Elimination of dengue by community programs using Mesocyclops(Copepoda) against Aedes aegypti in central Vietnam

From September 2000 to June 2003, a community-based program for dengue control using local predacious copepods of the genus Mesocyclops was conducted in three rural communes in the central Vietnam provinces of Quang Nam, Quang Ngai, and Khanh Hoa. Post-project, three subsequent entomologic surveys were conducted until March 2004. The number of households and residents in the communes were 5,913 and 27,167, respectively, and dengue notification rates for these communes from 1996 were as high as 2,418.5 per 100,000 persons. Following knowledge, attitude, and practice evaluations, surveys of water storage containers indicated that Mesocyclops spp. already occurred in 3-17% and that large tanks up to 2,000 liters, 130-300-liter jars, wells, and some 220-liter metal drums were the most productive habitats for Aedes aegypti. With technical support, the programs were driven by communal management committees, health collaborators, schoolteachers, and pupils. From quantitative estimates of the standing crop of third and fourth instars from 100 households, Ae. aegypti were reduced by approximately 90% by year 1, 92.3-98.6% by year 2, and Ae. aegypti immature forms had been eliminated from two of three communes by June 2003. Similarly, from resting adult collections from 100 households, densities were reduced to 0-1 per commune. By March 2004, two communes with no larvae had small numbers but the third was negative; one adult was collected in each of two communes while one became negative. Absolute estimates of third and fourth instars at the three intervention communes and one left untreated had significant correlations (P = 0.009-< 0.001) with numbers of adults aspirated from inside houses on each of 15 survey periods. By year 1, the incidence of dengue disease in the treated communes was reduced by 76.7% compared with non-intervention communes within the same districts, and no dengue was evident in 2002 and 2003, compared with 112.8 and 14.4 cases per 100,000 at district level. Since we had similar success in northern Vietnam from 1998 to 2000, this study demonstrates that this control model is broadly acceptable and achievable at community level but vigilance is required post-project to prevent reinfestation.

Antiretroviral therapy (ART) adherence among people living with HIV/AIDS (PLHIV) in the north of Vietnam : a multi-method approach

The antiretroviral therapy (ART) program for People Living with HIV/AIDS (PLHIV) in Vietnam has been scaled up rapidly in recent years (from 50 clients in 2003 to almost 38,000 in 2009). ART success is highly dependent on the ability of the patients to fully adhere to the prescribed treatment regimen. Despite the remarkable extension of ART programs in Vietnam, HIV/AIDS program managers still have little reliable data on levels of ART adherence and factors that might promote or reduce adherence. Several previous studies in Vietnam estimated extremely high levels of ART adherence among their samples, although there are reasons to question the veracity of the conclusion that adherence is nearly perfect. Further, no study has quantitatively assessed the factors influencing ART adherence. In order to reduce these gaps, this study was designed to include several phases and used a multi-method approach to examine levels of ART non-adherence and its relationship to a range of demographic, clinical, social and psychological factors. The study began with an exploratory qualitative phase employing four focus group discussions and 30 in-depth interviews with PLHIV, peer educators, carers and health care providers (HCPs). Survey interviews were completed with 615 PLHIV in five rural and urban out-patient clinics in northern Vietnam using an Audio Computer Assisted Self-Interview (ACASI) and clinical records extraction. The survey instrument was carefully developed through a systematic procedure to ensure its reliability and validity. Cultural appropriateness was considered in the design and implementation of both the qualitative study and the cross sectional survey. The qualitative study uncovered several contrary perceptions between health care providers and HIV/AIDS patients regarding the true levels of ART adherence. Health care providers often stated that most of their patients closely adhered to their regimens, while PLHIV and their peers reported that “it is not easy” to do so. The quantitative survey findings supported the PLHIV and their peers’ point of view in the qualitative study, because non-adherence to ART was relatively common among the study sample. Using the ACASI technique, the estimated prevalence of onemonth non-adherence measured by the Visual Analogue Scale (VAS) was 24.9% and the prevalence of four-day not-on-time-adherence using the modified Adult AIDS Clinical Trials Group (AACTG) instrument was 29%. Observed agreement between the two measures was 84% and kappa coefficient was 0.60 (SE=0.04 and p<0.0001). The good agreement between the two measures in the current study is consistent with those found in previous research and provides evidence of cross-validation of the estimated adherence levels. The qualitative study was also valuable in suggesting important variables for the survey conceptual framework and instrument development. The survey confirmed significant correlations between two measures of ART adherence (i.e. dose adherence and time adherence) and many factors identified in the qualitative study, but failed to find evidence of significant correlations of some other factors and ART adherence. Non-adherence to ART was significantly associated with untreated depression, heavy alcohol use, illicit drug use, experiences with medication side-effects, chance health locus of control, low quality of information from HCPs, low satisfaction with received support and poor social connectedness. No multivariate association was observed between ART adherence and age, gender, education, duration of ART, the use of adherence aids, disclosure of ART, patients’ ability to initiate communication with HCPs or distance between clinic and patients’ residence. This is the largest study yet reported in Asia to examine non-adherence to ART and its possible determinants. The evidence strongly supports recent calls from other developing nations for HIV/AIDS services to provide screening, counseling and treatment for patients with depressive symptoms, heavy use of alcohol and substance use. Counseling should also address fatalistic beliefs about chance or luck determining health outcomes. The data suggest that adherence could be enhanced by regularly providing information on ART and assisting patients to maintain social connectedness with their family and the community. This study highlights the benefits of using a multi-method approach in examining complex barriers and facilitators of medication adherence. It also demonstrated the utility of the ACASI interview method to enhance open disclosure by people living with HIV/AIDS and thus, increase the veracity of self-reported data.

Community-based control of Aedes aegypti by using Mesocyclops in southern Vietnam

We previously reported a new community-based mosquito control strategy that resulted in elimination of Aedes aegypti (Linn.) in 40 of 46 communes in northern and central Vietnam, and with annual recurrent total costs (direct and indirect) of only $0.28-$0.89 international dollars per person. This control strategy was extended to four provinces in southern Vietnam in Long An and Hau Giang (2004-2007) and to Long An, Ben Tre, and Vinh Long (2005-2010). In a total of 14 communes with 124,743 residents, the mean ± SD of adult female Ae. aegypti was reduced from 0.93 ± 0.62 to 0.06 ± 0.09, and the reduction of immature Ae. aegypti averaged 98.8%. By the final survey, no adults could be collected in 6 of 14 communes, and one commune, Binh Thanh, also had no immature forms. Although the community-based programs also involved community education and clean-up campaigns, the prevalence of Mesocyclops in large water storage containers > 50 liters increased from 12.77 ± 8.39 to 75.69 ± 9.17% over periods of 15-45 months. At the conclusion of the study, no confirmed dengue cases were detected in four of the five communes for which diagnostic serologic analysis was performed. The rate of progress was faster in communes that were added in stages to the program but the reason for this finding was unclear. At the completion of the formal project, sustainability funds were set up to provide each commune with the financial means to ensure that community-based dengue control activities continued.

Economic evaluation of adolescent reproductive health education interventions in Chilinh, Vietnam

This research was an economic analysis of two novel health education interventions compared to existing practice for reproductive health among young people in northern Vietnam. The research showed that implementing an educational intervention including school-based and health facility-based components was cost effective for males and females. The findings will assist decision makers in efficient allocation of scarce resources for adolescent health promotion in Vietnam and similar socio-economic contexts in Asia.

Developing improved supply chains for temperate fruits in transitional Asian economies of Thailand and Vietnam.

Asia's increasing demand for both tropical and temperate fruit is projected to grow significantly. Compared with most developed countries, the production of temperate fruits (peach, nectarine, plum and apple) has expanded rapidly in China over the past 20 years. In contrast, current production of plums and peaches in neighbouring countries (Thailand and Vietnam) is very low but their fruit enters the market earlier. Thailand and Vietnam have enormous potential to satisfy a market window in the northern hemisphere period from March to May inclusive when there is little or no stone fruit on the Asian market. In Vietnam, fruit is harvested in an immature state to avoid disease and fruit fly problems and consequently lacks size and flavour. Approximately 30-40% of locally produced fruit in Vietnam does not reach market due to disease and poor handling during picking and transport. In Thailand, much of the infrastructure needed to transport, store, process and market temperate fruits successfully are now in place. However, there are currently no cool chain management or quality assurance systems to ensure a fresh product reaches the consumer with minimal deterioration. In Vietnam, growing stone fruit under the traditional system with little or minimal inputs, the farmer may receive between AUD3,000-5,000 per ha. In comparison, under higher input systems incorporating fertiliser, irrigation and pest and disease management, net returns can be increased seven-fold. Strengths and weaknesses of the current supply chains in these two countries are discussed.

STREAM Country Strategy Paper: Vietnam

Vietnam is a coastal country in Southeast Asia with a population of over 80 million. Although Vietnam has long been listed among the poorest countries of the world, it has recently made large strides in reducing poverty and improving food security. However, the dramatic gains in poverty reduction in Vietnam still remain quite fragile. There is growing evidence to indicate that dependence on aquatic resources is correlated to poverty, and that aquatic resources constitute an important component of wider livelihoods strategies (largely from the Mekong Delta, Central Coast and the Northern Mountains). (PDF contains 19 pages)

THE PHYLOGENETIC-RELATIONSHIPS AND CLASSIFICATION OF THE DOUCS AND SNUB-NOSED LANGURS OF CHINA AND VIETNAM

The taxonomy of the douc and snub-nosed langurs has changed several times during the 20th century. The controversy over the systematic position of these animals has been due in part to difficulties in studying them: both the doucs and the snub-nosed langurs are rare in the wild and are generally poorly represented in institutional collections. This review is based on a detailed examination of relatively large numbers of specimens of most of the species of langurs concerned. An attempt was made to draw upon as many types of information as were available in order to make an assessment of the phyletic relationships between the langur species under discussion. Toward this end, quantitative and qualitative features of the skeleton, specific features of visceral anatomy and characteristics of the pelage were utilized. The final data matrix comprised 178 characters. The matrix was analyzed using the program Hennig86. The results of the analysis support the following conclusions: (1) that the douc and snub-nosed langurs are generically distinct and should be referred to as species of Pygathrix and Rhinopithecus, respectively; (2) that the Tonkin snub-nosed langur be placed in its own subgenus as Rhinopithecus (Presbytiscus) avunculus and that the Chinese snub-nosed langur thus be placed in the subgenus Rhinopithecus (Rhinopithecus); (3) that four extant species of Rhinopithecus be recognized: R. (Rhinopithecus) roxellana Milne Edwards, 1870; R. (Rhinopithecus) bieti Milne Edwards, 1897; R. (Rhinopithecus) brelichi Thomas, 1903, and R. (Presbytiscus) avunculus Dollman, 1912; (4) that the Chinese snub-nosed langurs fall into northern and southern subgroups divided by the Yangtze river; (5) that R. lantianensis Hu and Qi, 1978, is a valid fossil species, and (6) the precise affinities and taxonomic status of the fossil species R. tingianus Matthew and Granger, 1923, are unclear because the type specimen is a subadult.

Fine-grained Pleistocene deepwater turbidite channel system on the slope of Qiongdongnan Basin, northern South China Sea

Recently, as oil exploitation has become focused on deepwater slope areas. more multi-channel high resolution 2D and 3D seismic data were acquired in the deepwater part of the Qiongdongnan Basin, northern South China Sea. Based on 3D seismic data and coherence time slice, RMS and 3D visualization, a series of deepwater channels were recognized on the slope that probably developed in the late Quaternary period. These channels trend SW-NE to W-E and show bifurcations, levees, meander loops and avulsions. High Amplitude Reflections (HARs), typical for channel-levee complexes, are of only minor importance and were observed in one of the channel systems. Most of the detected channels are characterized by low-amplitude reflections, and so are different from the typical coarse-grained turbidite channels that had been discovered worldwide. The absence of well data in the study area made it difficult to determine the age and lithology of these channels. Using a neighboring drill hole and published data about such depositional systems worldwide, the lithology of these channels is likely to be dominated by mudstones with interbedded thin sandstones. These channels are formed by turbidity currents originated from the little scale mountain river of mid-Vietnam in SW direction and were probably accompanied by a relative sea level drop in the last glacial age. These channels discovered on the northern South China Sea slope are likely to be fine-grained, mud-dominant and low N:G deposits in a deepwater paleogeographic setting. (C) 2009 Elsevier Ltd. All rights reserved.

The Ri chicken breed and livelihoods in North Vietnam: characterization and prospects

For the last twenty years, the consumption of poultry meat has boomed in Vietnam as in the rest of the developing world. Capital-intensive production has grown rapidly to satisfy this demand. Based on a few numbers of genetically uniform strains, these systems threaten biodiversity. In Vietnam, both rural and urban households still keep indigenous chickens as part of a diversified livelihood portfolio. In line with the national in situ conservation strategy, this study approached the context of local poultry keeping in two rural and one suburban districts of Northern Vietnam. It aimed at understanding households’ willingness, constraints and opportunities for practice improvement, including breeds’ management. As the Ri chicken constitutes the large majority of backyard flocks, two particular objectives of this study are the morpho-biometric characterisation of phenotypic diversity among individuals classified as Ri by farmers and an assessment of their productive potential. Chicken was found to hold a different place in livelihoods of the three districts with consequences on the management of genetic resources. The most favourable conditions for improvement of the Ri breed was found in the rural district of Luong-Son, due to market integration. In the more remote district of Ky-Son, living standards were lower and much would be gained from Ri conservation. Ri breed was the most threatened in the suburban Gia-Lam district, where poultry was a minor side-activity, lacking incentive for genetic management. From motives and constraints, tracks about breeding goals are suggested. Further considerations about conservation, improvement, market integration and livelihoods are proposed.

Observed climate variations and change in Vietnam

In this study, observed changes of temperature, rainfall, and some extreme climate indices in Vietnam were investigated by using daily observations during the period 1961-2012. The observed data were collected from 80 meteorological stations for temperature, and from 170 stations for rainfall over the seven climatological sub-regions of Vietnam. Results show that there were insignificant differences between the trends of changes obtained from the 1961-2011 and 1979-2012 periods. Near-surface temperature, including mean (T2m), maximum (Tx) and minimum temperature (Tm), increased consistently at almost all stations. Tm increased faster than Tx. Temperature also increased faster in winter than in summer. Consequently, the number of hot days and warm nights increased whereas the number of cold days, cold nights and cool days decreased. In the northern regions, temperature tended to slightly decrease in May but significantly increased in June. Annual rainfall decreased in the northern area of Vietnam, while it increased at almost all stations in the central regions, and had insignificant trends in the southern sub-region. Changes in some extreme rainfall indices were likely consistent with changes in annual rainfall. Monthly rainfall in the central regions significantly increased from August to December. Rainfall generally increased in May and decreased in June over almost all country.

Climate change projections and selected impacts for Vietnam

In September 2013, the 5th Assessment Report (5AR) of the International Panel on Climate Change (IPCC) has been released. Taking the 5AR cli-mate change scenarios into account, the World Bank published an earli-er report on climate change and its impacts on selected hot spot re-gions, including Southeast Asia. Currently, dynamical and statistical-dynamical downscaling efforts are underway to obtain higher resolution and more robust regional climate change projections for tropical South-east Asia, including Vietnam. Such initiatives are formalized under the World Meteorological Organization (WMO) Coordinated Regional Dynamic Downscaling Experiment (CORDEX) East Asia and Southeast Asia and also take place in climate change impact projects such as the joint Vietnam-ese-German project “Environmental and Water Protection Technologies of Coastal Zones in Vietnam (EWATEC-COAST)”. In this contribution, the lat-est assessments for changes in temperature, precipitation, sea level, and tropical cyclones (TCs) under the 5AR Representative Concentration Pathway (RCP) scenarios 4.5 and 8.5 are reviewed. Special emphasis is put on changes in extreme events like heat waves and/or heavy precipita-tion. A regional focus is Vietnam south of 16°N. A continued increase in mean near surface temperature is projected, reaching up to 5°C at the end of this century in northern Vietnam un-der the high greenhouse-gas forcing scenario RCP8.5. Overall, project-ed changes in annual precipitation are small, but there is a tendency of more rainfall in the boreal winter dry season. Unprecedented heat waves and an increase in extreme precipitation events are projected by both global and regional climate models. Globally, TCs are projected to decrease in number, but an increase in intensity of peak winds and rain-fall in the inner core region is estimated. Though an assessment of changes in land-falling frequency in Vietnam is uncertain due to difficul-ties in assessing changes in TC tracks, some work indicates a reduction in the number of land-falling TCs in Vietnam. Sea level may rise by 75-100 cm until the end of the century with the Vietnamese coastline experienc-ing 10-15% higher rise than on global average. Given the large rice and aquaculture production in the Mekong and Red River Deltas, that are both prone to TC-related storm surges and flooding, this poses a challenge to foodsecurity and protection of coastal population and assets.

Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Hepatitis C and human immunodeficiency virus infections in injecting drug users in drug treatment centers in Vietnam

Background. Injecting drug users (IDUs) are at risk of infection with Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). Independently, each of these viruses is a serious threat to health, with HIV ravaging the body’s immune system, and HCV causing cirrhosis, liver cancer and liver failure. Co-infection with HIV/HCV weakens the response to antiretroviral therapy in HIV patients. IDUs with HIV/HCV co-infection are at a 20 times higher risk of having liver-related morbidity and mortality than IDUs with HIV alone. In Vietnam, studies to ascertain the prevalence of HIV have found high rates, but little is known about their HCV status. ^ Purpose. To measure the prevalence of HCV and HIV infection and identify factors associated with these viruses among IDUs at drug treatment centers in northern Vietnam. ^ Methods. A cross-sectional study was conducted from November 2007 to February 2008 with 455 injecting drug users aged 18 to 39 years, admitted no more than two months earlier to one of four treatment centers in Northern Vietnam (Hatay Province) (response rate=95%). Participants, all of whom had completed detoxification and provided informed consent, completed a risk assessment questionnaire and had their blood drawn to test for the presence of antibody-HCV and antibody-HIV with enzyme immuno assays. Univariate and multivariable logistic regression models were utilized to explore the strength of association using HIV, HCV infections and HIV/HCV co-infection as outcomes and demographic characteristics, drug use and sexual behaviors as factors associated with these outcomes. Unadjusted and adjusted odds ratios and 95% confidence intervals were calculated. ^ Results. Among all IDU study participants, the prevalence of HCV alone was 76.9%, HIV alone was 19.8%. The prevalence of HIV/HCV co-infection was 92.2% of HIV-positive and 23.7% of HCV-positive respondents. No sexual risk behaviors for lifetime, six months or 30 days prior to admission were significantly associated with HCV or HIV infection among these IDUs. Only duration of injection drug use was independently associated with HCV and HIV infection, respectively. Longer duration was associated with higher prevalence. Nevertheless, while HCV infection among IDUs who reported being in their first year of injecting drugs were lower than longer time injectors, their rates were still substantial, 67.5%. ^ Compared with either HCV mono-infection or HIV/HCV non-infection, HIV/HCV co-infection was associated with the length of drug injection history but was not associated with sexual behaviors. Higher education was associated with a lower prevalence of HIV/HCV co-infection. When compared with HIV/HCV non-infection, current marriage was associated with a lower prevalence of HIV/HCV co-infection. ^ Conclusions. HCV was prevalent among IDUs from 18 to 39 years old at four drug treatment centers in northern Vietnam. Co-infection with HCV was predominant among HIV-positive IDUs. HCV and HIV co-infection were closely associated with the length of injection drug history. Further research regarding HCV/HIV co-infection should include non-injecting drug users to assess the magnitude of sexual risk behaviors on HIV and HCV infection. (At these treatment centers non-IDUs constituted 10-20% of the population.) High prevalence of HCV prevalence among IDUs, especially among HIV-infected IDUs, suggests that drug treatment centers serving IDUs should include not only HIV prevention education but they should also include the prevention of viral hepatitis. In addition, IDUs who are HIV-positive need to be tested for HCV to receive the best course of therapy and achieve the best response to HIV treatment. These data also suggest that because many IDUs get infected with HCV in the first year of their injection drug career, and because they also engaged in high risk sexual behaviors, outreach programs should focus on harm reduction, safer drug use and sexual practices to prevent infection among drug users who have not yet begun injecting drugs and to prevent further spread of HCV, HIV and co-infection. ^