On a Wednesday morning in the village of Tam Dao in the Quy Hop District of Nghe An Province, people were gathering at the village community house. Those gathering had been invited by the local community health team to come and get free testing for the hepatitis C virus (HCV). Each person had been identified by local health workers as belonging to high-risk categories, including those who had received multiple blood transfusions, were on renal dialysis and those over 50 years – likely to have been exposed to shared needles and syringes in the past, as part of their medical care. To all of them, this was the first time they had ever received HCV testing.
“I understand that hepatitis C and HIV as well as syphilis are very infectious and dangerous. If you know that you have one of these diseases, you can take measures to protect the other members of your family”, shared Ms Pham Thi Mai Thiet. She was among the 69 villagers who came to the community-based testing that morning.
Community partners help increase access to HCV testing
Nghe An is one of the provinces in Viet Nam with a high burden of HIV and hepatitis. To achieve the national goal of hepatitis elimination by 2030, increasing access to hepatitis testing and care has been successfully demonstrated through a community-based intervention in this province.
Minh Phat, a social enterprise, helps expand access to hepatitis C testing in Nghe An with support from WHO Viet Nam. By tapping into community networks and collaborating with local health authorities, Minh Phat is able to reach hard-to-reach communities, including those isolated geographically and those who hesitate to go to health facilities due to stigma and discrimination.
The community-based testing provides not only HCV testing but also testing for HIV and syphilis; with those invited to test for HIV and syphilis identified by local health workers as being from higher-risk categories, including young people involved in intravenous drug use and women of childbearing age. When the integration service is brought closer to the community, people can get screened for three diseases, some of which they have not been aware of before. It is also timesaving as people do not have to travel to the district health center which is 6km away or even more than 120km to the provincial hospital for testing.
HCV testing is an important first step for treatment and prevention, particularly for those who are highly vulnerable to HCV infection, including people who inject drugs and people living with human immunodeficiency virus (HIV). In Viet Nam, about one-third of people living with HIV are coinfected with HCV. Early detection of HCV is urgently needed so people in need can access life-saving treatment.
HCV treatment has improved quality of life for community members
When people living with viral hepatitis are diagnosed through community-based testing, they get advised by Minh Phat about free-of-charge treatment, supported by the Global Fund.
Community member Mr Tran Van Ngan from Quyet Tien village in Nghe An has been receiving anti-retroviral (ARV) treatment for nearly 20 years. Five years ago, he started on methadone. One time when he was receiving treatment at the district health center, he was informed about the HCV testing. He then tested and was diagnosed with HCV infection and has been receiving treatment for the past two months. He has never missed a day to receive treatment. It used to take him three hours on motorbike to Vinh City, Nghe An to receive ARV treatment but now, HIV and HCV treatments are both provided at the district health center, located only 10km from his house.
“I am happy to beware of my health status and receive timely treatment. I just hope that every day I am healthy enough to help my wife make rice cakes to sell. I wish people like me can get HCV testing and receive treatment. It is precious that we can live even just one more day”, Mr Ngan smiled.
With the leadership of Viet Nam Administration for HIV/AIDS Prevention and Control, technical support from WHO and medication support from the Global Fund, 16,000 people living with HIV and on methadone have received a HCV diagnosis and treatment, like Mr Ngan, in the past 12 months in Viet Nam.
WHO aims to eliminate viral hepatitis by 2030 globally. To achieve this goal, countries need to reduce the number of new hepatitis B and C infections by 40% and deaths from liver cancer by 50% by 2025. Accelerating access to hepatitis C services has been among Viet Nam’s key interventions towards this goal.
Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends testing people who may be at increased risk of infection and continues providing technical support to government and community partners. By simplifying delivery of viral hepatitis services and bringing hepatitis care closer to communities, the Vietnamese government, local community partners and WHO are together bringing Viet Nam closer to hepatitis elimination.