NGHIÊN CỨU GỐC (ORIGINAL PAPERS)

Commentary: A Significant Transition of Mode of Teaching and Studying to meet the Covid-19 challenges in an university in Vietnam

DOI: https://doi.org/10.38148/JHDS.0502SKPT20-096 ↗
Thi Le Minh1
1 Trường Đại học Y tế công cộng

Tóm tắt

Since the coronavirus outbreak in January, many schools and universities in Vietnam have almost entirely closed for nearly three months as a means of social distancing. The Ministry of Education has requested institutions to shift to online teaching to ensure students are kept up with their study progress while staying at home, and millions of students have been using different digital online learning approaches to satisfy their home-based learning needs. This paper is to comment on the change and challenges of students and lecturers in adapting training strategies response to Covid 19. Although the social distancing lasted only 3 months and there were some concerns regarding the disadvantages of digital and online way of studying, the training strategies in the Universities have changed significantly. Covid -19 also brings an opportunity in rebuild our education system carefully and adaptably in this sensitive world.

Đã Xuất bản 2021-03-26
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Ngôn ngữ Tiếng Việt
Số Tập 5 Số 02 (2021): Tập 5, số 2-2021 (số Tiếng Anh)
Chuyên mục Nghiên cứu gốc (Original papers)
DOI https://doi.org/10.38148/JHDS.0502SKPT20-096 ↗
Trang số 81-83
Từ khóa
Covid-19 university training opportunity challenges Vietnam

Cách trích dẫn

Le Minh, T. (2021). Commentary: A Significant Transition of Mode of Teaching and Studying to meet the Covid-19 challenges in an university in Vietnam. Tạp Chí Khoa học Nghiên cứu Sức khỏe Và Phát triển, 5(02), 81-83. https://doi.org/10.38148/JHDS.0502SKPT20-096
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  2. 2. May, K.E., Elder, A.D. Efficient, helpful, or distracting? A literature review of media multitasking in relation to academic performance. Int J Educ Technol High Educ 15, 13 (2018). https://doi.org/10.1186/ s41239-018-0096-z
  3. 3. Candy Lee (2020). Challenges for education sector while coping with COVID-19. Available at https://vietnamtimes.org.vn/challenges- for-education-sector-while-coping-with- covid-19-19748.html
  4. 4. Lange CL (2020). COVID-19’s education revolution - where going digital is just half the battle. Available at https://www. channelnewsasia.com/news/commentary/ covid-19-coronavirus-education-digital- revolution-transformation-12650974
  5. 84 Journal of Health and Development Studies (Vol.05, No.02-2021) Nguyen Viet Nga et al. INTRODUCTION HIV infection affects the health of individuals and communities and the development of economic and social security. By June 30, 2020 in Vietnam, there are 212,816 people living with HIV and 108,623 deaths due to HIV- related causes. HIV epidemics are concentrated in Northern mountainous and Southeast regions, among high-risk populations such as people who inject drugs (PWID) (12,74%/2019), female sex workers (FSWs) (3,58%/2018) and men having sex with men (MSM) (11,36%/2018), mainly aged between 30 and 39 and tends to increase, with transmission shifted towards female The cost of HIV testing at five district health facilities intervented poct model to confirmation HIV detected Nguyen Viet Nga1*, Ho Thi Hien2, Nguyen Thanh Long3 ORIGINAL ARTICLES * Corresponding author: Nguyen Viet Nga Email: nvngabyt@gmail.com 1Vietnam Administration HIV/AIDS Control, Ministry of Health 2 Hanoi University of Public Health 3Ministry of Health ABSTRACT Objective: HIV testing is the only method to confirm people infected with HIV. There are many models providing HIV testing services. HIV testing cost is an important component for the investment and strategic direction of policies and programs on HIV. This paper describes HIV testing costs of HIV confirmatory testing by using three rapid diagnostic tests at district level (POCT- Point of Care testing). Methods: cross-sectional study design was employed, costs are calculated using the cost-allocation method based on the proportion of resources used for the personnel, investment such as infrastructure and equipments, routine operational costs including test kits and consumable supplies, administration and training, fuel costs using for HIV testing in the laboratory, transporting the sample to province for HIV positived confirmation and HIV confirmatory test at the province. Five district health centers (DHC) thực hiện mô hình can thiệp POCT HIV were studied, HIV tests were conducted for 4,636 clients in 2016. Results : 201 HIV positive cases were detected; after implementing the POCT model to confirm HIV status at these five DHCs, the cost per HIV screening test case is 7,4 USD on average; and cost per an HIV comfirmatory test is 206,8 USD. Conclusion: Applying the POCT model of HIV helps reducethe cost of HIV testing because of saving cost for sample transportion and implementing confirm HIV detected more in provincal standard laboratory. It should be expanded to use especially limitted resource settings in Vietnam Keywords: HIV, HIV test, POCT, cost Submited: 30 October, 2020 Revised version received: 17 November, 2020 Published: 26 March, 2021
  6. 85 Journal of Health and Development Studies (Vol.05, No.02-2021) Nguyen Viet Nga et al. population, implying a possible potential outbreak (1), (2). HIV testing is the only method to determine HIV infection, which helps inform monitoring solutions and responses for prevention, treatment and control of epidemic. Location of providing HIV testing services can be either at a health facility or in the community. HIV confirmatory testing can only be implemented at a health facility under two main models: (1) HIV testing at standardized laboratories (Slab). This model requires necessary infrastructure, good practice staff and testing equipment. So each province only had one HIV confirmatory laboratory; (2) The point-of-care testing model (POCT) is a method that use three rapid diagnostic tests, which allows flexibility, simplicity and no need for intensive training and is easy to implement at local level, therefore, it is helpful in expanding HIV testing coverage. Testing costs include: allowance for conducting the test, infrastructure, consumable supplies and operational cost for one client tested and one positive case. The cost depends on prevalence, client group, location, applied model, HIV testing algorithm, and techniques of HIV testing. When reviewing different testing models, the cost of facility-based HIV counseling and testing (VCT) was highest (36,78 USD), then community-based HIV testing (27,38 USD), testing at workplace and home (USD16,6 and USD8,58 respectively), testing during campaign months (11,17 USD), provider- initiated counselling and testing (PICT) in hospitals and clinics (12,56 USD and 12,32 USD respectively) (3). A New Jersey based study from 2008 to 2009 found that the average cost of test kit per test implemented standard method combining a rapid diagnostic test with an Webtern blot was USD27,8, while a rapid test only is 22,94 USD (4). The Systematic review found that testing costs were higher for general population group and in high income countries (5). In Vietnam, since the establishment of the first HIV laboratory in 1986, there are now more than 1250 HIV screening facilities in all districts and 138 HIV confirmatory laboratories in 63 provinces/cities (2). However, the cost of HIV testing is still high, for example, according to a study in Thai Nguyen in 2012, the cost of a facility-based HIV test was 36,9 USD per client (from testing to receiving the result), and 117 USD for an HIV confirmed case (6). In the context of limited resources, changing management mechanisms, implementing decentralization in health sector, it is necessary to study the application of providing HIV confirmatory testing at district levels that is suitable to the locality. This model is flexible, easy to apply in places with limited resources, it can provide services near the people, perform on-the-spot and combine with many other medical services, thereby increasing the efficiency of testing in difficult and remote areas, reducing time to deliver and return test results, and savingcosts (7),(4),(8),(5), (9), (10). Because of the above reasons, this study aims to describe the cost of HIV testing in five health facilities in the Northern mountainous districts where POCT model is used to confirm HIV test results. Total cost for HIV testing including personnel, investment and other regular expenses, transporting the sample to province for HIV positived confirmation and HIV confirmatory test at the province. Base on total costs, number of HIV testing and number of confirmation HIV detected to calculate the unit cost. METHODS
  7. 86 Journal of Health and Development Studies (Vol.05, No.02-2021) Study design: This is a cross-sectional study with collection of retrospective data on HIV testing expenditures at district and provincial health facilities in order to estimate total cost, component likes personnel, investment, other regular, sample transportion, comfirmation in PAC costs, and unit cost per screen testing and per case detected HIV test. Location and time: Dien Bien, Thanh Hoa and Son La are provinces selected for HIV/ AIDS sentinel surveillance in Vietnam, with 100% of districts/towns and over 80% of communes/wards having HIV infected people. These are places with low education level and concentration of drug addiction, diversity of cultures, beliefs, customs, leading to high risks of HIV infection and unpredictable progression of HIV epidemic (11), (12), (13), (13, 14). Still many people infected with HIV haven’t known their status. According to case-based surveillance estimates in 2015, the percentage of infection detected is only 49,79% in Dien Bien, 56,35% in Son La and 49,85% in Thanh Hoa; the proportion of people living with HIV detected and received ARV treatment was 61,99% in Dien Bien, 39,52% in Son La and 48,66% in Thanh Hoa, respectively. This issue is clearly in somes mountainous districts with difficult travel, low income, underdeveloped health infrastructure, insufficient human resources, access to health services for people living with HIV is very limited such as Tuan Giao and Dien Bien District of Dien Bien province, Muong Lat and Quan Hoa of Thanh Hoa, Moc Chau of Son La. Before 2015, all HIV samples in the district and surrounding areas were only screened for HIV at district health facilities (DHF) and the reactive screened samples are sent to provincial HIV/AIDS control center (PAC) for confirmation of HIV under the Slab model. The limitation of this model is that it takes long time requiring significant human and finanicial efforts, affecting the access to HIV testing and returning of test results (6, 15, 16). Since 2016, the district medical facilities have been invested with equipment, human resources, training and technical assistances to implement the intervention model to confirm HIV at the district level with three rapid diagnostic tests (POCT) (17). Selection criteria Testing facilities are selected according to the criteria to ensure they meet the HIV screening and confirmatory testing standards of the Ministry of Health, representing the northern mountainous regions of Vietnam, to be allowed to pilot POCT model to confirm HIV at district level. Sample size, sample selection 05 district health facilities were purposively selected with the intention to implement the intervention of HIV confirmation POCT model. Variables / indicators: Cost classification We have five types of variables in relation to cost classification used from provider perspective in this study, including: (1) Human resource costs: salary, allowances, % time allocated for HIV testing services. (2) Variables related to fixed costs: Items (equipments and consumable supplies used over 1 year), time of initiating use, time to start using, original price at purchase time, duration of use, simple depreciation coefficient, % used the items for HIV testing. (3) Variables related to other routine operational costs: electricity costs, water costs, fuel costs, test kits and consumable supplies, administration and training. Nguyen Viet Nga et al.
  8. 87 Journal of Health and Development Studies (Vol.05, No.02-2021) (4) Expenses related to transporting HIV reactived samples from the district health center to the provincial HIV/AIDS prevention center for HIV confirmatory testing and confirmation HIV detected in PAC Laboratory. (5) Other variables: Number of tested clients, number of clients with positive test results, number of HIV testing staff. The study indicators include: unit cost of personnel, investment, other regular, sample transportion, comfirmation in PAC, average cost per client, average cost per one positive case. Tools and data collection procedures Forms to collect expenditure data on HIV testing were referenced from international cost studies and studies in Vietnam. However, the forms had adjusted to supplement the cost related to sample transport and the cost of conducting HIV confirmatory tests at provincial levels. Lab staffs who conduct HIV testing were trained in filling forms of HIV testing activities, recording and collecting data on expenses for HIV testing activities. Data collection team was instructed on how to enter and verify data, using standardized data collection form in Microsoft Excel format. Cost calculationWe calculate the cost per unit of product using the method of cost allocation based on the proportion of resources used for the activity: determining the total cost, determining the number of units of product / service from which the average cost is calculated The cost of screen HIV testing = (Personnel costs + investment costs + Other regular expenses): - Personnel costs include: Salaries, bonuses, allowances, insurance. This is inclusive of percentage of time allocatedtesting service of part-time personnel (if any) - Investment costs include: infrastructure, equipments. In which, the value of fixed assets is adjusted according to the consumer price index of 2016, the asset depreciation is calculated on the assumption that duration of use of equipment is 10 years, facility is 25 years (according to guidelines of the Vietnamese Ministry of Finance) with a simple depreciation ratio and a discount rate to be 3%, percentage of use items of equipment for HIV testing. - Other regular expenses include: Electricity, water, fuel, maintenance, administration, training, test kits and consumable supplies for HIV testing ... The cost of HIV confirmed positive at screening facility (district laboratory) = Cost of HIV screening test + Cost of transporting the sample to province for HIV positived confirmation + Cost of HIV confirmatory test at the province. The cost for an HIV confirmatory test at province (PAC laboratory) = total cost for an HIV confirmation facility x percentage of samples conducted HIV confirmation sent from districts. The cost per patient tested was defined as the cost of the HIV testing services reported by a specific programme, divided by the number of people who received HIV testing services (5). The cost per case detected was defined as the cost of the HIV testing services reported by a specific programme divided by the number of people who were diagnosed HIV- positive (5). Nguyen Viet Nga et al.
  9. 88 Journal of Health and Development Studies (Vol.05, No.02-2021) In this study, the collected information was entered into a computer on Microsoft Excel template to calculate in VND at 2016’s prices then converted into USD at the World Bank rate. The exchange rate at the time of the study will be converted to the general rate of the World Bank at the time of the study (https:// data.worldbank.org/indicator/PA.NUS. FCRF?page=1): 1 USD = 21935,008 VND. Ethical procedures In this study, the data is only used for scientific study purposes, It will be shared with stakeholders aiming to develop related policies and planning. Study has been approved by the IRB of Hanoi University of Public Health at Decision No. 301 / 2017YTCC – HD3. RESULTS General characteristics of study participants Table 1 shows the general characteristics of all HIV testing facilities that belong to government managed system. These facilities provide lab-based HIV testing to all populations of the district, 4/5 districts respond both 2 functions include providing prevention and health care services, except Moc Chau Preventive Medicine Center that does not provide health care services. In 2016, 5 falicities performed HIV tests for 4,636 clients and detected 201 HIV-positive clients (positivity rate of 4,3%). Nguyen Viet Nga et al. Table 1. General characteristics of HIV testing facilities at five northern mountain districts in 2016 District Function of district health centre Testing model Number of years started HIV testing Number of sample HIV testing Suspect HIV Positive HIV Dien Bien District Prevention and treatment Facility - based 8 368 45 45 Moc Chau Prevention Facility - based 5 429 34 33 Muong Lat Prevention and treatment Facility - based 4 844 15 15 Quan Hoa Prevention and treatment Facility - based 6 1177 42 41 Tuan giao Prevention and treatment Facility - based 3 1818 70 67 Describe the costs of HIV testing in the district-level applying POCT model to confirmation HIV detected Figure 1 describes 5 types of component cost unit for HIV testing: The unit cost of human resources remains the high proportion of costs in 4/5 HIV testing facilities, highest in Muong Lat (7,9 USD) and lowest in Dien Bien District (0,6 USD), suggesting the need to expand to collect samples to maximize resources for HIV testing. Routine operational costs were almost similar among testing facilities, with an average of 2,4
  10. 89 Journal of Health and Development Studies (Vol.05, No.02-2021) USD, being the highest in Muong Lat and lowest in Dien Bien District. Investment cost is the lowest of all the cost components, but it gradually decreases if the laboratory continues to implement because it is a one-time investment and less arising. The unit cost for sample transportation and the provincial HIV confirmation test is found to be much higher than the other component unit costs, and these costs are only present in Dien Bien and Moc Chau districts because they have not done POCT model for HIV confirmation so there was still time when they had to send samples to the provincial level for HIV confirmation. Nguyen Viet Nga et al. Figure 1. Unit of component costs of HIV testing Figure 2 describes the average unit cost of HIV testing: The average cost per HIV testing at 5 studied districts in 2016 is 7,4 (2,1-12,3) USD, highest in Muong Lat and lowest in Dien Bien district. The average cost per positive case is 206,8 (82,9-691,6) USD, highest in Muong Lat and lowest in Moc Chau. There is a significant difference in average costs among the districts, which suggests that with the same investment, the lower the number of samples, the higher the cost will be.
  11. 90 Journal of Health and Development Studies (Vol.05, No.02-2021) Nguyen Viet Nga et al. Figure 2. Average cost of HIV testing DISCUSSION This study has shown that with the support of the POCT, this model leads to reduced cost of transporting samples, conducting HIV confirmatory testing at the provincial level, thereby reducing total testing costs. The average cost per HIV testing in the 5 district health facilities in this study is 7,4 USD, which is lower than those of previous study results using the Slab model in Thai Nguyen in 2012 (USD 36,9) (6); 7,6 USD in 9 HIV sential surveillance provinces in 2013 (18), lower than the average cost synthesized from world studies for the model of facility based testing, the average of the cost per HIV testing is 11(6-43) USD for the high-risk population (5). Compared with the POCT intervention studies in the world, the result calculated in our study is lower compared with the results of studies applying this model in các bệnh viện ở Uganda in 2009 (11,68 USD) (19), of 15 HIV testing facilities using combined rapid test and Western Blot to confirm HIV detected in New Jersey in 2008-2009 (26,10 USD) (4), and in HIV testing counseling facilities in West – Java province of Indonesia in 2008 (14,91 USD) (20). The lower cost of the study may be due to the intervention of the testing models in available resources of facilities so reducing the cost of investment in equipment and payment of labor. Using rapid algrothirm combined 3 rapid test also saving money more than algrothirm combine rapid test with ELISA or other test. The study results showed that although the cost for one positive case is not equally low at all study sites but the average cost is 206,8 USD, In some site, the cost is still higher due to the small number of samples performed but it is still necessary to invest equipment and personnel to meet standards such as Muong Lat and Quan Hoa. The averge cost per HIV detected is lower than that of the study in 9 HIV key provinces in 2013 (320,3 USD) (18), higher than the results of the study applying Slab for HIV testing in Thai Nguyen in 2012 (117,6 USD) (6). This could possibly be the fact that the study included both transportation cost and the cost of conducting HIV confirmatory testing at the province. In the study, POCT model have applied in five districts so the cost is lower than the study in 9 provinces where HIV testing using Slab models concentrating in province. Similarly, when compared with studies in the world, the average cost per client
  12. 91 Journal of Health and Development Studies (Vol.05, No.02-2021) tested for HIV testing at these five district health facilities was lower than the result of 334 (324-15308) USD for high-risk populations in the low and mid income countries summarized by the World Health Organization (5), much lower than the cost of 3637 USD in high income countries like the US in 2005-2006 (9). The results from our study are much lower than the cost of USD 2077,15 for one positive HIV case applying POCT model at 15 HIV testing facilities in New Jersey in 2008-2009 (4). In the study applying the POCT model for confirmed HIV testing, the average cost is lower than the studies applying the Slab (standard laboratory) or mixed model, and integrating the model at the district facilities will reduce the cost due to the utilization of available human resources and equipment. In summary, in order to optimize resources and improve cost effectiveness, it is necessary to increase the number of testing samples by identifying surrounding geographic areas for sample collection, expanding HIV testing services, continuing sustainable expansion of POCT intervention in remote and disadvantaged areas. Our study has some limitations such as the inability to evaluate the reduction in HIV incidence, followed by the cost of prevention of one HIV infection case after expanding the POCT model. The study can have certain imprecise number due to the cost estimation based on data extracted from books, reports may have unverified original errors, or percentage of time that lab staff spent for HIV testing is not completely accurate. CONCLUSION The study has provided sufficient information on HIV testing costs at district HIV testing facilities, helping to inform suitable cost norms for calculating health service fees and charges. The POCT model to confirm HIV status at the district level has helped to save program costs and reduce HIV testing costs compared to the previous Slab model. Expanding the POCT model is a solution that can both facilitate access to HIV testing, in order to achieve the first 90 target of having 90% of people living with HIV to know their HIV infection status in the context of reduced resources for HIV/AIDS prevention and control as well as promote the effecient use of program resources in disadvantaged areas. Acknowledgments: Authors would like to thank the members working in the District Health Care Centers and Preventive Medicine Centers of Dien Bien, Tuan Giao, Moc Chau, Muong Lat, Quan Hoa districts. Special thanks to Provincial HIV/AIDS Center in Dien Bien, Son La and Thanh Hoa provinces. REFERENCES
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