Circular No. 28/2018/TT-BYT on the management of treatment for people infected with HIV and people exposed to HIV at healthcare facilities

CIRCULAR

REGULATIONS ON THE MANAGEMENT OF TREATMENT FOR HIV-INFECTED PERSONS AND HIV-EXPOSED PERSONS AT HEALTH CARE FACILITIES

Pursuant to the Law on Prevention and Control of Infection with Viruses Causing Acquired Immunodeficiency Syndrome No. 64/2006/QH11 dated June 29, 2006; 64/2006/QH11 dated June 29, 2006;

Pursuant to the Decree No. 108/2007/NĐ-CP dated June 26, 2007 of the Government detailing a number of articles of the Law on Prevention and Control of Infection with Viruses Causing Acquired Immunodeficiency Syndrome (HIV/AIDS);concerning HIV/AIDS;

Pursuant to Decree No. 75/2017/NĐ-CP dated June 20, 2017 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

1. Positive HIV test results may only be notified when such results have been confirmed by a laboratory that has been authorized by the competent authority to conduct confirmatory testing for HIV-positive cases as stipulated in Decree No. 75/2016/NĐ-CP dated July 1, 2016 of the Government on conditions for conducting HIV tests and Decree No. 155/2018/NĐ-CP dated November 12, 2018 of the Government amending and supplementing certain provisions related to investment and business conditions under the management of the Ministry of Health.

The Minister of Health issues this Circular on the management of treatment for HIV-infected persons and HIV-exposed persons at health care facilities.This Circular stipulates the management of initial registration for treatment, follow-up examination, transfer between levels, and the management of treatment for HIV-exposed persons at health care facilities.This Circular applies to HIV antiretroviral drug treatment facilities, health care facilities dispensing antiretroviral drugs, HIV-infected persons, HIV-exposed persons, and other relevant agencies, organizations, and individuals.

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

Article 3. Diagnosis, Treatment, and Prescription of Antiretroviral Drugs for Outpatient Treatment for HIV-Infected Persons and HIV-Exposed Persons

Article 2. Applicability

Clause 1. Diagnosis and treatment for HIV-infected persons and HIV-exposed persons shall be carried out in accordance with Decision No. 5418/QĐ-BYT dated December 1, 2017 of the Minister of Health promulgating Guidelines for HIV/AIDS Treatment and Care and Decision No. 6250/QĐ-BYT dated October 16, 2018 of the Minister of Health regarding supplementary guidelines for Decision No. 5418/QĐ-BYT dated December 1, 2017 of the Minister of Health promulgating Guidelines for HIV/AIDS Treatment and Care temporarily using antiretroviral drugs (ARVs) for children to prevent mother-to-child transmission of HIV (hereinafter referred to as Guidelines for HIV/AIDS Treatment and Care).

Clause 2. Prescription of antiretroviral drugs for outpatient treatment for HIV-infected persons and HIV-exposed persons shall be carried out in accordance with Circular No. 52/2017/TT-BYT dated December 29, 2017 of the Minister of Health on prescriptions and prescription practices for chemical and biological products in outpatient treatment and Circular No. 18/2018/TT-BYT amending and supplementing some articles of Circular No. 52/2017/TT-BYT dated December 29, 2017 on prescriptions and prescription practices for chemical and biological products in outpatient treatment, and in accordance with the provisions of this Circular.

Clause 3. Use of outpatient treatment medical records according to the model prescribed in Decision No. 4069/QĐ-BYT dated September 28, 2001 of the Minister of Health on the issuance of medical record models (hereinafter referred to as Decision No. 4069/QĐ-BYT) and the instructions for recording medical records attached to this Circular.

Clause 4. For patients undergoing inpatient treatment, the provisions of Article 10 of this Circular shall apply.

Article 4. Plan for Supply of Antiretroviral Drugs

Clause 1. Each year, the lead agency for HIV/AIDS prevention and control at provincial and municipal levels shall develop plans for antiretroviral drug treatment for HIV-infected persons and HIV-exposed persons in accordance with Clauses 3, 4, and 5 of this Article based on local needs, and submit them to the Provincial Department of Health (hereinafter referred to as the Department of Health) for consolidation and submission to the National AIDS Control Center.

Clause 2. The National AIDS Control Center shall be responsible for:

a) Consolidating the antiretroviral drug treatment plans from various localities, developing procurement plans for antiretroviral drugs purchased from state budget sources and funded by domestic and foreign organizations and individuals, and submitting these plans for approval by the Minister of Health;

b) Allocating and coordinating the distribution of antiretroviral drugs to localities and HIV/AIDS treatment facilities according to the approved plan by the Minister of Health.

Clause 3. Antiretroviral drugs provided free of charge for HIV-infected persons shall be prioritized in the following order:

a) Cases specified in point a, b, c, Clause 3, Article 39 of the Law on Prevention and Control of HIV/AIDS;

b) HIV-infected persons in prisons, detention centers, compulsory educational facilities, and juvenile rehabilitation centers;

c) Other HIV-infected persons.

Clause 4. Antiretroviral drugs funded by domestic and foreign organizations and individuals shall be provided free of charge for HIV-infected persons in accordance with Clause 2 of this Article.

Clause 5. The groups guaranteed funding from the state budget for free antiretroviral drugs include:

a) Persons exposed to HIV, persons infected with HIV due to occupational accidents or risks, and persons infected with HIV due to medical risks;

b) Pregnant women infected with HIV and pregnant women with indications for HIV prevention treatment from mother to child;

c) Children under six years old infected with HIV and children with indications for HIV prevention treatment from mother to child.

Clause 6. In cases where the groups specified in Clauses 3, 4, and 5 of this Article have health insurance cards and do not receive free antiretroviral drug treatment from the state budget or aid, they will be reimbursed by the Health Insurance Fund.

MANAGEMENT OF TREATMENT FOR HIV-INFECTED PERSONS REGISTERING FOR TREATMENT

FIRST-TIME REGISTRATION, FOLLOW-UP EXAMINATION, AND TRANSFER

Chapter II

FIRST-TIME REGISTRATION AND FOLLOW-UP EXAMINATION FIRST REGISTRATION, FOLLOW-UP EXAMINATION, REFERRAL

Section 1

REGISTRATION FOR INITIAL TREATMENT AND FOLLOW-UP EXAMINATION

Article 5. Content to be implemented for individuals newly diagnosed with HIV

1. Verify personal information of the patient on the HIV confirmation test result form against the information on the patient's identification documents. For children under 18 months old, compare personal information on the Positive HIV Test Result Form using molecular biology techniques with the information on their birth certificate or birth registration.

2. Conduct a medical examination, assess clinical status, immune system, provide treatment advice, and handle according to the provisions set out in the Guidelines for HIV/AIDS Treatment and Care after verifying personal information of the patient.

3. Prepare antiretroviral therapy according to the content prescribed in the Guidelines for HIV/AIDS Treatment and Care. Initiate antiretroviral therapy immediately when the HIV-infected individual is ready to start treatment.

4. Prescribe antiretroviral drugs according to Clause 2, Article 3 of this Circular.

5. Dispense antiretroviral drugs according to Clauses 3, 4, 5, and 6, Article 4 of this Circular, with a maximum quantity sufficient for up to 30 days of use.

6. Schedule a follow-up appointment at the antiretroviral therapy facility (hereinafter referred to as the treatment facility) within 2 to 4 weeks or when there are unusual issues. Record the follow-up appointment schedule in the Outpatient Medical Record and Patient Health Book (hereinafter collectively referred to as the Health Book).

7. Complete the outpatient treatment medical record according to the guidance provided in Appendix No. 01 issued together with this Circular. File the original or a legally certified copy of the HIV Confirmation Test Result Form or Positive HIV Test Result Form using molecular biology techniques for children under 18 months old in the medical record.

Article 6. Content to be implemented for individuals returning for follow-up visits after initial diagnosis with HIV

1. Conduct a medical examination, monitor clinical response, immune system, viral load, adherence to treatment, diagnose accompanying diseases, and handle according to the provisions set out in the Guidelines for HIV/AIDS Treatment and Care.

2. Prescribe and dispense antiretroviral drugs

a) In cases where the patient has been receiving antiretroviral therapy for less than 12 months, prescribe and dispense medication with a maximum quantity sufficient for up to 30 days of use. If the patient wishes to collect antiretroviral drugs from the commune health center, evaluate the criteria for collecting drugs at the commune health center, prescribe, dispense, and guide the HIV-infected individual to collect drugs at the commune health center according to the provisions of point c, point d, Clause 2 of this Article. Write a Referral Letter according to the guidance provided in Appendix No. 02 issued together with this Circular. Schedule a follow-up visit according to the provisions of Clause 3 of this Article;

b) In cases where the patient has been receiving antiretroviral therapy for 12 months or more:

In cases where antiretroviral therapy is not stable: prescribe and dispense antiretroviral drugs with a maximum quantity sufficient for up to 30 days of use.

In cases where antiretroviral therapy is stable and the patient wishes to continue collecting antiretroviral drugs at the treatment facility: prescribe and dispense antiretroviral drugs with a maximum quantity sufficient for up to 90 days of use.

In cases where the patient has been receiving stable antiretroviral therapy and wishes to collect antiretroviral drugs from the commune health center: prescribe, dispense, and guide the HIV-infected individual to collect drugs at the commune health center according to the provisions of point c, point d, Clause 2 of this Article. Write a Referral Letter according to the guidance provided in Appendix No. 02 issued together with this Circular.

c) Criteria for patients to collect antiretroviral drugs at the commune health center: HIV-infected individuals who have received antiretroviral therapy for at least six months, showing good clinical response, immune system function, good adherence to treatment, no side effects requiring regular monitoring, no accompanying diseases, and wish to collect drugs at the commune health center;

d) Prescription and dispensing of antiretroviral drugs for patients collecting drugs at the commune health center: the treatment facility prescribes antiretroviral drugs in the outpatient medical record and Health Book of the patient with a maximum quantity sufficient for up to 90 days of use. The quantity of drugs prescribed in the prescription is dispensed in a maximum of three installments. Each installment is dispensed with a maximum quantity sufficient for up to 30 days of use. The first installment is collected at the treatment facility. Subsequent installments are collected at the commune health center. When the drugs dispensed at the commune health center are exhausted or according to the scheduled follow-up appointment, the patient returns to the treatment facility for another examination and prescription.

3. Schedule a follow-up appointment:

a) In cases where the patient collects antiretroviral drugs at the treatment facility: Schedule a follow-up appointment when the dispensed drugs are exhausted or when there are unusual signs, record the follow-up appointment schedule in the patient's Health Book;

b) In cases where the patient collects antiretroviral drugs at the commune health center: Schedule a follow-up appointment every three months at the treatment facility or when there are unusual signs; record the follow-up appointment schedule in the patient's Health Book.

4. In cases where the patient comes for examination and drug collection earlier than scheduled: The patient can still undergo examination and receive drugs; the quantity of drugs dispensed in this treatment period will be accumulated with the unused quantity from the previous period until the next scheduled follow-up appointment.

5. If the patient does not return for the follow-up appointment at the scheduled time: The treatment facility contacts the patient or the patient's family to remind the patient to return for re-examination and drug collection according to the scheduled time.

6. In cases where the patient has discontinued treatment and then resumes treatment: Based on the condition of the HIV-infected individual, the treatment facility provides examination and treatment according to the provisions of Article 5 or Article 6 of this Circular.

Article 7. Management of patients receiving antiretroviral therapy at commune health stations

1. Receiving patients and checking personal information on their identification documents against the information on the Referral Form.

2. Dispensing medication according to prescriptions recorded in the Referral Form and the Patient's Medical Record. Before dispensing medication, a medical examination, tuberculosis screening, and assessment of treatment adherence should be conducted. In cases where there are no unusual signs, and the patient adheres well to the treatment, monthly antiretroviral drugs should be dispensed according to the prescription. The name of the drug, quantity dispensed, and usage instructions should be clearly recorded in the Patient's Medical Record. If there are unusual signs, appropriate measures within the scope of expertise should be taken. If beyond the scope of expertise, referral should be made according to regulations.

3. Reminding patients to return for regular check-ups at the treatment facility as scheduled in the Patient's Medical Record and Referral Form.

Article 8. Use of medical records in HIV/AIDS treatment

1. Outpatient medical records for HIV-infected individuals shall be used throughout the course of treatment. In cases where the medical record is torn, damaged, or too thick and difficult to store, the treatment facility must open a new Outpatient Medical Record.

2. The procedure for opening a new Outpatient Medical Record shall be carried out in accordance with the guidelines set forth in Appendix No. 01 issued together with this Circular.

Section 3

REFERRAL AND DISPENSING OF ANTIRETROVIRAL DRUGS FOR PATIENTS WHO HAVE BEEN REFERRED BREFERRAL SYSTEM

Article 9. Referral and follow-up of referrals

1. The treatment facility transferring the patient:

a) Implementing the referral process in accordance with Circular No. 14/2014/TT-BYT dated April 14, 2014, issued by the Minister of Health regarding the referral process between healthcare facilities (hereinafter referred to as Circular No. 14/2014/TT-BYT) and the provisions of this Circular;

b) Summarizing the medical record in accordance with the guidelines set forth in Appendix No. 01 issued together with this Circular;

c) Writing the Referral Form in accordance with the guidelines set forth in Appendix No. 02 issued together with this Circular;

d) Providing sufficient antiretroviral drugs to last until the next scheduled appointment at the new treatment facility.

2. The treatment facility receiving the patient:

a) Receiving the patient and verifying personal information against the information recorded in the Referral Form;

b) Based on the information recorded in the Referral Form and the clinical condition of the patient, implementing the contents prescribed in Article 6 of this Circular;

c) Within a maximum period of thirty days from the date of receiving the patient, the treatment facility receiving the patient must provide feedback on the reception of the patient to the transferring facility in accordance with Circular No. 14/2014/TT-BYT.

3. After thirty days from the date recorded on the Referral Form, if the treatment facility transferring the patient does not receive notification about the reception of the patient from the treatment facility to which the patient was transferred, the transferring treatment facility must contact the receiving treatment facility to confirm the information regarding the patient's referral.

In cases where the patient does not attend the treatment facility as recommended by the referral, the transferring treatment facility must contact the patient or the patient's family to remind the patient to complete the referral process.

4. In cases of referral at the request of the patient, in addition to implementing the contents prescribed in Paragraphs 1, 2, and 3 of this Article, the treatment facility has the responsibility to provide information about the most suitable antiretroviral treatment facility for the patient so that the patient can independently choose a new treatment facility.

5. In cases where an HIV-infected patient undergoing antiretroviral therapy is admitted to a prison, temporary detention center, compulsory educational institution, or juvenile correctional school: the treatment facility must implement the referral process in accordance with Joint Circular No. 02/2015/TTLT/BCA-BQP-BYT dated January 22, 2015, issued by the Ministry of Public Security, the Ministry of National Defense, and the Ministry of Health guiding management, care, counseling, and treatment for HIV-infected individuals and prevention of HIV transmission in prisons, temporary detention centers, holding facilities, compulsory educational institutions, and juvenile correctional schools (hereinafter referred to as Joint Circular No. 02/2015/TTLT/BCA-BQP-BYT) and the guidelines for writing referral forms set forth in Appendix No. 02 issued together with this Circular.

6. In cases of referral involving HIV-infected children: the transferring treatment facility must advise the child's caregiver about the referral process. In cases where the child is using pediatric doses of antiretroviral drugs or non-standard regimens, prior contact must be made with the receiving treatment facility to ensure the availability of appropriate medication before the child is transferred.

7. In cases of referral from a pediatric treatment facility to an adult treatment facility: the transferring treatment facility must advise and provide knowledge about reproductive health for adolescent children, and counsel on the disclosure of HIV status before referral. The receiving treatment facility must continue to provide psychological support, reproductive health knowledge, and sexual health education to the patient in accordance with the HIV/AIDS Treatment and Care Guidelines.

Article 10. Guidelines for dispensing antiretroviral drugs to HIV-infected individuals undergoing inpatient treatment

In cases where HIV-infected individuals who are receiving outpatient treatment with antiretroviral drugs must be admitted for inpatient treatment for HIV-related diseases or non-HIV-related diseases, and their antiretroviral drugs run out during inpatient treatment, the following measures shall be taken:

1. Where the inpatient department is within the same facility as the outpatient HIV/AIDS department:

a) The patient may continue to receive antiretroviral drugs from the outpatient HIV/AIDS department or from the inpatient department if the physician in the inpatient department is qualified to prescribe antiretroviral drugs;

b) If the physician in the inpatient department is not qualified to prescribe antiretroviral drugs, they must consult or coordinate with the physician in the outpatient HIV/AIDS department to prescribe antiretroviral drugs for the patient. The quantity of antiretroviral drugs prescribed shall be recorded in the medical record, Outpatient Book, and dispensed together with the inpatient treatment drugs.

2. Where the inpatient facility is different from the facility where the patient is receiving antiretroviral drugs:

a) If the inpatient facility is also an antiretroviral drug dispensing facility, the patient may receive drugs at this facility. The patient must present the Outpatient Book detailing the treatment regimen and the quantity of drugs previously dispensed as the basis for subsequent drug issuance. The physician in the inpatient department may prescribe antiretroviral drugs if qualified to do so. If the physician in the inpatient department is not qualified to prescribe antiretroviral drugs, they must consult with a qualified physician to prescribe the drugs for the patient. The quantity of antiretroviral drugs prescribed shall be recorded in the medical record, Outpatient Book, and dispensed together with the inpatient treatment drugs:

b) If the inpatient facility is not an antiretroviral drug dispensing facility, the representative of the patient shall collect antiretroviral drugs at the facility where the patient is receiving antiretroviral drugs. When collecting the drugs, the representative must present identification (ID card, citizen identity card, passport still valid) and a Certificate of Inpatient Treatment according to the model specified in Appendix No. 03 issued along with this Circular. The treatment facility shall issue drugs in quantities not exceeding 30 days' supply.

Article 11. Guidelines for coordinating the treatment of HIV-infected individuals in detention centers, temporary detention centers, holding facilities, compulsory education centers, and juvenile rehabilitation schools

The treatment facility shall coordinate with healthcare facilities within detention centers, temporary detention centers, holding facilities, compulsory education centers, and juvenile rehabilitation schools to implement the following:

1. Providing HIV/AIDS treatment and care for HIV-infected individuals in accordance with Circular Joint No. 02/2015/TTLT/BCA-BQP-BYT.

2. Dispensing free antiretroviral drugs from the state budget and other legitimate sources of antiretroviral drugs when HIV-infected individuals are receiving antiretroviral treatment in detention centers, temporary detention centers, holding facilities, compulsory education centers, and juvenile rehabilitation schools.

3. Advising and supporting HIV-infected individuals to participate in health insurance when they leave detention centers, temporary detention centers, holding facilities, compulsory education centers, and juvenile rehabilitation schools to continue antiretroviral treatment from health insurance sources.

Chapter III

MANAGEMENT OF TREATMENT FOR INDIVIDUALS EXPOSED TO HIV

Article 12. Management of Treatment for Children Exposed to HIV

1. Management of treatment for children exposed to HIV (including children under 18 months old born from HIV-infected mothers; mothers with test results reactive to HIV screening tests; children with test results reactive to HIV screening tests) at reproductive health service facilities that are not HIV antiretroviral therapy (ART) treatment centers:

a) Advise on the benefits and necessity of using ART drugs for children to prevent mother-to-child transmission of HIV;

b) Prescribe ART drugs for children to prevent mother-to-child transmission of HIV; prescribe and manage early diagnostic testing for HIV infection in children according to the guidelines set forth in the HIV/AIDS Treatment and Care Guidelines;

c) Guide caregivers on how to store and administer ART drugs to ensure adequate dosage and how to give the child the medication at home;

d) Introduce and refer children to continue care and treatment at HIV treatment centers equipped to manage HIV-infected and exposed children when they reach four weeks of age. The referral procedures for children shall be carried out according to Decision No. 5877/QD-BYT issued by the Minister of Health on December 29, 2017 regarding the approval of "Guidelines for Implementing Prevention of Mother-to-Child Transmission of HIV at Healthcare Facilities." Write the Referral Form according to the instructions provided in Appendix No. 02 attached hereto.

2. Management of treatment for children exposed to HIV at HIV ART treatment centers equipped to manage HIV-infected and exposed children:

a) Establish outpatient treatment records according to the model prescribed in Decision No. 4069/QĐ-BYT and the instructions provided in Appendix No. 01 attached hereto;

b) Assess the overall condition, mental and physical development of the child; provide nutritional and care advice appropriate to the situation;

c) Continue to provide prophylactic treatment to prevent mother-to-child transmission of HIV using ART drugs according to the guidelines set forth in the HIV/AIDS Treatment and Care Guidelines;

đ) Prevent opportunistic infections according to the guidelines set forth in the HIV/AIDS Treatment and Care Guidelines;

e) Advise on adherence to treatment, monitor drug side effects, and provide guidance on managing adverse reactions;

g) Prescribe early diagnostic testing for HIV and manage according to the guidelines set forth in the HIV/AIDS Diagnosis and Treatment Guidelines and Decision No. 2674/QĐ-BYT dated April 27, 2018 issued by the Minister of Health regarding the issuance of National Guidelines for HIV Testing;

h) Closely monitor clinical progression, detect early signs of HIV infection in all visits;

i) Treat with ART drugs immediately when the child exhibits clinical signs of HIV infection or has a positive result from the first molecular biology technique test or a confirmatory HIV test;

k) Record all information fully in the HIV Exposure Follow-up Log according to the model prescribed in Appendix No. 04 attached hereto.

Article 13. Management of Treatment for Children Over 18 Months Old and Adults Exposed to HIV

1. Manage according to the guidelines set forth in the HIV/AIDS Treatment and Care Guidelines. In cases where post-exposure prophylaxis treatment is required, establish outpatient treatment records according to the model prescribed in Decision No. 4069/QĐ-BYT and the instructions provided in Appendix No. 01 attached hereto.

2. Provide post-exposure prophylaxis treatment with ART drugs according to the guidelines set forth in the HIV/AIDS Treatment and Care Guidelines.

3. Record all information fully in the HIV Exposure Follow-up Log according to the model prescribed in Appendix No. 04 attached hereto.

4. Manage after the completion of post-exposure prophylaxis follow-up treatment:

If the person exposed to HIV is confirmed to be infected with HIV, management and follow-up treatment shall be conducted according to Chapter II of this Circular.

If the person exposed to HIV is confirmed not to be infected with HIV, advise on HIV exposure and HIV prevention according to Circular No. 06/2012/TT-BYT dated April 30, 2012 issued by the Minister of Health regarding the establishment conditions and activities of organizations providing counseling on HIV/AIDS prevention and control.

Chapter IV

IMPLEMENTATION PROVISIONS

Article 14. Effective Date

1. This Circular takes effect from January 1, 2019.

2. Circular No. 32/2013/TT-BYT dated October 17, 2013 issued by the Minister of Health guiding the management and follow-up treatment of HIV-infected persons and persons exposed to HIV becomes invalid from the date this Circular takes effect.

Article 15. Reference Provisions

In case the referenced documents in this Circular are replaced or amended, they shall be applied according to the replacement, amendment, or supplementation documents.

Article 16. Transitional Provisions

Within twelve months from the date this Circular takes effect, healthcare facilities providing HIV treatment shall back up all current medical records to Outpatient Treatment Records according to the model prescribed in Decision No. 4069/QĐ-BYT and the instructions provided in Appendix No. 01 attached hereto.

Article 17. Implementation Organization

1. Responsibilities of the AIDS Control Department

a) Take the lead and coordinate with the Medical Examination and Treatment Administration Department to guide the implementation of this Circular;

b) Distribute and coordinate the supply of ART drugs, guide HIV treatment facilities to implement management, forecasting, distribution, storage, and use of ART drugs based on the availability of ART drug sources and the provisions on access to ART drugs in this Circular;

c) Organize inspections of the implementation of this Circular.

2. Responsibilities of the Medical Examination and Treatment Administration Department

a) Coordinate with the AIDS Control Department to guide the implementation of this Circular;

b) Coordinate inspections of the implementation of this Circular.

3. Responsibilities of the Maternal and Child Health Department

a) Coordinate with the AIDS Control Department to guide the implementation of this Circular;

b) Coordinate inspections of the implementation of this Circular.

4. Responsibilities of the Provincial Health Departments

a) Organize the implementation of management and treatment of HIV-infected persons and persons exposed to HIV according to the provisions of this Circular;

b) Guide provincial-level HIV/AIDS prevention and control focal points and HIV treatment facilities within their jurisdiction to implement management, distribution, and use of ART drugs for HIV-infected persons and persons exposed to HIV according to the provisions of this Circular, ensuring that patients only receive one source of supply for one type of ART drug during one treatment cycle;

c) Direct and guide treatment facilities to apply information technology in the management and treatment of HIV-infected persons and persons exposed to HIV;

d) Inspect the implementation of management and treatment of HIV-infected persons and persons exposed to HIV according to the provisions of this Circular.

5. Responsibilities of provincial and city-level HIV/AIDS prevention and control focal points

a) Supervise and provide technical support for the implementation of management and treatment of HIV-infected individuals, individuals exposed to HIV, and HIV-exposed children, access to antiretroviral drugs, management, use, and distribution of antiretroviral drugs at HIV/AIDS treatment facilities in accordance with the provisions of this Circular;

b) Coordinate with reproductive health service providers and antiretroviral drug treatment facilities in connecting, managing, and monitoring HIV-positive mothers and their children until the HIV status of the child is confirmed;

c) Report on the management and treatment of HIV-infected individuals, individuals exposed to HIV, and the management and use of antiretroviral drugs within the province/city to the Department of Health and the Ministry of Health (National AIDS Control Center) as prescribed;

6. Responsibilities of the provincial/city-level reproductive health service coordination agency

a) Guide reproductive health service providers in implementing the management and treatment of HIV-exposed children in accordance with the provisions of this Circular;

b) Coordinate with the provincial/city-level HIV/AIDS prevention and control coordination agency in supervising and providing technical support for the implementation of management and treatment of HIV-infected individuals, individuals exposed to HIV, access to antiretroviral drugs, management, use, and distribution of antiretroviral drugs at reproductive health service providers in accordance with the provisions of this Circular;

7. Responsibilities of antiretroviral drug treatment facilities

a) Manage and treat HIV-infected individuals and individuals exposed to HIV in accordance with the provisions of this Circular;

b) Advise patients about sources of antiretroviral drug supply at the treatment facility so that patients can choose appropriate drug supply sources;

c) Coordinate with the provincial/city-level HIV/AIDS prevention and control coordination agency and reproductive health service providers in connecting, managing, and monitoring HIV-positive mothers and their children until the HIV status of the child is confirmed;

d) Coordinate with commune health stations in managing and monitoring the treatment of HIV-infected individuals receiving antiretroviral drugs at commune health stations;

đ) Use the HIV Exposure Monitoring Logbook according to Appendix No. 04, Pre-treatment Registration Logbook for Antiretroviral Therapy according to Appendix No. 05, Treatment Registration Logbook for Antiretroviral Therapy according to Appendix No. 06 issued together with this Circular or utilize information technology applications to compile statistics and report on the situation of antiretroviral therapy for HIV-infected individuals at the facility as prescribed. In cases where information technology is utilized in the management and monitoring of HIV-infected individuals and individuals exposed to HIV, it is necessary to ensure that all information fields specified in the HIV Exposure Monitoring Logbook, Pre-treatment Registration Logbook for Antiretroviral Therapy, and Treatment Registration Logbook for Antiretroviral Therapy are adhered to as stipulated in this Circular;

e) Report on the management and treatment of HIV-infected individuals, individuals exposed to HIV, and the management and use of antiretroviral drugs to the provincial HIV/AIDS prevention and control coordination agency as prescribed;

8. Responsibilities of reproductive health service providers

a) Manage and treat HIV-exposed children in accordance with the provisions of this Circular;

b) Coordinate with the provincial/city-level HIV/AIDS prevention and control coordination agency and antiretroviral drug treatment facilities in connecting, managing, and monitoring HIV-positive mothers and their children until the HIV status of the child is confirmed;

9. Responsibilities of commune health stations

a) Distribute medication, manage, monitor, and assist HIV-infected individuals in the locality to access antiretroviral therapy;

b) Coordinate with district health centers and treatment facilities in supporting HIV-infected individuals who have discontinued antiretroviral therapy to resume treatment;

c) Distribute, manage patients' medical examinations and receipt of antiretroviral drugs at commune health stations in accordance with the provisions of this Circular;

d) Report on the management and monitoring of patients undergoing antiretroviral therapy, HIV-infected individuals receiving antiretroviral drugs at commune health stations as prescribed;

Article 18. Responsibility for Implementation

The Head of the Ministry's Office, the Inspector General of the Ministry, the Director of the National AIDS Control Center, Heads of Departments, Directors of Centers, and Deputy Directors-General under the Ministry of Health, Heads of agencies and units directly under the Ministry, Provincial Health Department Directors, Heads of health agencies under Ministries and sectors, and related organizations and individuals are responsible for implementing this Circular. During the implementation process, if there are any difficulties, agencies, organizations, and individuals should promptly reflect them to the Ministry of Health (National AIDS Control Center) for research and resolution.

During implementation, any difficulties shall be promptly reported to the Ministry of Health (HIV/AIDS Prevention and Control Department) for research and resolution./.