Author: Laval M, Ernst Wisse, Nguyen TT, Pham TM, Giang LM

Theme: Models of Care Year: 2019

Background: In Vietnam, People Who Inject Drugs (PWID) have very limited access to HCV screening,
diagnosis and treatment. Although Harm Reduction (HR) services exist, enhanced HR facilities (like
Drop-in centers or community spaces) are not available in Hanoi. Médecins du Monde and local
partners integrated a pilot peer-based intervention into a district level health center (DHC) as a
flexible support program to enhance screening, uptake and HCV treatment follow-up for PWID.
Description of model of care/intervention:A medical team together with 7 Peer Educators (PE) codesigned a treatment and follow-up pathway adapted to the needs of the PWID community. PEs
raise awareness in outreach settings, provide individualized support for screening, diagnostics
interventions and support initiation to treatment in a public health facility. This support model
navigates patients through the treatment pathway, including counseling and individualized active
case-finding to maximize adherence and post-treatment follow-up.
Effectiveness: DAA-based HCV treatment was initiated to 107 PWID in a public health care facility,
without any specialized hepatologist consultations. Adherence to treatment and retention in care
was achieved with 97% and 98% of beneficiaries who completed treatment were cured. The
participants of the program described the peer-driven support interventions as highly beneficial and
declared reduced risk behavior as a direct result of the information received from PEs over the
course of the intervention.
Conclusion and next steps: This small-scale pilot initiative demonstrates the feasibility of integrating
HCV treatment for PWID in a medium level public healthcare facility, though an integrated peerdriven support program. The very good outcomes suggest potential for scaling-up similar initiatives.
Such models could be highly efficient and sustainable, building upon the established public health
system, without requiring high-level medical specializations.
An in-depth capitalization has produced an operational handbook including lessons learned and
hands-on guidance to Vietnamese stakeholders willing to implement, scale-up or replicate a similar
affordable intervention.
Disclosure of Interest Statement: The authors declare no conflict of interest

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