A model for integrating family-centered care into HIV

clinical and community services in Vietnam

Kimberly GreenFamily Health International

August 11, 2009

Background• Concentrated epidemic

• Approximately 45% of PLHIV in care have children

• GoV & FHI with PEFPAR/USAID support 18 Continuum of Care (COC) sites

– District coordination committee

– District hospital HIV out-patient clinics (ART, palliative care, OI rx, nutrition support, etc)

– Linked community and home-based palliative care (CHBC) services and PLHIV support groups

– Support for children affected by HIV through routine family case management

Low uptake: challenges to family-centered care - 2006• Enrollment of children living with and affected by HIV was

much lower than expected given estimates – ~470 children enrolled in support services (16% of adults)

• Rapid assessment identified the following issues:– Lack of pediatric HIV care services in rural areas: adults

bringing their children into adult HIV clinics seeking care– CHBC teams more focused on care for adults– High levels of stigma, major barrier to enrolling children/families

into govt social welfare programs and other services

5-pronged approach

Goal: Increase OVC access to care using a family-centered care case management approach

focused on minimizing stigma and integrating OVC and families in existing social welfare services

1. Active but discrete

identification of OVC in need

of care

2. Family case management:

routine assessment and

care

4. Partnership with local

social welfare services

5. Addressing barriers to services: work withlocal leaders to address problems and

improve community acceptance

3. Enhanced package

of services inclfamily clinic

LabTB

Services

District Hospital -IPC and OPD

COMMUNITY/HOME

OTHER CBOs

PLHIV SUPPORT GROUPS

PLHIVPLHIVFamiliesFamilies

Family Centered Care

Family

Maternity

Tertiary Health Facilities

CHBC/OVC services

Pediatric

OPD

Adult and Adult and Pediatric HIV Pediatric HIV

Clinic – Clinic – includes includes PMTCTPMTCT

Results Mid 2009:

– Number of children enrolled approaching original estimate– Quality of pediatric care and treatment reported high by external

QA/QI– No LTFU of infected/exposed children– Majority children successfully enrolled/re-enrolled in school– Adoption of family centered approach in GoV National Plan of

Action for Children and HIV

  Mid-2006 Mid-2009

Adults 3,000 7,200

OVC 470 (16%) 2,922 (41%)

Table 1. Number and percentage of children receiving care versus adults: 2006 vs 2009

Challenges and way forward

• Child communication and counseling…an area that needs strengthening

• Support roll-out of the NPA – Work towards institutionalizing

family-centered care approaches within the GoV social welfare system

Key resources• Scaling up the Continuum of Care for PLHIV in

Asia and the Pacific: A Toolkit for Implementers– Establishing systems of care for adults and

children in concentrated and low level epidemics

• HIV Counseling Resource package (UNICEF/FHI/WHO)– Counseling guide for adults and children

• The Way We Care: A Guide for Managers of Programs for Vulnerable Children and Youth – Program guide: family centered care case

management

www.fhi.org

Acknowledgements• MoH/VAAC• PEPFAR• USAID• HHS-CDC• UNICEF• WHO• PACT• Clinton Foundation• FHI – Drs. Rachel Burdon, Vu Ngoc Phinh, Phan Thu

Phuong, Nguyen Thi Thanh Ha, Vu Ngoc Son• Viet Nam PAC/DHs – Hanoi, Hai Phong, Quang Ninh,

Dien Bien, Lao Cai, Nghe An, HCMC, Can Tho, An Giang

Thank You!

The Numbers…Vulnerable groups Numbers Source

Estimated number of children living with HIV

3,818(Range: 2,536-6,110)

MoH, 2009

Estimated number of children affected by HIV

283,667 MOLISA, 2003

Orphans from all causes- Double orphans- Maternal orphans- Paternal orphans

143,00025%43%34%

MOLISA, 2007

1,276,000 GSO, 2007

Children orphaned by AIDS 68,874(Range: 36,695-138,570)

UNAIDS, 2007

Package of Care

Cognitive Development: ChildrenPlay and educational

opportunities by age and stage;training parents/caregivers in parenting

skills and child development;schooling support

Social Support and Protection: Adults & Children

Link to government social welfare fundingLink families to IGA (eg Women’s Union)

Preventing abuse; identifying and caring for abused children

Physical Care: Adults & ChildrenOI treatment and prophylaxis,

palliative care, ART, adherence support

CT, PMTCT, prevention counselinggrowth monitoring, nutrition supportimmunizations, primary health care

Emotional Support: Adults & Children

Assessment of emotional well-being and lay counseling and support

Succession planning Support group