Key population and local government-led social contracting in Vietnam: a pathway to expanding coverage of publicly-financed HIV services

Title

Key population and local government-led social contracting in Vietnam: a pathway to expanding coverage of publicly-financed HIV services

Presenter

Yen Hai Vu

Authors

Y.H. Vu * (1), Q.X. Nguyen (2), C.T. Vu (2), N.T. Vu (2), T.M. Le (3), T.K. Le (4), T.H. Do (5), C.A. Nguyen (6), K.E. Green (1), B.N. Vu (1), T.T. Tran (1), T.M. Ngo (6), L. Basu (6), Z.J. Humeau (1)

Institutions

(1) PATH, Hanoi, Viet Nam, (2) Dong Nai Centers for Disease Control, Dong Nai, Viet Nam, (3) Thanh Danh Social Enterprise/Glink Vietnam, Ho Chi Minh City, Viet Nam, (4) Glink Dong Nai Clinic, Dong Nai, Viet Nam, (5) Vietnam Administration for HIV/AIDS Control, Vietnam Ministry of Health, Hanoi, Viet Nam, (6) United States Agency for International Development, Hanoi, Viet Nam

BACKGROUND: Social contracting (SC) can be an effective tool for sustaining key population (KP)-organization engagement in HIV service delivery as donor funding declines and domestic financing increases. In Vietnam, a novel SC model was piloted in a high-HIV-burden province, Dong Nai (DN), by the local centers for disease control (DN-CDC) and a KP-led social enterprise (SE) with support from the USAID/PATH Healthy Markets (HM) project.
DESCRIPTION: DN-CDC and HM followed seven critical steps to pilot SC from April ' October 2021:
1) mapped government of Vietnam (GOV) SC regulations and developed a pilot SC model;
2) secured endorsement from the Vietnam Administration for HIV/AIDS Control (VAAC) for the proposed model;
3) conducted rapid scoping of KP-SE clinics in DN to determine which had sufficient capacity to implement SC;
4) identified Glink SE clinic as the sole group matching the requirements;
5) held co-creation meetings between Glink and DN-CDC to agree on a service package, targets, budget and final contract aligning the capabilities of Glink with DN-CDC HIV service needs;
6) DN-CDC then monitored performance and adapted targets as COVID-19 lockdowns were enforced from June ' September;
7) identified key lessons to apply to national SC policy development.
LESSONS LEARNED: Key learnings generated through the model were:
1) securing strong VAAC and DN-CDC buy-in enabled rapid approvals and engagement;
2) identifying the right contracting mechanism up-front minimized implementation challenges;
3) focusing on trust generation between DN-CDC and Glink was essential for implementation;
4) enabling an adaptive approach by DN-CDC and Glink to rapidly respond to the lockdown helped change targets to meet real local needs: increasing home/quarantine site delivery of antiretroviral treatment (ART) and reducing reach and test targets.
As a result, Glink reached 110 KP, with 8 newly diagnosed HIV positive (7.27% positivity yield) and 100% enrolled on ART, and delivered ART and adherence support to an additional 200 ART clients from the DN-CDC HIV treatment clinic.
CONCLUSIONS: This pilot provides essential learning to inform national HIV SC policies as a pathway for public-sector domestic financing of KP-led organizations. Future efforts need to focus on securing ring-fenced domestic investment in SC and clear regulations for KP-organization SC.

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