Antiretroviral pre-exposure prophylaxis preferences among men who have sex with men in Vietnam: results from a nationwide cross-sectional survey
Catherine E. Oldenburg A B J , Bao Le C , Hoang Thi Huyen C , Dinh Duc Thien C , Nguyen Hoang Quan C , Katie B. Biello A B , Amy Nunn D , Philip A. Chan E , Kenneth H. Mayer A F G , Matthew J. Mimiaga A B H and Donn Colby C I
+ Author Affiliations
- Author Affiliations
A The Fenway Institute, Fenway Community Health, 1340 Boylston Street, Boston, MA 02215, USA.
B Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
C Center for Applied Research on Men and Health, 51–53 Vo Van Tan Street, Ward 6, District 3, Ho Chi Minh City, Vietnam.
D Department of Behavioral and Social Sciences and the Rhode Island Public Health Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
E Division of Infectious Diseases, The Miriam Hospital, 1125 N Main Street, Providence, RI 02904, USA.
F Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
G Department of Medicine, Beth Israel Deaconess Medical Center, 300 Brookline Avenue, Boston, MA 02215, USA.
H Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
I SEARCH, Thai Red Cross AIDS Research Centre, 104 Radjumri Road, Bangkok 10330, Thailand.
J Corresponding author. Email: ceo242@mail.harvard.edu
Sexual Health 13(5) 465-473 https://doi.org/10.1071/SH15144
Submitted: 24 July 2015 Accepted: 3 June 2016 Published: 22 July 2016
Abstract
Background: The HIV/AIDS epidemic in Vietnam is concentrated in subgroups of the population, including men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a viable strategy for HIV prevention, but knowledge about and preferences for PrEP delivery among Vietnamese MSM are not well understood. Methods: In 2015, an online survey was conducted with recruitment via social networking websites for MSM and peer recruitment. A description of daily oral, long-acting injectable, and rectal microbicide formulations of PrEP was provided to participants. Participants were asked about their prior awareness of and interest in PrEP, and ranked their most preferred PrEP modality. Multivariable logistic regression models were used to assess factors associated with having heard of PrEP and preference for each PrEP modality. Results: Of 548 participants who answered demographic and PrEP-related questions, 26.8% had previously heard of PrEP and most (65.7%) endorsed rectal microbicides as their most preferred PrEP delivery modality. Commonly-cited perceived barriers to uptake of PrEP included concern about side-effects, perception about being HIV positive, and family or friends finding out about their sexual behaviour. In multivariable models, older participants less often endorsed rectal microbicides (adjusted odds ratio (AOR) 0.95 per year, 95% confidence interval (CI) 0.91–0.99) and more often endorsed long-acting injectables (AOR 1.08 per year, 95% CI 1.03 to 1.14) as their preferred PrEP modality. Participants who were willing to pay more for PrEP less often endorsed rectal microbicides (AOR 0.81, 95% CI 0.72–0.92) and more often endorsed long-acting injectables (AOR 1.17, 95% CI 1.01–1.35) and daily oral pills (AOR 1.16, 95% CI 1.00–1.35) as their preferred form of PrEP. Conclusions: A variety of PrEP modalities were acceptable to MSM in Vietnam, but low knowledge of PrEP may be a barrier to implementation.
References
[1] Garcia MC, Meyer SB, Ward P. Elevated HIV prevalence and risk behaviours among men who have sex with men (MSM) in Vietnam: a systematic review. BMJ Open 2012; 2 e001511| Elevated HIV prevalence and risk behaviours among men who have sex with men (MSM) in Vietnam: a systematic review.Crossref | GoogleScholarGoogle Scholar | 23015604PubMed |
[2] Hoang TV, Tuan NA, Mills SJ, et al. Results from the HIV/STI integrated biological and behavioral surveillance (IBBS) in Vietnam: 2005–2006. 2006. Ministry of Health, Vietnam. Available online at: http://www.aidsdatahub.org/sites/default/files/documents/Results_ from_the_2006_Integrated_Biological_and_Behavioral_Survey_IBBS_2005_06_Report.pdf.pdf [verified 20 June 2016].
[3] Hoang TV, Tuan NA, Vi LNL, et al. Results from the HIV/STI integrated biological and behavioral surveillance (IBBS) in Vietnam – Round II 2009. 2009. Ministry of Health, Vietnam. Available online at: http://www.fhi360.org/sites/default/files/media/documents/Integrated%20Biological%20and%20Behavioral%20Surveillance%20Round%20II-2012_0.pdf [verified 20 June 2016].
[4] Oldenburg CE, Perez-Brumer AG, Reisner SL, et al Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis. PLoS One 2014; 9 e103549
| Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 25068720PubMed |
[5] Baral S, Poteat T, Stromdahl S, Wirtz AL, Guadamuz T, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13 214–22.
| Worldwide burden of HIV in transgender women: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 23260128PubMed |
[6] Baral S, Beyrer C, Muessig K, et al Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12 538–49.
| Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 22424777PubMed |
[7] Le L-VN, Nguyen TA, Tran HV, et al Correlates of HIV infection among female sex workers in Vietnam: injection drug use remains a key factor. Drug Alcohol Depend 2015; 150 46–53.
| Correlates of HIV infection among female sex workers in Vietnam: injection drug use remains a key factor.Crossref | GoogleScholarGoogle Scholar |
[8] Nadol P, O’connor S, Duong H, et al Findings from integrated behavioral and biologic survey among males who inject drugs (MWID) — Vietnam, 2009–2010: evidence of the need for an integrated response to HIV, hepatitis B virus, and hepatitis C virus. PLoS One 2015; 10 e0118304
| Findings from integrated behavioral and biologic survey among males who inject drugs (MWID) — Vietnam, 2009–2010: evidence of the need for an integrated response to HIV, hepatitis B virus, and hepatitis C virus.Crossref | GoogleScholarGoogle Scholar | 25692469PubMed |
[9] Grant RM, Lama JR, Anderson PL, et al Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–99.
| Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXit1ansg%3D%3D&md5=6e22600cda8924441c0d2faa55711ff6CAS | 21091279PubMed |
[10] Grant RM, Anderson PL, McMahan V, et al Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis 2014; 14 820–9.
| Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study.Crossref | GoogleScholarGoogle Scholar | 25065857PubMed |
[11] Choopanya K, Martin M, Suntharasamai P, et al Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2013; 381 2083–90.
| Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial.Crossref | GoogleScholarGoogle Scholar | 23769234PubMed |
[12] Baeten JM, Donnell D, Ndase P, et al Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367 399–410.
| Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtlSltrbK&md5=3cb82387c09c4694dae4fa80e1fa8ad3CAS | 22784037PubMed |
[13] Anderson PL, Glidden DV, Liu A, et al Emtricitabine–tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med 2012; 4 151ra125–5.
| Emtricitabine–tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 22972843PubMed |
[14] Thigpen MC, Kebaabetswe PM, Paxton LA, et al Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012; 367 423–34.
| Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtlSltrbE&md5=06ad452c0b2648054b2e24effdfd7b92CAS | 22784038PubMed |
[15] Marazzo J, Ramjee G, Nair G. Pre-exposure prophylaxis for HIV in women: daily oral tenofovir, oral tenofovir/emtricitabine, or vaginal tenofovir gel in the VOICE study (MTN 003). Conference on Retroviruses and Opportunistic Infections, 2013, Atlanta.
[16] Meyers K, Rodriguez K, Moeller RW, Gratch I, Markowitz M, Halkitis PN. High interest in a long-acting injectable formulation of pre-exposure prophylaxis for HIV in young men who have sex with men in NYC: a P18 cohort substudy. PLoS One 2014; 9 e114700
| High interest in a long-acting injectable formulation of pre-exposure prophylaxis for HIV in young men who have sex with men in NYC: a P18 cohort substudy.Crossref | GoogleScholarGoogle Scholar | 25502768PubMed |
[17] Hladik F, Burgener A, Ballweber L, et al Mucosal effects of tenofovir 1% gel. eLife 2015; 4 e04525
[18] Peinado J, Lama JR, Galea JT, et al Acceptability of oral versus rectal HIV preexposure prophylaxis among men who have sex with men and transgender women in Peru. J Int Assoc Provid AIDS Care 2013; 12 278–83.
| Acceptability of oral versus rectal HIV preexposure prophylaxis among men who have sex with men and transgender women in Peru.Crossref | GoogleScholarGoogle Scholar | 23422742PubMed |
[19] Andrews CD, Spreen WR, Mohri H, et al Long-acting integrase inhibitor protects macaques from intracrectal simian/human immunodeficiency virus. Science 2014; 343 1151–54.
| Long-acting integrase inhibitor protects macaques from intracrectal simian/human immunodeficiency virus.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXjsVegs7c%3D&md5=5ecf27b8703646ccf5746d64a2e093bdCAS | 24594934PubMed |
[20] Oldenburg CE, Biello KB, Colby D, et al Engagement with peer health educators is associated with willingness to use pre-exposure prophylaxis among male sex workers in Ho Chi Minh City, Vietnam. AIDS Patient Care STDS 2014; 28 109–12.
| Engagement with peer health educators is associated with willingness to use pre-exposure prophylaxis among male sex workers in Ho Chi Minh City, Vietnam.Crossref | GoogleScholarGoogle Scholar | 24601733PubMed |
[21] Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV? A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav 2014; 18 195–216.
| 23897125PubMed |
[22] Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education. J Acquir Immune Defic Syndr 2009; 50 77–83.
| Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education.Crossref | GoogleScholarGoogle Scholar | 19295337PubMed |
[23] Yang D, Chariyalertsak C, Wongthanee A, et al Acceptability of pre-exposure prophylaxis among men who have sex with men and transgender women in Northern Thailand. PLoS One 2013; 8 e76650
| Acceptability of pre-exposure prophylaxis among men who have sex with men and transgender women in Northern Thailand.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhs1aks7rE&md5=7ada6f344a7b01d6fb80233e953851e8CAS | 24116132PubMed |
[24] Newman PA, Cameron MP, Roungprakhon S, Tepjan S, Scarpa R. Acceptability and preferences for hypothetical rectal microbicides among a community sample of young men who have sex with men and transgender women in Thailand: a discrete choice experiment. AIDS Behav 2015; in press.
| 26696260PubMed |
[25] Newman PA, Roungprakhon S, Tepjan S. A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand. J Int AIDS Soc 2013; 16 18476
| A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand.Crossref | GoogleScholarGoogle Scholar | 23911116PubMed |
[26] Giguere R, Dolezal C, Bauermeister JA, et al Influence of partner type on acceptability and likelihood of use of a rectal microbicide among young men who have sex with men in the United States and Puerto Rico. J Sex Res 2016; 53 633–41.
| 26132717PubMed |
[27] Murphy DA, Lea T, de Wit JF, et al Interest in using rectal microbicides among Australian gay men is associated with perceived HIV vulnerability and engaging in condomless sex with casual partners: results from a national survey. Sex Transm Infect 2015; 91 266–8.
| Interest in using rectal microbicides among Australian gay men is associated with perceived HIV vulnerability and engaging in condomless sex with casual partners: results from a national survey.Crossref | GoogleScholarGoogle Scholar | 25416839PubMed |
[28] Lo Y-R, Kato M, Phanuphak N, et al Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region. Sex Health 2014; 11 126–36.
| Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region.Crossref | GoogleScholarGoogle Scholar | 25007911PubMed |
[29] Zhang W, O’Brien N, Forrest JI, et al Validating a Shortened Depression Scale (10 Item CES-D) among HIV-positive people in British Columbia, Canada. PLoS One 2012; 7 e40793
| Validating a Shortened Depression Scale (10 Item CES-D) among HIV-positive people in British Columbia, Canada.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtFSksb7P&md5=9869d675722411887dde26c40376c5e5CAS | 22829885PubMed |
[30] Oldenburg C, Biello KB, Colby D, et al Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City, Vietnam. Int J Public Health 2014; 59 833–40.
| Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City, Vietnam.Crossref | GoogleScholarGoogle Scholar | 24858522PubMed |
[31] Gual A, Segura L, Contel M, Heather N, Colom J. AUDIT-3 and AUDIT-4: effectiveness of two short forms of the alcohol use disorders identification test. Alcohol Alcohol 2002; 37 591–6.
| AUDIT-3 and AUDIT-4: effectiveness of two short forms of the alcohol use disorders identification test.Crossref | GoogleScholarGoogle Scholar | 12414553PubMed |
[32] Wheelock A, Eisingerich AB, Ananworanich J, et al Are Thai MSM willing to take prep for HIV prevention? An analysis of attitudes, preferences and acceptance. PLoS One 2013; 8 e54288
| Are Thai MSM willing to take prep for HIV prevention? An analysis of attitudes, preferences and acceptance.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhsVGksr0%3D&md5=8c9e5d44b6f66e3957079e5ef6c53174CAS | 23342121PubMed |
[33] Mimiaga MJ, Closson EF, Kothary V, Mitty JA. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. Arch Sex Behav 2014; 43 99–106.
| Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 24243002PubMed |
[34] Lorente N, Fugon L, Carrieri MP, et al Acceptability of an ‘on-demand’ pre-exposure HIV prophylaxis trial among men who have sex with men living in France. AIDS Care 2011; 24 1–10.
| Acceptability of an ‘on-demand’ pre-exposure HIV prophylaxis trial among men who have sex with men living in France.Crossref | GoogleScholarGoogle Scholar |
[35] Kubicek K, Arauz-Cuadra C, Kipke MD. Attitudes and perceptions of biomedical HIV prevention methods: voices from young men who have sex with men. Arch Sex Behav 2015; 44 487–97.
| Attitudes and perceptions of biomedical HIV prevention methods: voices from young men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 25633499PubMed |
[36] Kinsler JJ, Galea JT, Peinado J, Segura P, Montano SM, Sanchez J. Lubricant use among men who have sex with men reporting receptive anal intercourse in Peru: implications for rectal microbicides as an HIV prevention strategy. Int J STD AIDS 2010; 21 567–72.
| Lubricant use among men who have sex with men reporting receptive anal intercourse in Peru: implications for rectal microbicides as an HIV prevention strategy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cbitFaqsQ%3D%3D&md5=08802308f776024596144342b06c9983CAS | 20975090PubMed |
[37] Krakower DS, Mimiaga MJ, Rosenberger JG, et al Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site. PLoS One 2012; 7 e33119
| Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XlsVagt7s%3D&md5=fb71e1395bfe9d7b79cc0b66ff642070CAS | 22470438PubMed |
[38] Finitsis DJ, Pellowski JA, Johnson BT. Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials. PLoS One 2014; 9 e88166
| Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 24505411PubMed |
[39] Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS 2013; 27 248–54.
| From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City.Crossref | GoogleScholarGoogle Scholar | 23565928PubMed |
[40] Nguyen TA, Nguyen HT, Le GT, Detels R. Prevalence and risk factors associated with HIV infection among men having sex with men in Ho Chi Minh City, Vietnam. AIDS Behav 2008; 12 476–82.
| Prevalence and risk factors associated with HIV infection among men having sex with men in Ho Chi Minh City, Vietnam.Crossref | GoogleScholarGoogle Scholar | 17594139PubMed |
[41] Gonzalez JS, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr 2011; 58 181–7.
| 21857529PubMed |
[42] Biello KB, Colby D, Closson E, Mimiaga MJ. The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam. AIDS Behav 2014; 18 1264–71.
| 24081899PubMed |
[43] Weatherburn P, Schmidt AJ, Hickson F, et al The European men-who-have-sex-with-men internet survey (EMIS): design and methods. Sex Res Soc Policy 2013; 10 243–57.
| The European men-who-have-sex-with-men internet survey (EMIS): design and methods.Crossref | GoogleScholarGoogle Scholar |
[44] Biello KB, Rosenberger JG, Novak DS, Robertson AM, Mayer KH, Mimiaga MJ. Epidemiology of sexual health in the virtual environment: a multinational online survey of Spanish- and Portuguese-Speaking men who use an internet sexual networking site. AIDS Behav 2014; 18 1675–85.
| Epidemiology of sexual health in the virtual environment: a multinational online survey of Spanish- and Portuguese-Speaking men who use an internet sexual networking site.Crossref | GoogleScholarGoogle Scholar | 24980249PubMed |
[45] Vietnam Internet Network Information Center, Report on Vietnam Internet Resources 2012. 2012. Available online at: https://www.vnnic.vn/sites/default/files/tailieu/ReportOnVietNamInternetResources 2012.pdf [verified 20 June 2016].
[46] Justumus P, Colby D, Mai Doan Anh T, Balestre E, Becquet R, Orne-Gliemann J. Willingness to use the internet to seek information on HIV prevention and care among men who have sex with men in Ho Chi Minh City, Vietnam. PLoS One 2013; 8 e71471
| Willingness to use the internet to seek information on HIV prevention and care among men who have sex with men in Ho Chi Minh City, Vietnam.Crossref | GoogleScholarGoogle Scholar | 23977048PubMed |
