Abstract
Objective
To describe an exercise to identify priority provinces to be focused in the Vietnam National HIV Sentinel Surveillance (HSS).
Introduction
The Vietnam National HSS was established in 1994. In the late 1990s and early 2000s, when the epidemic was increasing rapidly, the HSS helped with the intensive close monitoring of the HIV epidemic. In its first 10 years, the HSS was rapidly expanded from 6 to 40 provinces and in some years, it was conducted semi-annually. After two decades, the HIV epidemic situation has changed. In most provinces, HIV prevalence has reported to have declined. Compared to the peak period, the HIV prevalence among key populations (KP) in the past decade decreased from 40-60% to 20% or lower. In many provinces, HIV prevalence was less than 10% among people who inject drugs (PWID) and less than 3% among female sex workers (FSW), and among men who have sex with men (MSM) (Table 1). At the same time, the HIV programme has since been scaled up widely with various interventions and expanded to most of the 63 provinces. In 2014, the government of Vietnam and international stakeholders conducted a joint review of the health sector response to the HIV epidemic and concluded that for better monitoring of the epidemic, a more focused and higher quality surveillance system was needed(1). In 2015, surveillance stakeholders conducted a detailed review of the HSS to discuss prioritization of the surveillance activities.
Methods
The prioritization exercise followed a principle that the HSS should be conducted in locations where there is a large population of KP with a high HIV prevalence and it is feasible to implement. Criteria for prioritizing provinces for inclusion were: 1) a high estimated KP size; 2) high HIV prevalence, measured as a 5 year (2011-2015) average prevalence (P); 3) few years with low HIV prevalence, defined as P <5% among PWID, <3% among FSW and MSM; 4) few years with insufficient HSS sample size, defined as n<150 for PWID, n<250 for FSW and MSM. Steps to prioritize provinces were:
- Reviewed provincial data on KP estimates; HIV prevalence and achieved HSS sample sizes in 5 years, 2011-2015.
- Developed a ranking algorithm taking into account KP size estimates, HIV prevalence and achieved sample sizes.
- For each survey on PWID, FSW, MSM, took top ranked provinces for which sum of KP size estimates of these provinces exceeded 50% of the national KP size estimates.
- Held a consultation workshop among domestic and international surveillance stakeholders to discuss the prioritization exercise. Issues of regional representation of the HSS in the North, South, Central and Highland regions was added as a criteria to adjust the priority list of HSS provinces. The consensus reached in the workshop was the basis for proceeding a formal approval at Ministry of Health.
Results
The data review and panel discussion suggested that the number of provinces to implement HSS should be 20 for PWID, 13 for FSW, and 7 for MSM surveys. While total number of provinces reduced from 40 to 20, all 4 geographical regions of the country were covered. Even with the reduction of the geographical coverage of the HSS, large proportions of the KPs (63.9% of PWID, 58.9% of FSWs and 36% of MSM) were covered under the HSS (Table 2). In February 2017, the Ministry of Health officially approved the 20 priority provinces as a part of the new strategic direction of the Vietnam National HSS.
Conclusions
The data review and panel discussion suggested that the number of provinces to implement HSS should be 20 for PWID, 13 for FSW, and 7 for MSM surveys. While total number of provinces reduced from 40 to 20, all 4 geographical regions of the country were covered. Even with the reduction of the geographical coverage of the HSS, large proportions of the KPs (63.9% of PWID, 58.9% of FSWs and 36% of MSM) were covered under the HSS (Table 2). In February 2017, the Ministry of Health officially approved the 20 priority provinces as a part of the new strategic direction of the Vietnam National HSS.
References
1. World Health Organization. Regional Office for the Western Pacific, 2016, Joint Review of the Health Sector Response to HIV in Viet Nam 2014.