HIV Recency Testing in Vietnam
HIV Recency Testing
Preliminary experiences from Vietnam
Dr.
Nguyen Hoang Long
Director General, Vietnam Authority of HIV/AIDS Control (VAAC)
Contents
1.
Implementation timeline
2.
Some initial findings
3.
Conclusions
HIV/AIDS Epidemic in Vietnam: Key Facts
96
millions pop
250.000
PLWH
Concentrated epidemic:
PWID
(14%),
MSM
(12%),
FSWs
(3,6%)
Reduce 2/3 during last
10 years.
90-90-90 Targets:
80-70-95
Recency Testing
Implementation timeline
Recency Testing on 804 Stored Samples to
Better Understand the HIV epidemic, May 2018
Highland/Mountainous
Midland
Urban/City
Recent Testing in 86 stored-samples,
MSM cohort, Hanoi 2017
86 stored-samples
86 stored-samples
Recency test and HIV VL
Recency test and HIV VL
39 tested
Recent
45 tested
Long-term
30 confirmed recent
(34.9%)
(Tested recent + VL≥1,000 copies/mL)
2 tested
negative
HIGH + YOUNG!
Recent Infections:
34.9%
Average age:
23 yrs
Routine recency testing
in 10 PEPFAR supported
provinces, Feb – May 2019
•
Start: Feb 2019
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Recent Infection Among Target Group, Feb–May 2019
Integrated Recency Test
in National HSS+ in 20 Provinces, 2018
To estimate proportion of recent infection
among HIV positives and HIV incidence rate
among KPs.
Results:
–
Highest recent infection: MSM
6.34%
.
–
Incidence rate among MSM:
1.7%
(per
100-person years)
Recency Testing and Index-partner Testing:
An Example from Binh Chanh District, Ho Chi Minh City
Integrate Recency Testing
into National HIV Testing Algorithm?
Conclusions
1.
Recency testing is useful to
better understand
the HIV/AIDS epidemics,
especially estimate the new infection/incidence in different KPs,
geographical areas for proper interventions.
2.
Recency testing, combined with index-testing, helps to
find partners
for
proper prevention (e.g., PrEP) and ARV treatment timely.
3.
Further steps need to be done to include Recency testing in Vietnam’s
national HIV testing algorithm
as a HIV diagnostic test.
Ha Long Bay, Vietnam
Preliminary experiences and key facts of the HIV/AIDS epidemic in Vietnam, including implementation timeline, initial findings, and conclusions. Details on recency testing implementation, recent testing on stored samples, and recent testing results in stored samples from MSM cohort in Hanoi.
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Presentation Transcript
HIV HIV Recency Recency Testing Preliminary experiences from Vietnam Preliminary experiences from Vietnam Testing Dr. Nguyen Nguyen Hoang Hoang Long Long Director General, Vietnam Authority of HIV/AIDS Control (VAAC)
Contents Contents 1. Implementation timeline 2. Some initial findings 3. Conclusions
HIV/AIDS Epidemic in Vietnam: Key Facts HIV/AIDS Epidemic in Vietnam: Key Facts 35000 96 96 millions pop 250.000 PLWH Concentrated epidemic: PWID PWID (14%), MSM FSWs FSWs (3,6%) Reduce 2/3 during last 10 years. 90-90-90 Targets: 80 80- -70 70- -95 30000 250.000 25000 20000 MSM (12%), 15000 10000 5000 95 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 HIV AIDS Death
Recency Testing Recency Testing Implementation timeline Implementation timeline 2020+ Jul 2019 Intergrate in the National HIV testing algorithm (?) Nationwide implementation (?) Integrate in the HIV surveillance system (HSS+) in 20 provinces Feb 2019 Routine recency testing in 10 PEPFAR supported provinces Jun 2018 Recency testing with 804 stored samples from 3 provinces Dec 2017 In-country lab validation
Recency Testing on 804 Stored Recency Testing on 804 Stored S Samples to Better Better U Understand the HIV epidemic, May 2018 nderstand the HIV epidemic, May 2018 amples to HIV positive samples, Recency Testing, and % of Samples as Recent (NO VL) 600 30% 27.8% 508 500 25% 21.7% 381 400 20% # Samples 348 % Recent 303 300 15% 14.2% 212 200 10% 120 106 100 5% 43 26 0 0% Son La Thanh Hoa Hanoi Total HIV positive samples 01/07-30/12 from VCT # samples tested for recency Recent Highland/Mountainous Proportion of Recent/tested samples Midland Urban/City
Recent Testing in 86 stored Recent Testing in 86 stored- -samples, MSM cohort, Hanoi 2017 MSM cohort, Hanoi 2017 samples, HIGH + YOUNG! Recent Infections: 34.9% Average age: 23 yrs 86 stored-samples Recency test and HIV VL 45 tested Long-term 39 tested Recent 2 tested negative 30 confirmed recent (34.9%) (Tested recent + VL 1,000 copies/mL)
Routine recency testing Routine recency testing in 10 PEPFAR supported in 10 PEPFAR supported provinces, Feb provinces, Feb May 2019 Number tested on RTRI Number RTRI recent tested HIV VL Number confirm recent (VL>1000 cp/ml) Number tested RTRI-recent Province May 2019 Long An 34 12 9 7 ng Nai 115 37 37 27 Binh Duong 100 22 22 17 T y Ninh 47 19 10 10 Start: Feb 2019 Ti n Giang 55 8 2 1 So far, 1,220 tests conducted/5 mths BR-V ng T u 114 11 9 5 Confirmed with VL: 110 (9.0%)(some provinces did not carry out VL for all samples) HCMC 243 33 31 30 H i Ph ng 51 6 6 4 H N i 425 42 19 8 Th i Nguy n Total 36 3 3 1 1,220 184 148 110
Recent Infection Recent Infection A Among mong T Target arget G Group, Feb roup, Feb May 2019 May 2019 Share of KP Groups among recent infections, Feb May 2019 Numbe of recent infection among target groups, 10 PEPFAR surged provinces, Feb May 2019 30 25 14.46% 25 20 14% 15 65.06% 10 7 6.02% 6 6 6 4 5 3 3 3 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 0 0 0 0 B nh D ng T y Ninh Long An Tien Giang BRVT HCMC Th i Nguy n H i Ph ng H N i MSM PwID Heterosexual Others MSM PwID Heterosexual Other
Proportion of recent infection among HIV positive Integrated Integrated R Recency Test in in N National HSS+ in 20 ational HSS+ in 20 P Provinces, 2018 ecency Test 3.03 FSW 97.0 rovinces, 2018 6.34 MSM 93.7 3.00 To estimate proportion of recent infection among HIV positives and HIV incidence rate among KPs. PWID 97.0 0 20 40 60 80 100 Recent infection Long term infection Estimated Prevalence and Incidence 11.21 Results: Highest recent infection: MSM 6.34%. Incidence rate among MSM: 1.7% (per 100-person years) 12 9.71 10 8 6 3.6 4 1.7 0.8 2 0.24 0 PWID FSW MSM Prevalence Incident rate
Recency Testing and Index Recency Testing and Index- -partner Testing: An Example from Binh An Example from Binh Chanh partner Testing: Chanh District, Ho Chi Minh City District, Ho Chi Minh City Part 1: HCMC 155, MSM, Neg PrEP Part 2: HCMC 156, MSM, Neg PrEP INDEX Recent HIV+ Case (MSM, 22 Age) Part 3: HCMC 157, MSM, Neg PrEP Counselling Part 4: HCMC 158, POS, LT; 30 yrs ART
Integrate Recency Testing Integrate Recency Testing into National HIV Testing into National HIV Testing A Algorithm? lgorithm? [3] To be used nationwide at the sites [2] To be included in the MOH s HIV testing guideline [1] To be approved by MOH as diagnostic test Available in the markets Reasonable price Meet national requirements on Sen (>99.5%) & Spec (> 98%) Recommended by WHO Meet national requirements for licensing and importing to Vietnam.
Conclusions Conclusions 1. Recency testing is useful to better understand especially estimate the new infection/incidence in different KPs, geographical areas for proper interventions. better understand the HIV/AIDS epidemics, 2. Recency testing, combined with index-testing, helps to find partners proper prevention (e.g., PrEP) and ARV treatment timely. find partners for 3. Further steps need to be done to include Recency testing in Vietnam s national HIV testing algorithm national HIV testing algorithm as a HIV diagnostic test.
Ha Long Bay, Vietnam Ha Long Bay, Vietnam
