Some of the greatest challenges in getting lifesaving antiretroviral (ARV) drugs to people with HIV are cost and accessibility. ARVs often are available only at hospitals or health centers in large towns and cities, forcing many patients to travel long distances to get treatment.

Shifting ARV distribution to the community level can help ensure that HIV treatment services are accessible, cost-effective and sustainable. In Ho Chi Minh City, FHI 360 and its partners are helping the Government of Vietnam integrate HIV prevention, care and treatment — specifically, antiretroviral therapies — into the government-funded commune-level health system. The initiative is part of FHI 360’s Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance (SMART TA) project, funded by the U.S. Agency for International Development.

In September 2011, SMART TA collaborated with the Ho Chi Minh City Provincial AIDS Committee, the U.S. Centers for Disease Control and Prevention and Thu Duc Preventive Medicine Center on a pilot program that decentralized HIV care and treatment — including ARV therapy for stable HIV patients — from the district to the communes. SMART TA worked with partners to develop criteria for transferring patients to commune health stations and systems for referring patients back to district-level health care providers as needed. SMART TA supported Thu Duc Preventive Medicine Center to implement systems for ARV distribution and laboratory monitoring between district and commune levels. The project also facilitated training and ongoing technical support in ARV adherence counseling for commune staff.

Some district health care providers and patients were initially hesitant about shifting care to the commune health system. The number of patients transferring to the community-based system has steadily increased, however, due to improved communication and a growing understanding of the long-term benefits to integrating ARV dispensing into the mainstream health system. As of December 31, 2012, 146 patients in Thu Duc Preventive Medical Center, 61 patients in Binh Thanh Preventive Medical Center and 43 patients in District 8 Preventive Medical Center are receiving care at the commune level.

Based on the success of the pilot program and implementation in Binh Thanh and District 8, the Ho Chi Minh City Provincial AIDS Committee plans to continue decentralization of ARV distribution to communes in other districts with the goal of at least 3,000 (12 percent), 5,000 (19 percent) and 11,000 (45 percent) patients receiving care at the commune level by end of 2013, 2014 and 2015, respectively.