Hanoi Summit on Pharmacist and AIDS

UCSF leaders in pharmacy, international health, and AIDS met with their Vietnamese peers in Hanoi this October to plan how Viet Nam pharmacy workforce can curtail the spread of HIV in Viet Nam.

By Wallace Ravven, UCSF Office of Public Affairs

HIV was first detected in Viet Nam in 1990. By the decade's end, HIV infection had spread to all 64 provinces and major cities in the country. Estimates now range from 80,000 to more than 100,000 people infected -- still well under 1% of the population, but growing. Commercial sex workers and drug users remain the most commonly affected, with infection rates approaching 25%. Sexually transmitted cases continue to rise, according to the United States Agency for International Development(USAID), in what is considered a "concentrated” epidemic.

National Strategy and US Funding

This year the Vietnamese government approved the National Strategy on HIV/AIDS Prevention and Control to slow the spread of HIV and spare the country the personal tragedy and economic loss an AIDS epidemic would surely bring. The strategy aims to:

• increase awareness of HIV transmission
• promote education programs in schools
• control transmission in groups with high-risk behaviors
• improve care and treatment for people living with HIV and
• provide antiretroviral therapy to eligible people, with a goal of treating 70% of AIDS patients by 2010.

The new effort should soon get a boost, as Viet Nam is slated to receive US funds for new antiretroviral drugs, treatment, and education under The President's Emergency Plan for AIDS Relief (PEPFAR). This is particularly good news in a country where less than 1,000 HIV-positive Vietnamese, and possibly only about 100, currently receive AIDS medications

But between the surging needs of HIV-infected people and the promise of new treatments lies a startling shortage of professionals trained to screen, educate, and treat those with HIV. Case in point: Only one doctor in Viet Nam is trained in HIV care for every 10,000 currently infected. This workforce gap threatens to sabotage the government's plans and prevent new drugs from reaching those who need them.

The Potential of 16,000 Pharmacies

Global Health Sciences Associate Director of Research Nancy Padian, PhD with staff from Hanoi University of Pharmacy.

Because the vast majority of Vietnamese have neither health insurance nor personal funds to pay for doctors’ visits, pharmacists and pharmacy workers are the primary source of medicine and medical advice for most Vietnamese. The October 2004 conference in Hanoi sought to flesh out a practical approach to improving HIV screening and patient management, drug quality and access, and comprehensive drug information by focusing resources on this pharmacy network.

Opening Remarks

As Viet Nam's Minister of Health Tran Thi Trung Chien said at the opening ceremony, "In the battle against this century's disease, pharmacists have great opportunities (to reach) patients and populations at risk. We should mobilize this source…of HIV/AIDS prevention."

In her opening address, Mary Anne Koda-Kimble, PharmD, dean of the UCSF School of Pharmacy, stressed the urgency of having a well-trained workforce in place prior to antiretroviral drug distribution through PEPFAR and other international programs. “We have learned from other countries the dire consequences of inappropriate use of antiretrovirals and inadequate numbers of health workers well trained in HIV screening, prevention, and treatment,” she said. “The result in Viet Nam could be resistance to antiretrovirals, an accelerating spread of HIV, inattention to drug quality, and poor adherence in following drug regimens.

Training Pharmacists

Global Health Sciences Executive Director Haile Debas, MD with Donn Colby, MD Harvard University.

"One of the wonderful things about the conferences was the flexibility and openness of our Vietnamese partners," said John Inciardi, PharmD, a UCSF School of Pharmacy faculty member who played a major role in planning the conference along with Sacramento clinical pharmacist Kate Nguyen, PharmD. "For example, retraining is not part of their tradition, but they quickly embraced this new idea.

Developing Clinical Curricula and Faculty Expertise

Viet Nam's pharmacy schools do not currently include a clinical focus, but by the end of the conference, Tu Minh Koong, PhD, rector of Hanoi University of Pharmacy, and his colleagues at other Vietnamese pharmacy schools asserted the need to integrate into their curricula information about HIV/AIDS and increasingly common diseases. The final recommendation urges using HIV/AIDS as the model for clinical pharmacy practice and later applying clinical pharmacy skills to the management of other ailments such as heart disease and cancer.

Stepping back from the current, urgent needs, Koong and the other Vietnamese pharmacy school leaders recognized  the need to increase HIV/AIDS expertise within their teaching staffs . Vietnamese and US conference participants agreed that this would require that select Vietnamese faculty members train at UCSF while also acquiring broad skills and knowledge to teach HIV/AIDS courses as well as other disease-based courses.

Creating a Drug Information Network

Conferees also recognized that Viet Nam needs an effective system to provide current information about medications to health care professionals throughout the country. Pending the identification of funding, UCSF School of Pharmacy leaders agreed to establish a drug information service for Viet Nam pharmacists, selecting key papers from the HIV/AIDS literature and current treatment guidelines. A goal is to create a drug information repository at Hanoi University of Pharmacy, drawing on expertise of the UCSF Drug Information Analysis Service.

Assuring Drug Quality

Information and clinical training about AIDS drugs is of modest value if the quality of such drugs is not good. Vietnamese planners stressed the need for the conference to include a pointed discussion on the topic of drug quality assurance. Conference participants from the United States Pharmacopeia led this discussion with Viet Nam's director of drug quality control. Their recommendations were to include drug quality evaluation in the pharmacy curricula, teach pharmacists and others the simple tasks of visually inspecting drugs and labels, and improve communication among government agencies in order to control the spread of substandard and counterfeit drugs.

Talks End, Work Begins

“The collegiality among all who participated was wonderful,” said Koda-Kimble. “The appreciation we developed for each other’s challenges and expertise will surely carry us forward as we work together to implement conference goals."

Debas found that the summit was on target to avert grave health and social problems. "The Hanoi conference," he said, "set priorities within the healthcare workforce where they should be, for without the right people in the right numbers with the right skills to deliver prevention and treatment in the right ways, no amount of antiretroviral therapy will halt the spread of AIDS in Viet Nam."

The 3-day summit included about 200 participants and ended with agreement for both countries to set up working groups to address the goals they had identified. Going forward, US delegates stressed the need to continually assess projects. Koong noted the need for Vietnamese academic leaders to develop the effective grant writing skills required to secure the international funding needed to implement conference recommendations.

This article was edited for length. The full version is available on the School of Pharmacy Web site.

UCSF School of Pharmacy, UCSF Global Health Sciences, UCSF AIDS Research Institute, United States Pharmacopeia through its Global Assistance Initiatives program, and USAID sponsored the summit in partnership with Hanoi University of Pharmacy.