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The Potential Impact of Expanding Antiretroviral Therapy and Combination Prevention in Vietnam: Towards Elimination of HIV Transmission

Kato, Masaya PhD, MPH*; Granich, Reuben MD, MPH; Bui, Duong D. MD, PhD; Tran, Hoang V. MD§; Nadol, Patrick MPH; Jacka, David MD, MPH*; Sabin, Keith PhD, MPH*; Suthar, Amitabh B. PharmD, MPH; Mesquita, Fabio MD, PhD*; Lo, Ying Ru MD; Williams, Brian PhD#

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2013 - Volume 63 - Issue 5 - p e142–e149
doi: 10.1097/QAI.0b013e31829b535b
Implementation and Operational Research: Epidemiology and Prevention

Background: Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs. We investigated the impact of expanded HIV testing and counseling (HTC) and early ART, combined with other prevention interventions on HIV transmission.

Methods: A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting subpopulations and examining combined strategies with methadone maintenance therapy and condom use.

Results: From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections and will cost US $22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost US $76.9 million. Annual HTC and immediate treatment offered only to people who inject drugs will reduce new infections by 13,578 (75%) and will cost only US $23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years.

Conclusions: Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

Supplemental Digital Content is Available in the Text.

*World Health Organization Vietnam Country Office, Hanoi, Vietnam;

World Health Organization HIV/AIDS Department, Geneva, Switzerland;

Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam;

§Partners in Health Research, Hanoi, Vietnam;

US Center for Disease Prevention and Control Vietnam Country Office, Hanoi, Vietnam;

World Health Organization Regional Office for the Western Pacific Manila, Philippines; and

#South African Centre for Epidemiological Modelling and Analysis, Geneva, Switzerland.

Correspondence to: Masaya Kato, PhD, MPH, World Health Organization Vietnam Country Office, 63 Tran Hung Dao Street, Hanoi, Vietnam (e-mail katom@wpro.who.int).

M.K., R.G., and B.W. contributed to conception of the study. B.W., M.K., R.G., D.D.B., A.B.S., F.M., and Y.R.L. contributed to design of the study. Data synthesis was undertaken by M.K., H.V.T., P.N., D.J., and K.S. Mathematical modeling was done by B.W. and A.B.S. The authors M.K., R.G., H.V.T., P.N., A.B.S., and Y.R.L. contributed in the literature review. M.K., B.W., and R.G. drafted the report. M.K., R.G., D.D.B., H.V.T., P.N., A.B.S., D.J., K.S., F.M., Y.R.L., and B.W. contributed to review and editing of the publication.

Supported by United Nations in Vietnam. Modeling work by B.W. was supported by United Nations in Vietnam through One United Nations fund to World Health Organization.

The opinions and statements in this article are those of the authors and do not represent the official policy, endorsement, or views of World Health Organization and US CDC

The authors have no conflicts of interest to disclose.

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Received November 11, 2012

Accepted March 22, 2013

© 2013 by Lippincott Williams & Wilkins