FHI - Family-centered HIV Care Is Making a Difference in Vietnam

SEPTEMBER 2008 — Van Anh and her two daughters live in one room on the outskirts of a town in Tan Chau District, An Giang Province, Vietnam. Her husband died some years ago. She became one of the first clients of the new Tan Chau HIV clinic in October 2005, and her health quickly began to improve after she started antiretroviral treatment (ART).

But Van Anh felt powerless to help her daughters, one of whom, Ha, was also HIV-infected. The nearest pediatric HIV facility was in Ho Chi Minh City (HCMC), more than a 12-hour bus ride away. Van Anh managed to save enough money to take Ha there twice, but ART was out of the question.

Then, with PEPFAR-funded FHI support, the Tan Chau clinic started providing pediatric ART in December 2006. Ha was immediately enrolled. She and her sister also receive some support to help them stay at school, and both attend a monthly playgroup for all children in the community, including those who are HIV-infected and affected.

At the clinic, family-care coordinators work as lay social workers who help to assess and address the psychosocial needs of families, including future planning and access to schooling and government social welfare schemes. The coordinators also link families to community-based and home-based care for ongoing support and other vital services.

Comprehensive Care for the Whole Family, in One Facility at the Same Time
Families affected by HIV/AIDS have multiple needs, and when services are not coordinated, care can become more complicated, costly, and fractured. By contrast, family-centered care provides comprehensive care in the same facility for parents, caregivers, and children living with and affected by HIV/AIDS, and at the same time and by the same staff. It includes treatment, management of opportunistic infections, palliative care, nutrition support, and protection and prevention programs.

At the clinic

Van Anh explained the difference family-centered care made for her and her daughters: "Before there was HIV care and ARVs for children at Tan Chau, we had to travel for 12 hours to HCMC so that Ha could be seen at the pediatric hospital. This cost a lot of money, and sometime we were both too sick to travel.

Now I can come with my daughter to the clinic in Tan Chau, and we can both have our health checkups, blood tests, adherence counseling, and pick up our ARV drugs at the same place at the same time. Ha is healthy, and she is now back at school. The clinic even helps me support my other child, who is not HIV infected. The home-based care team looks after all of us and makes sure we are all OK."

Support from Family Health International and PEPFAR
The request to FHI to help support the establishment of pediatric care and treatment services at district-level clinics came from clinical providers frustrated by having to refer HIV-positive children and adolescents to provincial or national referral hospitals, delaying access to timely ART and creating multiple barriers, particularly for the very poor and families with AIDS-related morbidity.

Through PEPFAR, FHI first supported the Government of Vietnam's efforts to provide family-centered care in October 2006. This entailed integrating pediatric HIV care and treatment and services to prevent mother-to-child transmission of HIV into adult HIV clinics, as well as employing community home-based care teams and family-care case managers to supply comprehensive HIV care and support for orphans and other vulnerable children.

To date, 2,434 orphans and other vulnerable children have been reached, 60 children are enrolled in clinical HIV care, and 45 children are on ART. At least 200 pregnant women have been counseled and tested, and nine have received ART, either to prevent transmission or for their own health.

In the next few years, FHI/Vietnam will extend the family-centered approach to other district sites, and is working with the Ministry of Health to adapt it on a national scale.

PHOTOS: (Top) Mother and daughter receive HIV care and treatment at the family-centered HIV clinic in Tan Chau District, An Giang Province. (Bottom) Pharmacists and adherence counselors help mothers, caregivers, and children adhere to antiretroviral drug regimens. (FHI/Vietnam)