Modeling the impact of alternative program choices

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Modeling the impact of alternative program
choices to strengthen AIDS responses in Ho Chi
Minh City, Vietnam
Integrated Analysis and Advocacy (A2) Using data
that's there to move responses that aren't XVII
IAC, Mexico City August 3-8, 2008
Nguyen Duy Tung
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Content

• Introduction Ho Chi Minh city, Vietnam
• Background AEM baseline scenario
• Outputs of the alternative program choices
  modeling linking GOAL and AEM
• Recommendation and Lesson learnt

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1. Introduction Ho Chi Minh city, Vietnam

• Population
• 6 millions
• 1.5 millions migrants
• MARPs size estimation
• IDU 30,000
• FSW 20,000
• MSM 36,000
• HIV/AIDS reported cases (3/2008)
• HIV 38,245
• AIDS 18,806
• Death 6,786

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2. Background

• 2.1. Technical working groups
• AEM HCMC, EWC, FHI, NIHE
• GOAL HCMC, Constella Future/HPI
• Link AEM GOAL HCMC, EWC, FHI, Constella
  Future/HPI
• 2.2. Highlights of the HIV epidemic in HCMC
• 2.3. AEM baseline scenario

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2.3. AEM baseline scenarioHIV prevalence among
high risk populations to 2004
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2.3. AEM baseline scenarioHIV prevalence in HCMC
2020 1.86
2010 1.68
2006 1.45
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2.3. AEM baseline scenarioFSW Clients
contributing the largest number of new infections
Male clients
Low-risk female
MSM
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2.3. AEM baseline scenarioThe number of new AIDS
case will increase to 7,700 in 2010
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3. Linking GOAL and AEM ? Outputs of the
alternative program choices modeling

• Considerations setting HIV/AIDS priorities
• Epidemic trends and size of risk groups
• Effectiveness of interventions
• Cost effectiveness
• Cost of interventions
• Implementation capacity
• Four Scenarios developed for HCMC
• Scenario A Focus on FSWs potential clients
• Scenario B Focus on MSMs and MSWs
• Scenario C Focus on IDUs
• Scenario D Prevention combination

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Coverage Targets Budget under Scenario A, B, C
D
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New Infections for Various Scenarios relative to
Baseline Projection (from 2006 to 2010)
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Summary of Scenarios A - D
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• Scenario D
• Combination of prevention interventions,
  recommended for HIV/AIDS Actions Plans
• of Ho Chi Minh City (2006-2010)

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Recommended Scenario
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Analysis of Different Prevention Investments
Number of New Infections under different
Prevention Investment
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Analysis of Different Prevention Investments
Future treatment costs avoided for different
Prevention Investment
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Analysis of Different Prevention Investments
Summary of Costs and Impacts
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4. Recommendation lesson learnt

• Recommendation for HCMC
• Investment in prevention now will result in
  substantial savings in the cost of ARV treatment
  in future
• Current resources are inadequate to reverse the
  growth of the epidemic needs to be filled
• Prevention Combination Scenario is recommended.
  Programs need to reach sufficient numbers of
  people from MARPs in order to acquire behavior
  change

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4. Recommendation lesson learnt

• Policy and Program Impact
• HCMC PAC adjusted its overall goal. The new goal
  is to prevent more than 16,000 new HIV cases by
  2010.
• A2 results and recommendations led the HCMC
  Provincial HIV/AIDS Committee (PAC) to adapt the
  Nine Actions Plan to focus on most-at-risk
  groups (FSW, IDU, MSM), harm reduction and many
  HIV programs have intensified efforts to prevent
  new husband to wife transmission.
• Lesson learnt
• A2 is an effective analysis tool for policy
  advocacy and can apply for other provinces and
  the country. However, it requires strong
  technical assistant and significant coordination
  efforts.
• Biological and behavioral surveillance needs to
  be strengthened to fill the gaps in the
  surveillance system. Monitoring of programs
  (coverage, quality of programs) need to be
  enhanced.

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• Thank you!