC transition program. The tools and procedures developed and the technical assistance provided will help to build local procedural infrastructure and staff capacity for conducting broader assessments of the HCMC-wide transitional program and other related service delivery components.

The qualitative assessment component will be used to enrich the findings from the process evaluation and cohort studies to gain in-depth information about the extent, nature, and perceived value and benefit to clients of the transitional interventions provided by all project partners, including PEPFAR/FHI, the Ho Chi Minh City Provincial AIDS Committee (PAC), and the Department of Labor, Invalids, and Social Affairs (DOLISA), and the level of coordination among service providers.

The cost analysis is primarily intended to measure the cost of the Nhi Xuan Transitions Pilot in order to assess its sustainability and replicability. The cost analysis will be integrated into the program monitoring data component. The result of the cost analysis will be estimates of the cost per client to deliver the transitional intervention. The cost analysis will seek to capture cost data on services provided by all partners in the program -- PEPFAR (FHI, CDC), HCMC PAC, DOLISA, Voluntary Youth Force.

The cohort study, led by FHI, will track a cohort of individuals transitioning from Nhi Xuan and other rehabilitation centers back to their communities over time to measure intervention outcomes and impacts. Key indicators will include measures of relapse to various levels of drug use; sexual behavior, including commercial sex and condom use; quality of life; adherence to ART for PHA; and exposure to project and other interventions.