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Innovative viral hepatitis initiative increased awareness and service uptake among high-risk populations in Vietnam

July 20, 2022 by PATH

PATH, Vietnam’s Ministry of Health, and The Hepatitis Fund share the results of HepLINK: a novel model of community-based and HIV-integrated viral hepatitis service delivery.

Hanoi, Vietnam, July 20, 2022 – Today, PATH and the Vietnam Administration of Medical Services (VAMS) of the Ministry of Health held a workshop to conclude the two-year HepLINK project, which ran from 2020 through 2022. A joint initiative between PATH and The Hepatitis Fund (EndHep2030), HepLINK integrates viral hepatitis screening into the delivery of HIV and related services in locations where key populations often prefer to receive care. These locations include community-based organizations and health facilities such as methadone maintenance therapy centers (which provide methadone treatment for drug users), outpatient clinics (which offer HIV antiretroviral therapy for those living with HIV), and private key population–led primary care clinics (which provide a range of health services including pre-exposure prophylaxis, a daily pill for preventing HIV).

Through HepLINK, PATH actively engaged 9 community-based organizations and 18 health facilities in viral hepatitis service delivery and worked closely with them to stay responsive to changing context and strategies, including through swiftly adapting to COVID-19 lockdowns. From April 2021 through May 2022, these facilities tested 19,601 people for hepatitis C (HCV) and 19,518 people for hepatitis B (HBV), detected 2,285 people infected with HCV and 1,552 people infected with HBV, and identified 874 people with chronic HCV and 604 with chronic HBV needing treatment, of which 668 and 464 people initiated HCV and HBV treatments, respectively.

The project’s work to boost demand generation, strengthen providers’ skills in pre- and post-test counseling and referral systems, and increase the use of social health insurance and domestic financing yielded a significant increase in diagnosis and treatment uptake. Among clients with a positive screening test result, 48.1% and 43.8% received confirmatory testing for HCV and HBV, respectively, and 76.4% of those diagnosed for HCV and 76.8% of those diagnosed for HBV were enrolled on treatment. This is a breakthrough change compared to the national estimate in 2020 that only 7% of people living with HCV and 17% of people living with HBV were diagnosed, and only 1% were treated annually.

“HepLINK is an innovative solution to help people detect viral hepatitis early on, enhance community awareness of the disease, and boost community engagement in the viral hepatitis response.”
— Assoc. Prof. Luong Ngoc Khue, General Director, VAMS

While Vietnam’s Ministry of Health has shown a strong commitment to eliminating viral hepatitis and increasing access to key prevention, testing, diagnosis, and treatment services among high-risk populations, a stand-alone viral hepatitis program is extremely resource-intensive. At the project dissemination event, Associate Professor Luong Ngoc Khue, General Director of VAMS, said: “The Vietnam Administration of Medical Services (VAMS) highly appreciates the HepLINK project's efforts in implementing a pilot activity to integrate viral hepatitis screening into HIV services. HepLINK is an innovative solution to help people detect viral hepatitis early on, enhance community awareness of the disease, and boost community engagement in the viral hepatitis response.”

The lessons learned from HepLINK are now being put into action. PATH is continuing to work closely with the Ministry of Health to offer this model of integrated service delivery at larger scale and advocate for essential financing and policy that could help motivate those at risk for viral hepatitis to seek HBV and HCV testing and diagnosis; receive and adhere to treatment; and in the case of HCV, achieve cure. While progress toward HBV and HCV elimination is still a real challenge, optimizing use of resources through service integration may help eliminate some of the key cost and access barriers.

“Resources for a viral hepatitis program are scarce, so integrating viral hepatitis into HIV services that have been built up and offered in the community and primary health care health facilities for decades is a great starting point. This approach helps reach people where they are, and addresses what they need to prevent advanced HIV, chronic liver disease and cancer, and death,” said Dr. Vu Ngoc Bao, Senior Technical Director, HIV/TB and Viral Hepatitis at PATH, who oversees the HepLINK project.

Viral hepatitis

Viral hepatitis is one of the most deadly and neglected diseases and health crises, affecting more than 350 million people and claiming more than 1.1 million lives per year. In Vietnam, viral hepatitis is the third leading cause of death, with almost 9 million chronic infections from HBV and HCV combined. People living with HIV and key populations—including people who inject drugs, men who have sex with men, transgender women, and female sex workers—are among those at highest risk for both viral hepatitis and HIV infection in the country.