Is Viet Nam ready for ARVs?

With the Pasteur Institute in Saigon, I accompanied two doctors to evaluate and report the progress of HIV/AIDS treatment in Kien Giang province located in the southwestern part of Viet Nam. Their job is to provide ongoing communication and honest feedback with the southern provinces on HIV/AIDS prevention, treatment, and care.

Several hours later of riding on planes, cars, and ferries, I found myself in clinics and hospitals listening to the updates from medical directors of hospitals. I quietly observed the Pasteur doctors scrutinize every chart, note, and log which revealed disorganization and lack of education by Kien Giang doctors. Charting was incomplete; binders were missing; personnel were unavailable; and questions were left unanswered.

Yet the hospitals filled in these gaps with sometimes unbelievable explanations. One director explained that he did not believe in the WHO guidelines for ARV treatment and sincerely believed that his method of monotherapy was more practical and effective. However, a well-trained physicians would know that monotherapy is a recipe for drug resistance, which would render the drug obsolete over time. At another location, bactrim was never prescribed because doctors believed that bactrim was medically useless and caused too many undesirable side effects. However, studies show that bactrim is a crucial prophylaxis to a serious type of pneumonia known as PCP and without bactrim many patients might be unnecessarily hospitalized. More frighteningly, one clinic showed nearly 0% adherence to the ARV regimen. The lack of adherence was likely due to the patient and physician minimal understanding that ARVs require lifelong daily compliance with unwanted side-effects.

On the other hand, many clinics faced undeniable barriers. One clinic had only one doctor trained to evaluate and diagnosis HIV for an entire city. Also sometimes access to lab values, particularly CD4 counts was tedious and slow. Thus an efficient ARV program require tremendous amount of money, paperwork, manpower, and experience.

Sadly this trend and barriers do not only exist in Kien Giang, but all over Viet Nam. Unfortunately many rural hospitals are not properly trained to run a newly complicated system on top of an overstretched system. I can only hope time and continuous communication will able to resolve the seemingly insurmountable issues facing Viet Nam ARV treatment facilities.