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Table 2 Strengths and constraints of HIV health service delivery in improving HIV case detection and retention in care

From: A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam

  Strengths Constraints
Availability - Outreach peer educators in more than half of districts [D,R] - Less than one-third of districts offering VCT/ART at district level in middle/low HIV burden provinces [D,R]
- Two-thirds of districts offering VCT/ART at district level in high HIV burden provinces [D,R] - Lack of physically accessible VCT/ART in remote areas in high/middle burden provinces [D,R]
Connectedness   
Hub & Heart - Coordination mechanism between administrative detention centers and HIV outpatient clinics emerging [R] - No coordination mechanism between districts with VCT/ART and those without [D,R]
- HIV outpatient clinic ‘plus’ at district level expanded in high and middle burden provinces [D,R] - Clinical services only in government funded HIV outpatient clinic at provincial level [D,R]
- No system to monitor expansion of outpatient clinic ‘plus’ [D,R]
Chronological - Chronic care based ART case management established for IDU and non-IDU [R] - Limited capacity to address the needs of PLHIV on ART for many years [R]
- Palliative care initiated integrated with cancer care [R] - Pre-ART care under-developed [R]
- Linkage from VCT to pre-ART care under-developed [R]
Horizontal - HIV testing and counseling integrated into TB and antenatal care in donor funded districts with ART/VCT in high (and middle) burden provinces [D] - Lack of linkage for HIV-TB and HIV-MCH in non-donor funded districts without VCT/ART in middle/low burden provinces [D]
- Referral system between administrative detention centers and HIV outpatient clinics being developed [R] - HIV service register not designed to facilitate TB/HIV and PMTCT [R]
Vertical - Extensive mobilization of peer educators to facilitate MARPs to access VCT [D] - Access to HIV testing and care and treatment in advanced stage of HIV infection [D,R]
- Alternative approaches to reach hidden MARPs emerging [D] - Health workers commonly providing verbal advice only to patients for referral across different levels of health facilities [R]
- CHBC models mobilizing a wide range of stakeholders [R] - No system to monitor referral services [R]
  1. Remark:
  2. [D] stands for a strength or constraint that is related to HIV case detection.
  3. [R] stands for a strength or constraint that is related to retention in care.