Directive No. 10/BYT-CT on Strengthening Work to Prevent and Control HIV/AIDS Infection

DIRECTIVE

On strengthening work to prevent and control HIV/AIDS

The HIV/AIDS epidemic continues to show an increasing trend in our country. From the first case detected in 1990, by August 30, 1997, the number of people infected with HIV reached 6,588, including 957 cases that had progressed to AIDS, and 505 AIDS patients died. The situation is becoming more complex, with 55 out of 61 provinces and cities having reported HIV-infected individuals. The disease has spread from high-risk groups to transmission through medical services and into the general community.

In recent years, the Health sector has made many efforts in coordinating with various departments to implement activities to prevent and control HIV/AIDS. However, the effectiveness of these prevention and control activities has not been high, with uneven performance across all areas, particularly in program management and professional technical aspects at healthcare facilities, which need to be improved. Many healthcare facilities have not truly prioritized blood safety measures; in some emergency cases, blood from relatives was used for transfusion without HIV testing, and the regulations on handling HIV/AIDS were not strictly followed, especially those concerning sterility. Some healthcare facilities are not adequately prepared to receive, treat, and care for AIDS patients, and some medical staff still exhibit discriminatory attitudes towards HIV/AIDS patients.

To correct and enhance the effectiveness of HIV/AIDS prevention activities throughout the Health sector, the Minister of Health instructs the heads of subordinate units under the Ministry, Directors of Provincial Health Departments, and all healthcare facilities and units within the entire sector to immediately implement the following requirements:

1. Strictly implement the "Professional Regulations for Handling HIV/AIDS" as stipulated in Decision No. 2557/BYT-QĐ dated December 26, 1996 of the Ministry of Health. a) Strictly enforce the regulations on blood safety. Ensure that 100% of blood bags and blood products are screened for HIV before use. All blood transfusions (including blood from family members) must be screened for HIV. All blood units are only screened once using one type of reagent; if the result is positive or suspicious for HIV infection, they must be discarded and not retested. Coordinate with central and local departments to organize voluntary blood donation campaigns and gradually reduce the practice of professional blood selling.

b) Organize refresher training for healthcare workers at all levels regarding sterilization and aseptic procedures to prevent HIV/AIDS transmission in medical services.

c) The provincial health inspection departments shall regularly inspect state and private healthcare facilities regarding compliance with professional regulations for handling HIV/AIDS.

d) Unit leaders shall frequently inspect the implementation of this regulation within their units. Transmission of HIV through medical services must be prevented.

Any unit where HIV transmission occurs through blood transfusion or medical services shall bear legal responsibility.

2. Strengthen management, care, treatment, and counseling for HIV/AIDS-infected individuals:

a) Appropriately allocate counseling points and counselors for HIV/AIDS, ensuring that individuals undergoing testing receive pre- and post-test counseling. For HIV-positive cases, regular counseling should be maintained.

b) All healthcare facilities providing treatment must not refuse to treat AIDS patients. Depending on the circumstances and the number of AIDS patients in each locality, treatment may be organized in three forms:

+ In areas with many HIV-infected individuals and severe cases requiring specialized intervention, a number of isolation rooms should be set up in the infectious diseases department of the provincial general hospital. If the infectious diseases department cannot accommodate all patients, those showing signs of opportunistic infections may be placed in related departments such as dermatology or tuberculosis. Healthcare facilities with AIDS treatment wards should be strengthened and supplemented with necessary conditions to receive and treat AIDS patients.

+ For mild AIDS patients, community (home) treatment is primarily recommended. Management, treatment, and monitoring of AIDS patients at home are handled by district or county health centers. These centers are responsible for guiding patients to seek treatment at provincial hospitals or transferring them to village health stations for outpatient care and management.

+ Charitable and humanitarian facility treatment applies to areas capable of organizing such facilities to accept AIDS patients without families or support, and AIDS patients in difficult circumstances.

c) Principles for treating AIDS patients:

- Treatment according to guidelines issued by the Ministry of Health

- Organizing separate rooms for AIDS patients

- Leaders of healthcare facilities treating AIDS patients must provide material conditions and personal protective equipment for medical staff directly caring for and treating AIDS patients. Implement sterile practices to prevent cross-infection in hospitals.

- After stable inpatient treatment for AIDS patients, healthcare facilities must inform the Preventive Health Centers and District/County Health Centers to carry out community-based management, care, and coordinated outpatient treatment for HIV-infected individuals.

d) The AIDS Prevention Department of the Provincial Health Department is responsible for organizing training sessions for healthcare workers to improve skills in caring for and counseling HIV/AIDS patients.

3. Rectify HIV/AIDS surveillance work to accurately assess the current status of HIV/AIDS infection nationwide:

a) Provincial Preventive Health Centers are responsible for implementing HIV/AIDS surveillance activities and ensuring the number of samples tested complies with regulations. In non-priority surveillance areas, testing should only be conducted for voluntary cases and not indiscriminately, which would waste reagents.

b) After confirming HIV/AIDS infection through testing, the Department of Health or the Preventive Health Center authorized by the Department of Health shall notify the infected person, the family of the infected person, and key local officials after providing adequate counseling.

c) Strictly implement regulations on epidemic reporting and key surveillance result reporting according to the agreed format and timeframe.

4. Management of equipment and consumables for the HIV/AIDS prevention program

Equipment and consumables for the HIV/AIDS prevention program must be recorded in detail in logbooks: date of receipt, condition of the equipment upon receipt, user of the equipment. There must be a history record and a usage guide for each machine. Consumables must be stored properly, closely monitored, and if nearing expiration, immediately transferred to the Provincial/City Preventive Health Center for use in key surveillance purposes. The allocation list of sterile equipment and consumables, arranged based on the proposal of the Department of Health, may only be adjusted with approval from the National Committee for HIV/AIDS Prevention and the Government’s Organizational Cadre Board. Equipment must be used for its intended purpose.

5. Strengthening management and leadership of the program at all levels:

Localities that have not established an HIV/AIDS Prevention Board (including district level) must immediately set up such boards and assign dedicated staff to assist the Department of Health leadership in overseeing and coordinating HIV/AIDS prevention activities in their locality according to guidelines from the National Committee for HIV/AIDS Prevention and the Government’s Organizational Cadre Board.

Upon receipt of this directive, the Ministry requests the heads of subordinate units under the Ministry, provincial/city health directors, and health sector leaders to organize the implementation of the aforementioned activities and report the results to the Ministry of Health (Preventive Health Department, Treatment Department).