MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH CENTRAL INSTITUTE OF HYGIEN AND EPIDEMIOLOGY VU CONG THAO REAL SITUATION AND ACCESS THE EFFICIENCY OF AIDS PATIENT CARE, SUPPORT AND TREATMENT AT OUTPATIENT CLINICS FOR ADULTS IN PROVINCES OF VIETNAM, 2009 - 2010 Major: Epicemiology Code: 62 72 01 17 SUMMARY OF MEDICAL DOCTOR THESIS Hanoi, 11/2011 The work is completed at: Central Institute of Hygiene and Epidemiology The science supervisor: Ass.Pro.Dr Nguyen Thanh Long Ass.Pro.Dr Ho Ba Do Objection 1: Objection 2: Objection 3: The thesis will be defenced at the State Council of thesis mark in Central Institute of Hygiene and Epidemiology at , date month year The thesis can be serached at: National library The library of National Institute of Hygiene and Epidemiology LIST OF THE AUTHORS’ ANNOUNCED RESEARCH WORK RELATED TO THE THESIS Vu Cong Thao, Nguyen Thanh Long, Ho Ba Do, (2011) “Some features and demand of care, support and treatment of the infected at the non-resident clinics in privinces of Vietnam in 2009”, Preventive Medical Magazine– Special issue for Vietnam Teacher Day, November 20th and 2011’s postgraduate science conference of postgraduate training bases, Central Institute of Hygiene and Epidemiology File XXI, No (125) pp 148 – 154 Vu Cong Thao, Nguyen Thanh Long, Ho Ba Do and et al (2011), “Some comments on HIV/AIDS patient treatment by ARV at outpatient clinics in Vietnam, 20092010”, Vietnam Medical Megazine – File 388, No 1, December 2011 pp.30 – 34 INTRODUCTION It has been 30 years since the world confronted with HIV/AIDS epidemic In spite of many achievements in medicine, biology, sociology, media education information, community mobilization, etc in the field of HIV/AIDS prevention, it is not strong enough to prevent the HIV/AIDS epidemic’s attack Especially, in the developing countries where the source for diagnosing, treating, monitoring and managing HIV/AIDS infected patients is limited, HIV/AIDS is still the issue of top concern of public and social health To limit spreading the HIV/AIDS epidemic and prolong the life for the patients, a lot of methods such as education propaganda to increase the awareness, understading on HIV for the community, provision treatment, potential infection treatment, anti-retrovirus medicine (ARV) for infected persons were conducted Among above methods, caring, supporting and treating by ARV medicine play an important role Although ARV medicines not completely treat HIV/AIDS, it significantly reduces the diseases and death, prolong and improve meaningful life for many patients with AIDS In Vietnam, in order to meet HIV epidemic prevention, in 2000, Ministry of Health issued national instructions on HIV/AIDS dignosis and treatment, which were supplemented and amended in 2005, 2009 Ministry of Health also had the plan to classify the treatment by establishing outpatient clinic in provinces, cities HIV/AIDS infected people can register to be freely cared and treated at one of these clinics Treatment extension by ARV and treatment monitor in outpatient clinics have been conducted since March, 2006 with the support of the projects of global fund, American President’s urgent assistance fund (Pepfar), Bill-Clinton Fund, etc This treatment implementation brought the hope and future for a lot of HIV/AIDS infected persons, and timely prevent HIV infection for the potential subjects and community.At these clinics, HIV/AIDS infected persons are provided with a lot of essential services: Adequately consulted to ensure complying with the treatment with high efficiency, discrimination reduction, community intergration, etc and create conditions for HIV/AIDS infected persons to obtain many chances to live, self-work, self-care, reduce the burden for the family and society After years of outpatient clinic development, as of 30/6/ 2011, the whole nation had 54.637 AIDS patients who were managed and treated by anti-retrovirus medicine (ARV) It is very issential to evaluate the efficiency of AIDS patient care, support and treatment at the outpatient clinics and then extend the program to meet AIDS patients’ increasing demand of care, support and treatment Starting from above base, in the framework of the project “ Provision and care for the HIV/AIDS infected persons in Vietnam – Life-Gap” by Ministry of Health and Department of HIV/AIDS prevention, we conduct to research the theme: "Real situation and efficiency evaluation of AIDS patient care, support and treatment at the adults’ outpatient clinics in provinces of Vietnam, 2009-2010” with the targes: Describe real situation and some factors related to supplying the services of AIDS patient care, support and treatment in the adults’ outpatient clinics in provinces/cities: Hanoi, Nghe An, Ho Chi Minh City Assess the efficiency of AIDS patient care, support and treatment management in the adults’ outpatient clinics at the place of research * New contributions of the thesis: - Describe operation situation of outpatient clinic models and services supplied for the patients by outpatient clinics and efficiency of AIDS patient treatment by anti-retrovirus medicine (ARV) as well as several factors related to the outpatient clinics’s care, treatment support - The model of outpatient clinics associated with available medical bases is proved to obtain good efficiency, in appropriateness with the nations which have public health network like Vietnam The research result is the scientific base to support the State Agencies on HIV/AIDS prevention and for the projects, the donars have basses to adjust the activities more appropriate and effective * The thesis’ structure: The thesis including 120 pages (excluding the appendixes, table of contents, abbreviations) constitues into chapters: - Introduction: pages - Chapter Overview: 33 pages - Chapter2 Subject and research method: 21 pages - Chapter Result: 38 pages - Chapter Discussion: 23 pages - Conclusion: pages - Recomendation: page - The thesis include: 37 tables, 10 maps - Reference: 137 CHAPTER I OVERVIEW 1.1 Real situation of HIV/AIDS infection According to the report at the end of year 2010 by UNAIDS and WHO, the whole world has about 70 million of infected people, 30 million of dead persons and currently, there are about 40 million persons with HIV/AIDS Each day, there is further about 7.000 new infected persons (of which, there are 6.000 adults and 1.000 children), 95% new infected cases occurs in slowly developing or developing nations, mainly in African nations nearly Sahara, then it extends to East-South countries HIV/AIDS ranks the fourth among the causes leading to the dealth in African countries The women accounts for over 50% of total persons infected with HIV in the whole world Among 70 million persons infected with HIV in the world, 45% are at the youth age of 15-24 years old The first HIV/AIDS infected case in Vietnam is detected in December, 1990 in Ho Chi Minh City As of 30/6/2011, according to the report of Vietnam HIV/AIDS Prevention Department, the number of detected HIV infected cases is 190.902 persons who are alive; of which, there are 46.056 AIDS patients and 108 persons died due to HIV/AIDS The current infection rate is 224,6/100.000 people 1.2 Situation of HIV/AIDS infected patient care, support and treatment The HIV/AIDS infected patient care, support and treatment is considerred to be the focus of AIDS control and prevention Care, support and treatment reduce the pain of physical and spiritual state, help to prolong the life and enhance life quality for HIV/AIDS infected persons Zămbia is one of the first African nations which implement the HIV infected patient care service at home This service was internationally recognized because of high quality Currently, it is estimated that the whole world has 32,3 HIV infected persons who are alive and mainly gather in developing countries High efficiency HIV virus resistance treatment medicine support (started to implement in 1996) opened new prospects, bringing the hope to prolong the life for HIV/AIDS infected persons Up to now, several other nations un the region of Thai Binh Duong’s west established the base for extending HIV resistance treatment with the Government’s strong commitment in steering, finance and active participation of boards, sectors, unions in the society In Vietnam, currently, the system of HIV infected person care and support in the community which was initiated since 1996, with the program of management, care and consulting in provinces, cities was implemented in the whole country The outpatient clinics, voluntary test room (VCT) were established in combination with consulting HIV test, including the provision for HIV infection from mother to children (PLTMC) in 40 provinces In addition, to gain the target that HIV infected persons can get easy access to the services of care, support and treatment, with the support of Global Project on HIV/AIDS, Ministry of Health conducted the model of care, treatment support in 100 districts of 20 provinces, of which, there are 60 outpatient clinics at the district level which conducted AIDS treatment by HIV resistance medicine CHAPTER II RESEARCH SUBJECT AND METHOD 2.1 Research subject, place and time 2.1.1 Research subject - AIDS infected adults (identified ≥ 18 years old) - The Health staff directly participate in AIDS patient care and treatment at the outpatient clinics and in the community - Colleagues, co-ordinators - AIDS patient’s relatives: Father, mother, wife/husband, brothers, sisters - Reports on HIV/AIDS by Ministry of Health of research provinces/cities; AIDS’s medical document of AIDS patient participating in the research 2.1.2 Research place The research is conducted with clear purpose in outpatient clinics supplying the service of care, support and treatment for AIDS infected adults in provinces, cities: Ha Noi, Nghe An and Ho Chi Minh The outpatient clinics in researched provinces which are choosen to participate researching on the convient base are the ones supplying the ARV treatment services at least years At least, there are 300 patients who are cared, supported and treated with ARV medicine 2.1.3 Research time: Conduct to investigate, intervene for researched subjects from 6/2009 to 12/2010 - The first investigaiton: 6/2009 - 9/2009 (Research real situation description) - The second investigation: 10/2010 - 12/2010 (Access after treatment intervention by ARV medicine) 2.2 Research method 2.2.1 Design research Is the description research method including analysis (combine the quantitative and qualitative) and clinic intervention research in comparison with before and afterintervention 2.2.2 Research method - Method of cross description investigation - Method of secondary data analysis - Method of deep interview, group discussion - Method of clinic test with the comparison 2.2.4 Research sample 2.2.4.1 Quantitative research Size for desdription research calculated according to the fomula of minimal calculation of epidemiology research method describes: p(1 – p) n1 = Z2(1-α/2) x (p.ε)2 n1: Minimal sample size; α: Statistic meaning level(0,05); p: the rate of managed HIV/AIDS infected persons (p=0,5 for maximal sample size); Z(1-α/2): Confidence coefficient with desired confidence of 95% (Z(1-α/2) = 1,96); ε: Relative value (ε = 0,1); Because of choosing sample with clear target, multiply with DE = sample design influence coefficient; it is estimated that the rate of research refuse is 105 With above-mentioned parameters, sample size for research is 844, in reality, when conducting the research, 100 AIDS patients of each outpatient clinics are taken into the research; therefore, total number of research subjects is 900 Sample size for clinical trial study: Assess the effectiveness of intervention, the size was calculated basing on the form to calculate the radix of noncontrolled cohort study [(1 – p1)/p1 + (1 – p2)/p2] n2 = Z (1-α/2) [ℓn(1 – ε)]2 n2: sample size of clinical trial study; Z(1-α/2): confidence coefficient, with desired reliability was 95% (Z(1-α/2) = 1,96); P1: Rate of AIDS patient being taken cared of, supported before intervention p1 = 35% = 0,35; P2: Rate of AIDS patient being taken cared of, supported after intervention p2 = 80% = 0,8; ε: Relative accuracy (Acceptale error), at 10%; expecting the rate of patient reusing to take part in the study is 10% With the above parameters, n2 = 730 as the common sample size calculated for all three outpatient clinic In studying, we took 300 AIDS patients from each outpatient clinic; total number of studying subjects was 900 2.2.4.2 Qualitative study In each clinic, choose subjects for intensice interview (total number of interview was 15) and 20 subjects for focused group discussion (each group included 8-10 people, one group of AIDS patient; group for officers, medical staff in the clinic and caring people) In fact, there were 75 subjects taking part in this study 2.2.5 Sample choosing method 2.2.5.1 Desciption of studying subject * Quantitive study: Choose sample intentionally, in each province or city, choose outpatient clinic the number of AIDS being managed, cared and supported and treated >300, data was collected from a random sample of 300 patients In practical studying, because the sample was chosen on purpuse, outpatient clinic taking part in the study all have sufficient amount of AIDS patient of 300 Total number of patients taking part in the study is 900 * Qualitative study: Subjects taking part in group discussion were chosen intentionally, especially AIDS patients chosen among 300 subjects taking part in the quantitive study Subject taking part in the interview were chosen intentionally 2.2.5.2 Subject of clinical intervention study Studying subjects are AIDS patients studied in stage were patient using ARV medicine of the management board of province, city and district choose until the sample size is 300 for each clinic and were minitored continuously in year 2.2.6 Equipment to collect studying information, indexs and enrolls Set of studying indexes includes parts with 43 indexes in order to describe actual situation, related factors and assess effectiveness of AIDS patient caring, supporting and treatment managing activities before and after treatment with ARV Table of group discussion and intensive interview instruction Table of equipment and facility checking Effectiveness indicator, to compare increasing effectiveness before and after intervention in percent, calculated as following: ‫׀‬Indicator before intervention - Indicator before intervention ‫׀‬ Effectiveness indicator = x 100 Indicator before intervention 2.2.7 Data collecting method The data was collected by: testing table, cross-sectional survey, medical record, AIDS monitoring and caring book, clinical test result of hematology, biochemical, microbiological basing on studying indexes 2.3 Data processing The data were entered with EPI-Info software, SAS program were used to compare and deal with any dissimilarity between data After data entering, data sets were transferred to STATA software version 8.2 (Stata Corp, 2004) 2.5 Limitation of the topic 2.5.1 Topic range Studying location of the topic was chosen interntionally, not really representing provincces, citites, areas with morphological features as well as socio-economic condition of each area Outpatient clinics chosen were clinics financed from projects; then the studying results may not reflect actual situation of HIV/AIDS patient caring, supporting and treating activities currently 2.5.2 Topic limitation The topic is performed in narrow range, not representative, studying subjects were chosen interntionally without randomness The cohort studying was applied for clinical intervention studying but without control 2.5.3 Overcome topic limitation - Investigators and supervisors were chosen and trained consistently in term of studying method, tested tools and practised investigating skills (trial investigating) - The investigating process was supervised closely by field work supervision and quality control survey as well as medical records 2.6 Morality in studying Only study subjects that agreed to take part in Information, data is ensured to be confident and only support for studying purpose The studying result is used to 10 built up and adjusted intervention content for HIV and AIDS patients more and more effectively, helping other HIV / AIDS patients in the studying territory to get benifits directly or indirectly from the program CHAPTER STUDYING RESULTS 3.1 Actual situation and some factors related to supplying of caring, supporting and treating services to AIDS patient in outpatient clinic for audults in studying location 3.1.1 Actual situation of supplying of caring, supporting and treating services to AIDS patients in in outpatient clinic for audults in studying location Outpatient clinic for audults in studying location had sufficient working room as regulated, including: welcoming room, examiniation room, blood testing room, medicine room, consulting room, administration room; in average, there wee 5,6 rooms/ outpatient clinic Officers, staff of outpatient clinics included: doctors, nurse, consultants, technicians, ppharmaceutical workers, supporting staff, other staff; in average, there were 16 officers , staff / outpatient clinic Outpatient clinic in studying location were also supported by peers (HIV/AIDS patients, drug addictors, prostitutes) and coordinators In average, there were 27.3 peers and 28.3 coordinator supporting the outpatient clinics in studying location Rate (%) 85,6 100 80 60 40 20 8,2 6,2 Quantity 1-2 times 3-6 times >6 times Diagram 3.1 Number of times that AIDS patients taking part in the training 100% of studied patients were trained before taking part in the ARV treatment; in that 85.6% took part in the training 3-6 times, took part in more than times 3.1.2 Some factors related to supplying of caring, supporting and treating services to AIDS patients in outpatient clinics for adults in studying location 3.1.2.1 Characteristics of studied patients before intervention 32.6% of AIDS patients at the age of 20-29, while those at the age of 30-39 are 54.5% Male patients still accounted for majority with 72.8% while female ones accounted for 27.2% Studied subject with low education (from primary school downward) accounted for 15.1% There was a difference between high school level, college and university between Nghe An and two cities of Ho Chi Minh city and Hanoi (High school in Hanoi 44.5%, Ho Chi Minh city 38.8%, Nghe An 16.4%) 54.5% of AIDS patients have had husband or wife, the rest (45.5%) was not married or divorced, widow or judicially separated 71.1% of studied subjects lived 13 Diagram 3.3 Knowledge about treatment compliance Almost all the research patients understood that treatment compliance was to take the ARV on time (94.8%), take ARV with specified amount (86.6%) and take the right medicine (81.4%) Table 3.12 Knowledge about treatment non-compliance Rate ARV treatment non-compliance Frequency (n = 900) (%) - Skip dosage among the specified dosages 650 72.2 - Skip day without taking the medicine 612 68.0 - Do not care about the time between the dosages 492 54.7 - Do not know 1.0 72.2% of the research patients considered treatment non-compliance as skipping dosage among the specified dosages; skipping day without taking the medicine (68.0%), and Do not care about the time between the dosages (54.7%) Only 1% of the research patients did not know what should be consider as treatment noncompliance Table 3.14 Knowledge about taking additional missed medicine and the supporting measures for treatment compliance Frequency Rate Contents (n = 900) (%) - Take the missed dosage immediately 744 82.7 Take and count the time for the next dosage additional missed - Skip the missed dosage and take the next 146 16.3 medicine dosage as usual - Do not know 1.0 - Make the plan on my own 691 76.8 Supporting measures for - Cooperate with the supporters 398 44.2 treatment - Notify the health officers 360 40.0 compliance - Do not know 19 2.1 14 When the research patients missed to take one dosage, most of them thought that the missed dosage ought to be taken immediately and count the time for the next dosage (82.7%), 16.3% of them skip the missed dosage and take the next dosage as usual, 1.0% of them did not know what to when they missed one dosage Most of the research patients understood the supporting measures for treatment compliance: Make plane by themselves (76.8%), cooperate with the supporters (44.2%), and notify the health officers (40.0%) Rate (%) 80 60 40 20 61,9 38,1 Pass Fail Level Diagram 3.4: General knowledge about ARV treatment compliance Only 61.9% of the research patients passed the test for General knowledge about ARV treatment compliance, 38.1% did not pass the test 3.1.3 Conditions of the research patients before the ARV treatment 72.8% of the research patients had the history of opportunistic infections 27.2% the research patients did not have the history of opportunistic infections, the highest rate: shingles (9.6%), following by: tuberculosis (8.4%), oral candidiasis: (6.0%), the lowest rate: Retinitis due to CMV (0.2%) 84.8% of the research patients did not have the history of tuberculosis Among 15.6% of the research patients with the history of tuberculosis, 11.2% were being treated, 4.4% of then had been treated 71.1% of them got pulmonary tuberculosis, 26.7% got extrapulmonary tuberculosis Table 3.17 History of ARV preventive treatment and treatment of the research patients Research Location Hanoi Nghe An HCM Total (n= 300) (n= 300) (n= 300) (n= 900) History (%) (%) (%) (%) Cotrimoxazole (preventive ) - Yes 48.7 93.7 48.3 63.6 - No 51.3 6.3 51.7 36.4 Fluconazole (preventive ) - Yes 45.7 33.7 43.7 41.0 - No 54.3 66.3 56.3 59.0 Have used ARV before - Yes 16.7 4.0 14.0 11.6 - No 83.3 96.0 86.0 88.4 15 11.6 % of the research patients had used ARV before registering at the outpatient clinics 63.6% had received the preventive treatment with Cotrimoxazole 41.0% had received preventive treatment with fluconazole The result did not show the number of patients who received preventive treatment with such type of medicines and the rate of patients who did not received the preventive treatment Diagram 3.5 Type of ARV treatment of the research patients before registering at the outpatient clinics Among 99 research patients who had received ARV treatment before registering at the outpatient clinics, 58.6% used ARV by themselves; only 16.2% were treated at other outpatient clinics, 3.0% were treated at private clinics There are types of ARV treatment regimens for the AIDS patients before registering at the outpatient clinics The most popular regimen is d4T/3TC/NVP (57.7%), following by d4T/3TC/EFV (20.8%); the least popular regimen is ZDV/3TC/LPV/R (1.0%) Other type of treatment accounts for 9.6%, and 5.8% could not identify the regimen Table 3.20: Opportunistic infection status of the researched patients before AVR treatment Research place Status With opportunistic infection Without opportunistic infection - Stomatomycosis - Pneumonia PCP - Toxoplasma Infection - Penicillium marneffei - Retinitis by CMV - Tuberculosis - Zona - Other Hanoi (n= 300) (%) 64,3 35,7 27,0 0,3 0,7 1,0 0,0 3,7 2,0 5,3 Nghe An (n= 300) (%) 58,0 42,0 22,0 2,3 0,7 4,0 0,3 12,0 2,3 6,3 HCM city (n= 300) (%) 58,0 42 16,7 0,3 0,0 0,3 0,0 21,0 2,3 26 Total (n= 900) (%) 60,1 39,9 21,9 1,0 0,4 1,8 0,1 12,2 2,2 9,2 16 Before ARV treatment, 60.1% the researched patients not have opportunistic infection Among 39.9% the researched patients have the opportunistic infection, rate of Stomatomycosis is the highest (21.9%), the next is Tuberculosis (12.2%), Zona (2.2%) and retinitis by CMV is rank the lowest (0.1%) 3.1.4 Subclinical indicator before ARV treatment of the the researched patients 83% the researched patients (743/895) have test result CD4 before ARV treatment in outpatient clinic, of which CD4 level of them is mainly low 300 cells: 6.3% and >500 cells: 1.6% 90.4% (809/895) the researched patients have test result liver intoxication before ARV treatment, of which, most of them is at medium level: 53.3%; minor level: 41.9% The number of patients at serious level is low, accounting for 1.1%, the patients at extremely serious level: 0.2% Anemias extend of the researched patients before ARV treatment: 53.4% patients have Hgb test result, of which, most of them are at medium level: 83.5%, the number of patients are at serious level: 0.6% and extremely serious level (can threaten their life): 2.5% 65.7% (588/895) the researched patients have test results about kidney impairment (Creatine indicator – mg/dl), the patients having medium level account for 95.9%, I level (minor): 4.1% None is at level II, III and IV 3.2 Effectiveness of caring, assistance and treatment management activities for the AIDS patients in the adult outpatient clinic in the research place 3.2.1 The result of caring, assistance and treatment management activities for the AIDS patients Table 3.26 Result of consultation, assistance activities for the AIDS patients Research place Hanoi Nghe An HCM city Total Content (n = 300) (n = 300) (n = 300) (n = 900) • • • Group consulting Number of day Number of patient taking part Personal consulting Consulting at family, community • Re-examination 25 521 729 1.925 18 438 653 1.422 27 544 648 1.789 70 1.503 2.030 5.136 2596 2845 2634 8.075 The caring, assistance and treatment management activities for the AIDS patients in the research place are complemented under the regulations In average, the researched patients take part in 1.67 (1,053/900) times of group counsulting; personal consulting is 2.25 times (2030/900), the lowest level is Nghe An: 1.58 times; consulting in community is 5.7 times (5136/900) and re-exammination is 8.97 times (8057/900), the highest level is Nghe An: 9.48 times 17 Table 3.27 Initial ARV treatment regimen of the patients in the research place Reseach place Type of regimen d4T/3TC/NVP d4T/3TC/EFV ZDV/3TC/NVP ZDV/3TC/EFV TDF/3TC/LPV/R Other Not given Hanoi (%) 75,3 20,7 0 0 Nghe An (%) 73,3 18,3 0,3 0 HCM city (%) 45,3 36 11,3 6,3 0,7 0,3 Total (%) 64,7 25 7,4 2,4 0,1 0,2 0,1 The initial ARV treatment regimen at the outpatient clinic of the the researched patients is degree I regimen, mainly regimen with Lamivudin (3TC): 99.7% Associating d4t: 89.7% and Associating ZDV: 10.0% 0.1% patients are treated under inexplicit regimen 5.3% the researched patients have interruption of treatment Most of them have time I interruption: 85.4% Cause of this mainly is acute side effects: 18.8%, being treated tuberculosis: 12.5%, other causes: 60.4% None have interruption of treatment causing by treatment failure or end of drugs 30.4% (272/895) the researched AIDS patients being treated ARV change treatment regimen Main cause is acute and chronic side effects: 59.9%; treatment of tuberculosis: 12.9%; 5.1% patients change their treatment regimen because of ending of drugs (in Hanoi and Nghe An) 0.7 patients change their regimen because of treatment failure Chart 3.7: Result of management for the researched AIDS patients After 12 months treatment ARV, the percentage of patients with active treatment is 75.9%; others: 24.1%, of which: active treatment but stopping ARV: 0.1%, mortality: 10.9%, moving: 8.6% and not control: 4.6% Among 41 research subjects which are not control, the cause is moving to center 06: 7.4%, changing location: 2.4%, mainly inexplicit (56.1%) 18 3.2.2 Effectiveness of caring, assistance and treatment management activities for the AIDS patients in the research place Chart 3.8 Effectiveness of caring, assistance activities for the AIDS patients by their relatives Support and caring people to the AIDS patients during treatment mainly are their wife/ husband, father/mother, brother/sister Percentage of patients being cared, supported by their relatives after 12 month intervention and treatment ARV virus is higher than before intervention Percentage of patients being cared, supported by their wife/ husband increases the highest: from 41.5% to 67.6%; Percentage of patients being cared by their brothers/ sisters insignificantly increases: from 18.4% to 19.8% Effectiveness indicator is 7.6%, 32.96% and 62.89% respectively Chart 3.9: Effectiveness of caring, assistance and treatment management activities for the AIDS patients in the research place of peers and collaborators Percentage of patients being treated by antiviral drug taking part in the research in the research place who are cared and supported by the peers and collaborators after 12 months of antiviral drug intervention and treatment is higher than that before intervention, from 22.3% to 44.1% from the peers and from 33.7% to 53.5% from collaborators, the effectiveness indicator are 97.75% and 39.25% respectively 19 Chart 3.10: Effectiveness of accessing caring, assistance services for the AIDS patients in the research place The AIDS patients taking part in the research have change in accessing the caring, assistance services, receive the caring, assistance from the peers and the collaborators Percentage of the AIDS patients being treated by antiviral drug taking part in the research in the research place who are received injection needle, condom, increases from 43.8% to 51.2% and taking part in club for HIV/AIDS infected people increases from 21.9% to 38.7%, the effectiveness indicators are 16.68% and 76.7%, respectively 3.2.3 Treatment effect of ARV medicine for the researched patients Table 3.32 CD4 index after ARV treatment of the researched patients Before treatment After months After 12 months Number of CD4 cells lg (%) lg (%) lg (%) * ** *** - < 100 426 57,3 63 18,3 19 6,9 - 100 – 200 202 27,2 131 38,1 93 33,8 - 200 - 300 68 9,2 96 27,9 73 26,5 - 300 - 500 35 4,7 36 10,5 62 22,5 - >500 12* 1,6 18** 5,2 28*** 10,2 * ** * * *** & : OR=6,2 ,95%CI(4,5-8,6), p