JOINT CIRCULAR No. 32/2005/TTLT-BLDTBXH-BYT GUIDING THE PREVENTION AND CONTROL OF TUBERCULOSIS, HIV/AIDS AND SEXUALLY TRANSMITTED DISEASES AT REHABILITATION-CORRECTION-SOCIAL LABOR CENTERS

JOINT CIRCULAR

Guidelines for preventing and controlling tuberculosis, HIV/AIDS, and sexually transmitted diseases at Rehabilitation-Education-Social Work Centers through sexual contact ||

at the Rehabilitation - Education - Social Labor Center ||

Implementing Decree No. 135/2004/NĐ-CP dated June 10, 2004 of the Government on the regime of applying measures to admit individuals into medical facilities, organizing activities of such facilities under the Administrative Violations Handling Law, and the regime applicable to minors and voluntary admissions, the Ministry of Labor, Veterans and Social Affairs and the Ministry of Health issue guidelines for preventing and controlling tuberculosis, HIV/AIDS, and sexually transmitted diseases at Rehabilitation-Education-Social Work Centers as follows:

I. GENERAL PROVISIONS

1. These guidelines stipulate preventive measures against tuberculosis, HIV/AIDS, and sexually transmitted diseases; diagnosis and treatment of tuberculosis, AIDS, and sexually transmitted diseases; responsibilities of agencies, organizations, and individuals in preventing and controlling tuberculosis, HIV/AIDS, and sexually transmitted diseases at Rehabilitation-Education-Social Work Centers.

2. In this Circular, the following terms shall be understood as follows:

a) Rehabilitation-Education-Social Work Center (hereinafter referred to as the Center) as defined in this Circular is an entity established and operated according to Decree No. 135/2004/NĐ-CP dated June 10, 2004 of the Government on the regime of applying measures to admit individuals into medical facilities, organizing activities of such facilities under the Administrative Violations Handling Law, and the regime applicable to minors and voluntary admissions;

b) Sexually Transmitted Diseases (hereinafter referred to as STD) are diseases caused by bacteria, viruses, fungi, single-cell parasites, and other causes that spread through unprotected sexual contact.

3. Individuals undergoing drug rehabilitation or treatment at the Center who have tuberculosis, HIV infection, or STDs shall not be discriminated against; their illnesses shall be kept confidential; they shall be managed, cared for, counseled, and treated appropriately in accordance with the organizational and management conditions of the Center.

4. Prohibited acts:

a) Spreading information about HIV/AIDS infections within the Center;

b) Tattooing, engaging in sexual relations, using addictive substances, using syringes and sharp objects illegally that may cause bleeding within the Center;

c) Intentionally infecting others with HIV.

II. PREVENTION AND CONTROL OF TUBERCULOSIS, HIV/AIDS, AND STD AT THE CENTER

1. Prevention of Tuberculosis, HIV Infection, and STD

1.1. For the Center

a) Organize communication activities to prevent and control tuberculosis, HIV/AIDS, and STD through various forms such as posters, brochures, leaflets, pamphlets, specialized lectures, creative writing contests, cultural performances;

b) Educate on civilized and healthy lifestyles and awareness of disease prevention in daily living and hygiene at the Center;

c) Enhance knowledge about tuberculosis, HIV/AIDS, and STD, including information on disease groups, sources of transmission, clinical symptoms, complications, and methods to prevent tuberculosis, HIV infection, and STD;

d) Enhance skills in implementing safe behaviors to prevent and control tuberculosis, HIV infection, and STD;

đ) Provide legal education on preventing and controlling tuberculosis, HIV/AIDS, and STD;

e) Develop and implement regulations on preventing tuberculosis, HIV infection, and STD;

g) Process items and waste contaminated with blood or body fluids, including bedding (quilts, sheets, pillows, mattresses), before providing them to other learners in accordance with the regulations of the Ministry of Health.

1.2. For Center staff

a) Do not discriminate against individuals with tuberculosis, HIV infection, or STD; maintain close relationships, comfort, encourage, and assist them so they can feel secure while undergoing treatment and rehabilitation at the Center;

b) Adhere to legal provisions regarding the confidentiality of information related to the prevention and control of tuberculosis, HIV/AIDS, and STD;

c) Follow preventive measures against the transmission of tuberculosis, HIV, and STD as directed by the Ministry of Health;

d) Guide learners to comply with the Center's hygiene regulations for disease prevention.

1.3. For learners undergoing rehabilitation and treatment at the Center

During the period of rehabilitation and treatment at the Center, learners must take measures to prevent the transmission of tuberculosis, HIV infection, and STD to themselves and others as follows:

a) Actively engage in health exercises to enhance their resistance to disease;

b) Strictly adhere to the Center's hygiene regulations for disease prevention:

- Maintain general cleanliness, avoid spitting or littering indiscriminately;

- Items contaminated with blood or body fluids, such as clothing, bedding, sheets, pillows, must be soaked in soap water or Javen solution for 30 minutes before washing;

- Contaminated waste, such as bandages, sanitary napkins (for women), must be collected and placed in designated areas;

- Do not share personal items such as clothing, bedding, sheets, pillows, toothbrushes, razors;

c) Participate in the Center's activities aimed at preventing and controlling tuberculosis, HIV/AIDS, and STD.

2. Diagnosis and Treatment of Tuberculosis, HIV/AIDS, and STD

2.1. Diagnosis of Tuberculosis, HIV, and STD:

During the health examination process when admitting learners for rehabilitation and treatment or during regular and emergency health checks, the Center organizes or collaborates with healthcare agencies to test for tuberculosis, HIV, and STD among learners showing signs of these diseases.

a) Diagnosis of Tuberculosis:

The diagnosis of tuberculosis is carried out in accordance with the national tuberculosis prevention program.

b) Diagnosis of HIV:

- Collaborate with local healthcare facilities capable of performing HIV testing techniques to conduct HIV tests;

- Before and after conducting HIV tests for learners, healthcare staff at the Center provide counseling to learners about HIV testing according to the content and guidance specified in Part IV of this Circular.

c) Diagnosis of STD:

- The diagnosis of STD among learners undergoing rehabilitation and treatment at the Center should be based on clinical symptoms;

- Based on clinical symptoms and the material conditions of the Center, the Center conducts or collaborates with health authorities in the area to perform necessary tests according to the regulations of the health sector for each type of disease to determine the disease and treatment regimen.

2.2. Treatment of Learners with Tuberculosis, HIV Infection, and STD:

The Center is responsible for coordinating with state medical facilities during the treatment of trainees. In cases where trainees suffer from serious illnesses that exceed the Center's treatment capacity, the Center must transfer the trainees to state medical facilities for treatment. State medical facilities are responsible for cooperating, receiving, and treating trainees who are transferred for treatment.

a) Treatment of trainees with tuberculosis:

Trainees with tuberculosis are treated in isolation areas and follow the tuberculosis treatment regimen established by the Ministry of Health;

b) Treatment of trainees infected with HIV:

- The Center treats common opportunistic infections for HIV-infected trainees;

- Trainees infected with HIV who suffer from diseases beyond the Center's treatment capacity shall be transferred to state medical facilities according to the doctor's prescription.

c) Treatment of trainees with STDs:

The treatment of trainees with STDs is carried out strictly according to the prescribed treatment regimen.

3. Management of trainees with tuberculosis, HIV infection, and STDs

3.1. During the detoxification and treatment period at the Center, the Center's Health Department establishes a Health Management Record (attached model) to monitor health changes and conduct regular health check-ups every six months to proactively detect trainees with tuberculosis, HIV infection, and STDs.

3.2. Upon detection of trainees with tuberculosis, HIV infection, and STDs, the Center's health staff are responsible for:

a) Guiding infected trainees on preventive measures against the spread of tuberculosis, HIV, and STDs to others;

b) For trainees with tuberculosis, upon receiving positive AFB test results and other necessary tests, they will be immediately admitted to the isolation area. The admission file for trainees with tuberculosis includes:

- Medical records;

 - Results of AFB tests and other necessary tests (X-rays, lymph node puncture...);

- Transfer form to the isolation area confirmed by the Center Director.

Trainees with tuberculosis who have completed the prescribed treatment duration and have three consecutive negative sputum smear results (-), the treating physician will conclude the medical record, assess their health status, propose the Center Director to approve and transfer the trainee out of the isolation area for further treatment, study, and daily activities in groups.

c) Developing appropriate treatment, study, and labor programs based on the physical conditions and health status of trainees with tuberculosis, HIV infection, and STDs.

III. ISOLATION TREATMENT AREA

1. Based on physical conditions, scale, and number of trainees with tuberculosis, the Center establishes an isolation treatment area to receive and treat these patients during the detoxification and treatment period at the Center.

2. Staff working in the isolation treatment area, directly treating tuberculosis patients, must comply with medical regulations concerning contact with infectious diseases.

3. Trainees undergoing treatment in the isolation area must abide by the rules of the isolation treatment area.

IV. HIV/AIDS COUNSELING

The Center's health staff organize counseling for trainees to voluntarily undergo HIV testing and provide post-test counseling.

1. Counseling before testing

1.1. On risk factors for HIV transmission, routes of transmission through injection drug use or unsafe sexual practices;

1.2. On the purpose and significance of HIV testing;

1.3. On the impact of HIV test results;

1.4. On lifestyle and methods to prevent HIV transmission;

1.5. On handling HIV test results;

1.6. On social support for people living with HIV.

2. Counseling after testing

2.1. Test results must be directly communicated to trainees by counselors or responsible personnel. Disclosure of positive HIV test results to trainees must ensure confidentiality and should not be done via mail, telephone, or other means.

2.2. Personnel disclosing test results must provide psychological and social counseling to trainees if their test results are positive and maintain confidentiality with everyone (except spouse and responsible personnel) in accordance with legal provisions on HIV prevention and control.

3. Counseling for trainees with negative test results

3.1. Counseling to persuade trainees to change risky behaviors, adopt healthy behaviors, and avoid HIV transmission risks;

3.2. Negative test results may indicate no current HIV infection but could also mean an infection in the "window period," thus counseling trainees to change behavior and retest after three months.

4. Counseling for trainees with positive HIV test results

4.1. Counseling on difficulties and solutions in the subsequent period;

4.2. Counseling on the benefits of early detection and timely treatment of opportunistic infections;

4.3. Counseling on maintaining a healthy lifestyle and practicing safe sex.

V. IMPLEMENTATION

1. The Department of Labor, Invalids, and Social Affairs is responsible for:

1.1. Leading and coordinating with the Department of Health to develop programs and plans for tuberculosis, HIV/AIDS, and STD prevention and control at the Center.

1.2. Directing, supervising, and inspecting the implementation of regulations and activities related to tuberculosis, HIV/AIDS, and STD prevention and control at the Center.

2. The Department of Health is responsible for:

2.1. Guiding local Social Rehabilitation Centers to implement regulations issued by the Ministry of Health regarding medical record models, medical records, and other relevant regulations concerning tuberculosis, HIV/AIDS, and STD prevention and treatment at the Center.

2.2. Coordinating with the Department of Labor, Invalids, and Social Affairs to develop training programs for Center staff on tuberculosis, HIV/AIDS, and STD prevention and control.

2.3. Advising provincial People's Committees on allocating funds from the provincial target program on tuberculosis and HIV/AIDS prevention and control for activities related to tuberculosis and HIV/AIDS prevention and control at the Center.

2.4. Directing local hospitals and health agencies to cooperate with the Center in implementing tuberculosis, HIV/AIDS, and STD prevention and control activities at the Center.

3. The Social Rehabilitation Center is responsible for:

3.1. Cooperating with local healthcare facilities to implement tuberculosis, HIV/AIDS, and STD prevention and control activities at the Center.

3.2. Compile and report periodically and urgently on the situation of tuberculosis, HIV/AIDS, and sexually transmitted diseases (STDs) among drug rehabilitation and treatment patients at the Center.

3.3. Advise the Department of Labor, Invalids, and Social Affairs to develop inter-sectoral plans between Labor, Invalids, and Social Affairs and Health regarding the implementation of tuberculosis, HIV/AIDS, and STD prevention and control activities at the Center quarterly and annually.

4. Hospitals, Tuberculosis Prevention Centers, HIV/AIDS Prevention Centers, Preventive Medical Centers, and provincial STD management agencies shall be responsible for

4.1. Providing professional guidance on tuberculosis, HIV/AIDS, and STD prevention and control to the Center.

4.2. Cooperating with the Center to organize testing, treatment, and counseling for patients with tuberculosis, HIV infection, and STDs.

VI. EFFECTIVE DATE OF IMPLEMENTATION

This Circular takes effect fifteen days from the date of publication in the Official Gazette and revokes Circular No. 14/2000/TTLT/BLDTBXH-BYT dated June 16, 2000, issued jointly by the Ministry of Labor, Invalids, and Social Affairs and the Ministry of Health, guiding the management, care, and counseling for people infected with HIV/AIDS at medical facilities under the Labor, Invalids, and Social Affairs sector. Any previous guidelines that conflict with this Circular are hereby abolished.

In the course of implementation, if there are any difficulties, units and localities are requested to report to the Ministry of Labor, Invalids, and Social Affairs and the Ministry of Health for timely guidance.