V-VHA follows the “Cascade of Care” model for viral hepatitis service delivery. Starting with the Planning process, V-VHA works with its partners to obtain formal permission from local authorities before it conducts screening activities in the community each time; this includes obtaining institutional review board (IRB) approval for each project. Once official permission has been granted, V-VHA works with local authorities, clinics, and/or community partners to secure and confirm screening and testing sites that are accessible for program participants / patients.
During the Outreach & Education phase, V-VHA staff engage in inviting program participants by going door to door with invitation letters hand delivered to their home, using the Probability Proportionate to Size (PPS) sampling method. The PPS sampling method enables V-VHA to make sure that each district in the city is well represented in our study.
On the Screening and Testing day, V-VHA staff will pre-screen participants to assess their risks before collecting blood samples for diagnosis.
Once V-VHA receives test results for each site sampled, at least one physician will review and verify the test results before handing them to a V-VHA Program Manager. The V-VHA Program Manager will assign staff to contact program participants (patients) to share their results verbally and confirm their mailing address to send official results.
For those who tested positive for HBV and/or HCV, a V-VHA staff will refer and link the patient to care and treatment services. Patients who need hepatitis B vaccination will be referred for service. Additional education seminar and counseling opportunities will also be provided to patients.
Planning
Outreach & Education
Screening & Testing
Patients who need hepatitis B vaccination will be referred for service.
Outreach & Education
V-VHA provides general outreach and awareness to the community about the health burden of liver diseases, including liver cancer, in Vietnam.
H.E.L.P. for Vietnam
In addition, V-VHA has a health education program called Health Education for Liver Professionals and Patients (H.E.L.P.) in Viral Hepatitis for Vietnam, which is a two-track program.
Track One is geared towards physicians and health care workers who provide care and treatment for patients who are infected by viral hepatitis. The purpose of the Track One program is to provide up to date evidence-based information on hepatitis B virus (HBV), hepatitis C virus (HCV), and liver cancer so providers are well equipped with knowledge and resources to test, diagnose, and treat patients with liver diseases.
Track Two is geared towards patients who have been infected with HBV and/or HCV. The purpose of the Track Two program is to provide patients with up to date evidence-based information on HBV, HCV, and liver cancer so they can make educated decisions on how to manage their health condition. Patients are linked to care and treatment services through the Pathways for Access to Hepatitis Treatment (P.A.T.H.) to Cure in Vietnam, which includes opportunities to receive health counseling from their providers.
H.E.L.P. in Viral Hepatitis for Vietnam includes in-person and virtual educational seminars. Annually, in celebration of World Hepatitis Day on July 28th, V-VHA has also coordinated national CME conferences that convene over hundreds of providers with guest speakers from other countries.
Screening & Testing
Pilot project 2015 - 2016
In 2016, V-VHA led the development and supported a Pilot Program to validate the feasibility of a large-scale program to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Ho Chi Minh City (HCMC) in Vietnam. The Pilot Program randomly screened over 1,000 individuals using the Probability Proportionate to Size (PPS) sampling method. The PPS sampling method enables V-VHA to make sure that each district in the city is well represented in our study. Access to health care and vaccination were provided as appropriate.
Cornerstone project 2017 - 2018
Following the Pilot Program, V-VHA secured funds and additional donor support to launch the Cornerstone Program. The Cornerstone Program was rigorously designed as a HBV and HCV prevalence and surveillance study of hepatitis B and C in HCMC that also provided free outreach, education, screening, linkage to care, and HBV vaccination (when indicated). Over 1,000 individuals were screened in 2017, adding to the 1,000 individuals screened during the 2016 Pilot Program.
World Hepatitis Day community screening 2018
In 2018, V-VHA organized “Happy Liver Happy Life” community health screening day at the Reunification Palace (formerly Independence Palace) to commemorate World Hepatitis Day on July 28th. V-VHA engaged over 100 college student volunteers, and a dozen pro bono physicians and healthcare workers to directly serve approximately 2,000 individuals, providing them with free HBV and HCV education, screening, testing, and health consultation.
CHIME project 2019 - 2020
With a generous grant from Gilead Sciences to jumpstart the Conquering Hepatitis via Micro-Elimination for Vietnam (C.H.I.M.E.) for Vietnam project in 2019, V-VHA was able to screen and provide access to care for a representative sample of 20,000 residents in HCMC. C.H.I.M.E. for Vietnam allowed V-VHA with the opportunity to leverage its resources to secure additional funding to also expand and evaluate its linkage to care model for viral hepatitis in HCMC. Preliminary results of C.H.I.M.E. for Vietnam showed 7.6% of the screened population tested positive for HBV and 1.92% tested positive for HCV. All patients who tested positive for HBV and/or HCV were linked to care and treatment services through the Pathways for Access to Hepatitis Treatment (P.A.T.H.) to Cure in Vietnam Program.
Below is a Heat Map that illustrates HBV and HCV prevalence in HCMC based on data collected from all screening programs since 2016 (not including the community screening on World Hepatitis Day in 2018, which did not follow the PPS sampling method).
Linkage to Care & Treatment
P.A.T.H. to Cure in Vietnam
Pathways for Access to Hepatitis Treatment (P.A.T.H.) to Cure in Vietnam Program’s goal is to link and cure patients who test positive for hepatitis B virus (HBV) and/or hepatitis C virus (HCV). The program has two major objectives:
- To provide patient navigation services, including guidance and strategies to claim insurance coverage for at least 1,000 HBV and/or HCV positive patients to ensure access to care through V-VHA’s referral network and other partnering community healthcare providers in HCMC.
- To provide patients with liver health education seminars with culturally appropriate material on viral hepatitis and liver cancer education.
Advocacy & Policy
H.E.A.T. in Vietnam
In collaboration with the Coalition for Global Hepatitis Elimination at the Task Force for Global Health in 2020, V-VHA started the Hepatitis Evaluation to Amplify Testing and Treatment (H.E.A.T.) in Vietnam. Under the guidance of a coalition of local stakeholders in Vietnam, V-VHA has been coordinating the support of expanded HBV and HCV testing and treatment efforts in Vietnam (beyond HCMC) to focus on the two objectives below.
Program Objective #1: Identify feasible strategies to scale testing and proven models of care.
Program Objective #2: Developing policy recommendations to inform further program development.
The expected outcome for the project is a long-term public private partnership to implement public health policies that address the burden of viral hepatitis in Vietnam and work towards viral hepatitis elimination by 2030.
