@article{f759d63abfdb4139b7cca9d0a1939f2c,
title = "The relationship between health policy and public health interventions: A case study of the DRIVE project to {"}end{"} the HIV epidemic among people who inject drugs in Haiphong, Vietnam",
abstract = "We present a case study of the effects of health policies on the implementation and potential outcomes of a public health intervention, using the DRIVE project, that aims to 'end' the HIV epidemic among people who inject drugs in Haiphong, Vietnam. DRIVE's success depends on two policy transitions: (1) integration of donor-funded HIV outpatient clinics into public health clinics and expansion of social health insurance; (2) implementation of a {"}Renovation Plan{"} for substance use treatment. Interviews and focus group discussions with key informants and review of policy documents and clinic data reveal that both policy transitions are underway but face challenges. DRIVE promises to show how evolving policy affects health interventions and how advocacy based on project data can improve policy. Broad lessons include the importance of clear and consistent policies, vigorous enforcement, and adequate funding of promulgated policies.",
keywords = "HIV treatment, People who inject drugs, Substance use treatment, Vietnam",
author = "Hammett, {Theodore M.} and Trang, {Nguyen Thu} and Oanh, {Khuat Thi Hai} and Huong, {Nguyen Thi} and Giang, {Le Minh} and Huong, {Duong Thi} and Nicolas Nagot and {Des Jarlais}, {Don C.}",
note = "Funding Information: We base this paper on 15 semi-structured interviews and three focus group discussions (20 total participants) with key informants and stakeholders in Hanoi and Haiphong between late August and late September, 2016. We selected informants based on their knowledge of, responsibility for, or experience with the two key policy transitions relevant to DRIVE. We identified policy respondents at both central level and provincial levels. Central-level interviewees in Hanoi included officials of the Ministry of Health, Vietnam Administration on HIV Prevention and Control, the Ministry of Labor, Invalids, and Social Affairs (in charge of substance use treatment), the National Assembly Social Affairs Committee, a leading Vietnamese nongovernmental organization active in the relevant policy arenas (Supporting Community Development Initiatives), and the Abt Associates/Health Finance and Governance Project, funded by the US Agency for International Development. Funding Information: Services covered by Social Health Insurance Several government documents purportedly specify HIV services and medications covered by social health insurance. These documents include Circulars 15 (2015) and 40 (2014) and the Basic Health Care Service Package for Medical Examination and Treatment Services for HIV Patients Paid by Health Insurance Fund [Vietnam Ministry of Health/VAAC, Draft Basic Health Services Package: February, 2016]. However, questions persist about what medications and services will continue to be free once the integration of outpatient clinics is complete, and what services will be covered under social health insurance. (As noted, antiretroviral drugs fully funded by donors and Vietnam{\textquoteright}s National Target Program for HIV will not come under health insurance coverage until 2019.) Several respondents asserted that CD4 and viral load tests will continue to be free but others said that the new system might reduce free laboratory tests because of withdrawal of donor funding [Standalone outpatient clinics. Focus group discussion, Haiphong, 1 September 2016]. Under current plans, third-line regimens are not covered by social health insurance and this may be a serious problem because rates of drug resistance are on the rise in Vietnam [Didier Laureillard. Remarks at VAAC/Global Fund meeting, Hanoi, 6 March 2017]. Prevention and treatment of opportunistic infections are covered by social health insurance [Le Thi Thu Huong, Director, Treatment Department, Haiphong PAC. Interview, Haiphong, 26 September 2016] but the extent of this coverage remains unclear. Funding Information: Acknowledgements The authors acknowledge the contributions of the entire international DRIVE project team and the funding support of the National Institute on Drug Abuse, US National Institutes of Health, Grant # RO1 DA041978, and France Recherche nord & sud sida-hiv Hepatites, Agence Autonome de l{\textquoteright}Inserm (ANRS), Grant # 12353.",
year = "2018",
month = may,
day = "1",
doi = "10.1057/s41271-017-0115-7",
language = "English (US)",
volume = "39",
pages = "217--230",
journal = "Journal of Public Health Policy",
issn = "0197-5897",
publisher = "Palgrave Macmillan Ltd.",
number = "2",
}