AIDS and Behavior

, Volume 23, Issue 10, pp 2840–2848 | Cite as

Factors Associated with Improved HIV/AIDS Treatment Outcomes: Comparing two Major ART Service Delivery Models in Vietnam

  • Bach Xuan TranEmail author
  • Quang Nhat Nguyen
  • Long Hoang Nguyen
  • Cuong Tat Nguyen
  • Huyen Phuc Do
  • Nu Thi Truong
  • Carl A. Latkin


A mixed design approach was performed to assess the CD4 count levels over time and their associated factors among 362 HIV patients on ART from clinics with HIV testing and counseling (ART-HTC) services and those with general healthcare (ART-GH) services. Longitudinal CD4 count data were retrospectively collected from medical records. Sociodemographic, clinical, alcohol use and smoking characteristics were obtained via face-to-face interviews. Multivariate mixed effect linear regression was utilized to determine the association. We found that HIV patients at ART-GH clinics were more likely to achieve higher CD4 counts over time compared to patients at ART-HTC clinics. Additionally, having an increase in CD4 counts was found to be associated with having longer duration of ART and higher baseline CD4 levels. Cigarette smoking and hazardous alcohol use, however, were not associated with CD4 count improvement. Our findings suggest that combining HTC and GH services might provide a synergistic benefit in ART treatment outcomes through an improved access to comprehensive HIV healthcare services for HIV patients on therapy.


ART service delivery models HIV testing and counseling services HIV treatment outcome Cigarette smoking Alcohol use 



We would like to thank the participants and staffs at the participating clinics.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    UNAIDS. Snapshot - HIV investment Geneva, Switzerland: UNAIDS; 2016. Accessed 20 Aug 2018.
  2. 2.
    UNAIDS. Fact sheet — global HIV statistics Geneva, Switzerland: UNAIDS; 2017. Accessed 20 Aug 2018.
  3. 3.
    VAAC VAoHAC. Report on HIV/AIDS prevention and control in 2017 and key tasks in 2018. Hanoi, Vietnam: VAAC; 2017.Google Scholar
  4. 4.
    Todini N, Hammett TM, Fryatt R. Integrating HIV/AIDS in Vietnam’s social health insurance scheme: experience and lessons from the health finance and governance project, 2014–2017. Health Syst Reform. 2018;4(2):114–24.CrossRefGoogle Scholar
  5. 5.
    Duong AT, Kato M, Bales S, Do NT, Minh Nguyen TT, Thanh Cao TT, et al. Costing analysis of national HIV treatment and care program in Vietnam. J Acquir Immune Defic Syndr. 2014;65(1):e1–7.CrossRefGoogle Scholar
  6. 6.
    Church K, Wringe A, Fakudze P, Kikuvi J, Simelane D, Mayhew SH. Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland. J Int AIDS Soc. 2013;16(1):17981.CrossRefGoogle Scholar
  7. 7.
    Tran BX, Vu PB, Nguyen LH, Latkin SK, Nguyen CT, Phan HT, et al. Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam. BMC Public Health. 2016;16:238.CrossRefGoogle Scholar
  8. 8.
    Mukora R, Charalambous S, Dahab M, Hamilton R, Karstaedt A. A study of patient attitudes towards decentralisation of HIV care in an urban clinic in South Africa. BMC Health Serv Res. 2011;11:205.CrossRefGoogle Scholar
  9. 9.
    Kemp CG, Weiner BJ, Sherr KH, Kupfer LE, Cherutich PK, Wilson D, et al. Implementation science for integration of HIV and non-communicable disease services in sub-Saharan Africa: a systematic review. AIDS (London, England). 2018;32:S93–105.CrossRefGoogle Scholar
  10. 10.
    Patel P, Rose CE, Collins PY, Nuche-Berenguer B, Sahasrabuddhe VV, Peprah E, et al. Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS (London, England). 2018;32(Suppl 1):S5–20.CrossRefGoogle Scholar
  11. 11.
    Brent RJ, Brennan M, Karpiak SE. Economic evaluations of HIV prevention in rich countries and the need to focus on the aging of the HIV-positive population. Curr Opin HIV AIDS. 2010;5(3):255–60.CrossRefGoogle Scholar
  12. 12.
    Simeone CA, Seal SM, Savage C. Implementing HIV testing in substance use treatment programs: a systematic review. J Assoc Nurses AIDS Care. 2017;28(2):199–215.CrossRefGoogle Scholar
  13. 13.
    Nguyen LT, Tran BX, Tran CT, Le HT, Tran SV. The cost of antiretroviral treatment service for patients with HIV/AIDS in a central outpatient clinic in Vietnam. ClinicoEcon Outcomes Res. 2014;6:101–8.PubMedPubMedCentralGoogle Scholar
  14. 14.
    WHO. The treatment 2.0 framework for action: catalysing the next phase of treatment, care and support. 2011.Google Scholar
  15. 15.
    Kato M, Long NH, Duong BD, Nhan DT, Nguyen TT, Hai NH, et al. Enhancing the benefits of antiretroviral therapy in Vietnam: towards ending AIDS. Curr HIV/AIDS Rep. 2014;11(4):487–95.CrossRefGoogle Scholar
  16. 16.
    Aaronson LS, Kingry MJ. A mixed method approach for using cross-sectional data for longitudinal inferences. Nurs Res. 1988;37(3):187–9.CrossRefGoogle Scholar
  17. 17.
    Giordano TP, Guzman D, Clark R, Charlebois ED, Bangsberg DR. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clin Trials. 2004;5(2):74–9.CrossRefGoogle Scholar
  18. 18.
    Tran BX, Nguyen LT, Nguyen NH, Hoang QV, Hwang J. Determinants of antiretroviral treatment adherence among HIV/AIDS patients: a multisite study. Global Health Action. 2013;6:19570.CrossRefGoogle Scholar
  19. 19.
    Mai HT, Le GM, Tran BX, Do HN, Latkin CA, Nguyen LT, et al. Adherence to antiretroviral therapy among HIV/AIDS patients in the context of early treatment initiation in Vietnam. Patient Prefer Adherence. 2018;12:2131–7.CrossRefGoogle Scholar
  20. 20.
    Tran BX, Nguyen LH, Tran TT, Latkin CA. Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients. PLoS ONE. 2018;13(1):e0190941.CrossRefGoogle Scholar
  21. 21.
    Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–17.CrossRefGoogle Scholar
  22. 22.
    HIV Testing and Counselling in Prisons and Other Closed Settings: Technical Paper: [S.l.]: Geneva: World Health Organization, 2009.Google Scholar
  23. 23.
    Farahani M, Mulinder H, Farahani A, Marlink R. Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis. Int J STD AIDS. 2017;28(7):636–50.CrossRefGoogle Scholar
  24. 24.
    Collins LF, Clement ME, Stout JE. Incidence, long-term outcomes, and healthcare utilization of patients with human immunodeficiency virus/acquired immune deficiency syndrome and disseminated. Open Forum Infect Dis. 2017. Scholar
  25. 25.
    Altekruse SF, Shiels MS, Modur SP, Land SR, Crothers KA, Kitahata MM, et al. Cancer burden attributable to cigarette smoking among HIV-infected people in North America. AIDS (London, England). 2018;32(4):513–21.PubMedCentralGoogle Scholar
  26. 26.
    Kahler CW, Liu T, Cioe PA, Bryant V, Pinkston MM, Kojic EM, et al. Direct and indirect effects of heavy alcohol use on clinical outcomes in a longitudinal study of HIV patients on ART. AIDS Behav. 2017;21(7):1825–35.CrossRefGoogle Scholar
  27. 27.
    Hessol NA, Weber KM, Holman S, Robison E, Goparaju L, Alden CB, et al. Retention and attendance of women enrolled in a large prospective study of HIV-1 in the United States. J Womens Health (Larchmt). 2009;18(10):1627–37.CrossRefGoogle Scholar
  28. 28.
    Nguyen LH, Tran BX, Nguyen NP, Phan HT, Bui TT, Latkin CA. Mobilization for HIV voluntary counseling and testing services in Vietnam: clients’ risk behaviors, attitudes and willingness to pay. AIDS Behav. 2016;20(4):848–58.CrossRefGoogle Scholar
  29. 29.
    Organization WH. Treatment of injecting drug users with HIV/AIDS: promoting access and optimizing service delivery. Geneva: World Health Organization; 2006.Google Scholar
  30. 30.
    Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retroviruses. 2010;26(5):511–8.CrossRefGoogle Scholar
  31. 31.
    Malbergier A, Amaral RA, Cardoso LD. Alcohol dependence and CD4 cell count: is there a relationship? AIDS Care. 2015;27(1):54–8.CrossRefGoogle Scholar
  32. 32.
    Samet JH, Cheng DM, Libman H, Nunes DP, Alperen JK, Saitz R. Alcohol consumption and HIV disease progression. J Acquir Immune Defic Syndr. 2007;46(2):194–9.CrossRefGoogle Scholar
  33. 33.
    Shuter J, Bernstein SL. Cigarette smoking is an independent predictor of nonadherence in HIV-infected individuals receiving highly active antiretroviral therapy. Nicotine Tob Res. 2008;10(4):731–6.CrossRefGoogle Scholar
  34. 34.
    O’Cleirigh C, Valentine SE, Pinkston M, Herman D, Bedoya CA, Gordon JR, et al. The unique challenges facing HIV-positive patients who smoke cigarettes: HIV viremia, ART adherence, engagement in HIV care, and concurrent substance use. AIDS Behav. 2015;19(1):178–85.CrossRefGoogle Scholar
  35. 35.
    Pollack TM, Duong HT, Pham TT, Do CD, Colby D. Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam. PLoS ONE. 2017;12(3):e0173534.CrossRefGoogle Scholar
  36. 36.
    Hahn JA, Cheng DM, Emenyonu NI, Lloyd-Travaglini C, Fatch R, Shade SB, et al. Alcohol use and HIV disease progression in an antiretroviral naive cohort. J Acquir Immune Defic Syndr. 2018;77(5):492–501.CrossRefGoogle Scholar
  37. 37.
    Wandera B, Tumwesigye NM, Nankabirwa JI, Kambugu AD, Mafigiri DK, Kapiga S, et al. Hazardous alcohol consumption is not associated with CD4 + T-cell count decline among PLHIV in Kampala Uganda: a prospective cohort study. PLoS ONE. 2017;12(6):e0180015.CrossRefGoogle Scholar
  38. 38.
    Cagle A, McGrath C, Richardson BA, Donovan D, Sakr S, Yatich N, et al. Alcohol use and immune reconstitution among HIV-infected patients on antiretroviral therapy in Nairobi. Kenya AIDS Care. 2017;29(9):1192–7.CrossRefGoogle Scholar
  39. 39.
    Conen A, Wang Q, Glass TR, Fux CA, Thurnheer MC, Orasch C, et al. Association of alcohol consumption and HIV surrogate markers in participants of the swiss HIV cohort study. J Acquir Immune Defic Syndr. 2013;64(5):472–8.CrossRefGoogle Scholar
  40. 40.
    Carrieri MP, Protopopescu C, Raffi F, March L, Reboud P, Spire B, et al. Low alcohol consumption as a predictor of higher CD4 + cell count in HIV-treated patients: a french paradox or a proxy of healthy behaviors? The ANRS APROCO-COPILOTE CO-08 cohort. J Acquir Immune Defic Syndr. 2014;65(4):e148–50.CrossRefGoogle Scholar
  41. 41.
    Winhusen T, Feaster DJ, Duan R, Brown JL, Daar ES, Mandler R, et al. Baseline cigarette smoking status as a predictor of virologic suppression and CD4 cell count during 1-year follow-up in substance users with uncontrolled HIV infection. AIDS Behav. 2018;22(6):2026–32.CrossRefGoogle Scholar
  42. 42.
    Brown JL, Winhusen T, DiClemente RJ, Sales JM, Rose ES, Safonova P, et al. The association between cigarette smoking, virologic suppression, and CD4 + lymphocyte count in HIV-infected Russian women. AIDS Care. 2017;29(9):1102–6.CrossRefGoogle Scholar
  43. 43.
    Akhtar-Khaleel WZ, Cook RL, Shoptaw S, Surkan P, Stall R, Beyth RJ, et al. Trends and predictors of cigarette smoking among HIV seropositive and seronegative men: the multicenter aids cohort study. AIDS Behav. 2016;20(3):622–32.CrossRefGoogle Scholar
  44. 44.
    Kabali C, Cheng DM, Brooks DR, Bridden C, Horsburgh CR, Samet JH. Recent cigarette smoking and HIV disease progression: no evidence of an association. AIDS Care. 2011;23(8):947–56.CrossRefGoogle Scholar
  45. 45.
    Gordon LL, Gharibian D, Chong K, Chun H. Comparison of HIV virologic failure rates between patients with variable adherence to three antiretroviral regimen types. AIDS Patient Care STDs. 2015;29(7):384–8.CrossRefGoogle Scholar
  46. 46.
    Míguez-Burbano MJ, Lewis JE, Fishman J, Asthana D, Malow RM. The influence of different types of alcoholic beverages on disrupting highly active antiretroviral treatment (HAART) outcome. Alcohol Alcohol (Oxford, Oxfordshire). 2009;44(4):366–71.CrossRefGoogle Scholar
  47. 47.
    Kowalski S, Colantuoni E, Lau B, Keruly J, McCaul ME, Hutton HE, et al. Alcohol consumption and CD4 T-cell count response among persons initiating antiretroviral therapy. J Acquir Immune Defic Syndr. 2012;61(4):455–61.CrossRefGoogle Scholar
  48. 48.
    Conen A, Fehr J, Glass TR, Furrer H, Weber R, Vernazza P, et al. Self-reported alcohol consumption and its association with adherence and outcome of antiretroviral therapy in the Swiss HIV cohort study. Antiviral Ther. 2009;14(3):349–57.Google Scholar
  49. 49.
    Kobin AB, Sheth NU. Levels of adherence required for virologic suppression among newer antiretroviral medications. Ann Pharmacother. 2011;45(3):372–9.CrossRefGoogle Scholar
  50. 50.
    UNAIDS. 90–90–90 - An Ambitious Treatment Target to Help End the AIDS Epidemic. Geneva, Switzerland: World Health Organiztion; 2017.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
  2. 2.Johns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  3. 3.Université Claude Bernard Lyon 1VilleurbanneFrance
  4. 4.Institute for Global Health InnovationsDuy Tan UniversityDa NangVietnam
  5. 5.Center of Excellence in Behavioral MedicineNguyen Tat Thanh UniversityHo Chi Minh cityVietnam
  6. 6.Center of Excellence in Health Services and System ResearchNguyen Tat Thanh UniversityHo Chi Minh cityVietnam

Personalised recommendations