A delegation from Viet Nam visited the drug quality control division of a Thai factory that manufactures antiretroviral medicines. L to R: Dr Chu Quoc An, Head of Delegation, Mr Bang from Viet Nam Social Security, Mr Tien from Drug Administration of Viet Nam, Dr Nhan from Viet Nam Administration for AIDS Control Credit: UNAIDS/Bich.N
Mr Dong, a 37-year-old man from Hanoi, has been living with HIV for a number of years. He is in good health thanks to the antiretroviral treatment that is provided free of charge in Viet Nam and is a leading member of the Viet Nam Network of People Living with HIV (VNP+).
But Mr Dong, as well as many other colleagues in the Network, is worried. He knows that the donors who pay for nearly all of Viet Nam’s HIV treatment programme will soon leave. Who will pay for his antiretroviral (ARV) medicines in the future?
“The first-line of antiretrorival treatment I am currently on costs about US$ 98 per person per year. That is with imported generic medicines,” explains Mr Dong. “I can afford it for now if treatment is no longer free. But I don’t know until when I can stay this healthy and keep my job, while antiretrorival treatment is life-long. That is not to mention that treatment cost could be much higher if I have to shift to second-line treatment or buy non-generic drugs,” he noted.
At the end of 2012, Viet Nam was providing antiretroviral treatment for nearly 60% of all people in need, according to the Viet Nam Administration for HIV/AIDS Control (VAAC). However, 97% of the funds for antiretroviral medicines come from external funding, which is expected to significantly decrease after 2015.
This is the result of Viet Nam’s recent achievement of middle-income country status and the prolonged economic downturn in donor countries. The Government of Viet Nam is increasing its national budget allocations to the HIV response, but much more slowly than the expected decrease in donor support. Current projections of the amount of funding required to purchase antiretroviral medicines for all in need indicate there will be a significant gap by 2016.
Deputy Prime Minister Nguyen Xuan Phuc has called on VAAC to address this potential funding crisis, and VAAC has initiated the development of a “National Plan to Ensure the Sustainable Supply of ARVs Beyond 2015”, in collaboration with development partners, including UNAIDS.
South-south learning and political leadership is key
Collecting evidence and good practice from countries in the region was identified by VAAC as essential to inform the development of the plan. In April 2013, UNAIDS supported a study visit by a multi-sectoral Government delegation to Thailand.
The delegation learned how Thailand, as a middle-income country, is providing universal access to antiretrovirals and all HIV-related tests free-of-charge, financed by the state budget and provided to all in need through national health insurance schemes. They also learned how Thailand has issued compulsory licenses for two kinds of ARVs and centralized procurement and supply chain management of ARVs to keep costs down while also ensuring the Thais have access to high-quality first-line and second-line drugs.
We learned a lot about how Thailand went through a long process to achieve universal coverage of healthcare for all Thai people and antiretroviral treatment for those in need, and about their challenges.
Dr Chu Quoc An, head of the Viet Nam delegation
“We learned a lot about how Thailand went through a long process to achieve universal coverage of healthcare for all Thai people and antiretroviral treatment for those in need, and about their challenges,” said Dr Chu Quoc An, head of the Viet Nam delegation. “Yet, the most important lesson learned is that strong political leadership at the highest levels has been Thailand’s key to success.”
Positive outlook
Delegates agreed that leadership, determination and a strong multi-sectoral coordination will be critical for Viet Nam to adapt and adopt lessons learned from Thailand. As the study tour emphasized, adequate time is also needed to enable plans to come to fruition.
“I believe Viet Nam can do it,” said Steve Kraus, UNAIDS Regional Director for Asia and the Pacific. “We can see how the country is accelerating progress towards national targets and international commitments on HIV treatment. We can see the determination is there. UNAIDS is committed to continue supporting this South-South cooperation, and to assist Viet Nam in its quest to ensure life-long treatment for all in need.”
For Mr Dong, the progress towards a sustainable plan for treatment is encouraging, but concerted action is critical. “I am excited to hear about VAAC’s development of the ARVs sustainability plan and the engagement of many sectors,” he said. “I hope National Assembly and Government leaders will pay more attention to this issue so the plan can soon become a reality, for the benefits of people living with HIV and the wider community.”
