Nguyen Truong Manh, Tran Giang Van, Pham Thach Ngoc, Matsumoto Shoko, Nagai Moeko, Tanuma Junko, Oka Shinichi
Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam.
National Hospital for Tropical Diseases, Hanoi, Vietnam.
Glob Health Med. 2025 Jun 30;7(3):252-259. doi: 10.35772/ghm.2025.01045.
Vietnam is a lower-middle-income country where HIV drug resistance (DR) testing is not widely accessible, and antiretroviral therapy (ART) options remain limited. Since 2016, HIV services have gradually transitioned from international donor support to national Social Health Insurance (SHI). Under the decentralized policy of SHI, HIV treatment has been delivered at local neighborhood hospitals, where experience in managing ART failure is still lacking. This study evaluated a pilot model of centralized DR testing combined with decentralized treatment implementation in Northern Vietnam. Seven provincial hospitals and three healthcare facilities participated. Patients' viral loads (VL) were monitored every six months over a 48-month period (October 2019-September 2023). ART failure was defined as VL ≥ 1,000 copies/mL, which triggered DR testing at the National Hospital for Tropical Diseases in Hanoi. Based on DR results, tailored ART recommendations were provided to local hospitals and healthcare settings. The effectiveness of subsequent ART following DR testing was assessed by VL suppression at 90 days or later. Among 179 patients experiencing ART failure, DR testing was successful in 170 cases. DR mutations were detected in 126 patients (74.12%), while 44 (25.88%) showed no mutation. Patients who followed the ART recommendations had a significantly higher VL suppression rate (87.72%) than those who did not (70.37%, = 0.026). This association was significant in district hospitals (87.50% 60.00%, = 0.032) but not in provincial hospitals (87.93% 76.47%, = 0.240). This study highlights the potential clinical benefit of our model in resource-limited situations, particularly where ART management capacity is limited.
越南是一个中低收入国家，在该国，艾滋病毒耐药性（DR）检测尚未广泛普及，抗逆转录病毒疗法（ART）的选择仍然有限。自2016年以来，艾滋病毒服务已逐渐从国际捐助者支持过渡到国家社会医疗保险（SHI）。在SHI的分权政策下，艾滋病毒治疗在当地社区医院进行，而这些医院在管理ART失败方面仍缺乏经验。本研究评估了越南北部集中式DR检测与分散式治疗实施相结合的试点模式。七家省级医院和三家医疗机构参与其中。在48个月期间（2019年10月至2023年9月），每六个月对患者的病毒载量（VL）进行监测。ART失败定义为VL≥1000拷贝/毫升，这会触发在河内的国家热带病医院进行DR检测。根据DR结果，向当地医院和医疗机构提供量身定制的ART建议。通过90天或更晚时的VL抑制来评估DR检测后后续ART的有效性。在179例经历ART失败的患者中，170例DR检测成功。126例患者（74.12%）检测到DR突变，而44例（25.88%）未显示突变。遵循ART建议的患者的VL抑制率（87.72%）显著高于未遵循建议的患者（70.37%，P = 0.026）。这种关联在地区医院显著（87.50%对60.00%，P = 0.032），但在省级医院不显著（87.93%对76.47%，P = 0.240）。本研究强调了我们的模式在资源有限的情况下，特别是在ART管理能力有限的情况下的潜在临床益处。
