Prepped for PrEP? Acceptability, continuation and adherence among men who have sex with men and transgender women enrolled as part of Vietnam’s first pre-exposure prophylaxis program

Kimberly Elizabeth Green; Long Hoang Nguyen; Huong Thu Thi Phan; Bao Ngoc Vu; Minh Hung Tran; Huu Van Ngo; Van Thi Thu Tieu; Hung Van; Thanh Minh Le; Khang Quang Do; Phong Anh Nguyen; Trang Minh Ngo; Anh Hong Doan; Diep Thi Ngoc Bui; Trang Nguyen Nhu Nguyen; Lan Thi Xuan Hang; Tham Thi Tran; Binh Quoc Luong

doi:10.1071/SH20167

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 18(1)

Prepped for PrEP? Acceptability, continuation and adherence among men who have sex with men and transgender women enrolled as part of Vietnam’s first pre-exposure prophylaxis program

Kimberly Elizabeth Green

^A ^J , Long Hoang Nguyen ^B , Huong Thu Thi Phan ^B , Bao Ngoc Vu ^A , Minh Hung Tran ^C , Huu Van Ngo ^A , Van Thi Thu Tieu ^D , Hung Van ^D , Thanh Minh Le ^E , Khang Quang Do ^F , Phong Anh Nguyen ^G , Trang Minh Ngo ^H , Anh Hong Doan ^A , Diep Thi Ngoc Bui ^C , Trang Nguyen Nhu Nguyen ^I , Lan Thi Xuan Hang ^I , Tham Thi Tran ^A and Binh Quoc Luong ^D

+ Author Affiliations

- Author Affiliations

^A PATH, Level 11, Hanoi Towers, Hanoi, Vietnam.

^B Ministry of Health/Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam.

^C Center for Creative Initiatives in Health and Population, Hanoi, Vietnam.

^D Ho Chi Minh City Center for Disease Control (former Provincial AIDS Center), Ho Chi Minh City, Vietnam.

^E Glink Social Enterprise, Ho Chi Minh City, Vietnam.

^F Galant Clinic, Ho Chi Minh City, Vietnam.

^G My Home Clinic, Ho Chi Minh City, Vietnam.

^H United States Agency for International Development, Hanoi, Vietnam.

^I Life Center, Ho Chi Minh City, Vietnam.

^J Corresponding author. Email: kgreen@path.org

Sexual Health 18(1) 104-115 https://doi.org/10.1071/SH20167
Submitted: 25 September 2020 Accepted: 23 December 2020 Published: 3 March 2021

Journal Compilation © CSIRO 2021 Open Access CC BY-NC-ND

Abstract

Background: HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) in Vietnam is high, whereas coverage of effective HIV prevention services has been inadequate. Studies have measured MSM and TGW demand for pre-exposure prophylaxis (PrEP) services, which led to the design of the first ever PrEP program in Vietnam, Prepped for PrEP (P4P). Methods: In March 2017, PrEP services were offered in Ho Chi Minh City as part of the P4P demonstration project, enabling same-day enrolment in three key population (KP)-led clinics and four public clinics. P4P aimed to assess acceptability and feasibility of PrEP services through calculating the rate of PrEP enrolment over time, and quarterly measures of continuation and adherence over an 18-month period. Results: A total of 1069 MSM and 62 TGW were enrolled in P4P. Average monthly PrEP enrolment among MSM increased five-fold from the first 3 months (March–June 2017) to the last 3 months of active enrolment (March–June 2018), whereas for TGW, no increased trend in PrEP enrolment per quarter was seen. Self-reported PrEP adherence was >90% at all time points among MSM, but varied from 11.1% to 88.9% among TGW. PrEP continuation was calculated at months 3, 6, 9, 12, 15 and 18. For MSM, it was 88.7% at month 3, 68.8% at month 12 and 46.6% at month 18, whereas for TGW, it was 87.1%, 54.8% and 52.8%, respectively. Multivariable regression identified that MSM with lower-than-average income (adjusted odds ratio (aOR) 2.38 (95% confidence interval (CI): 1.59–3.54), P = 0.000), aged >30 years (aOR 2.03 (95% CI: 1.30–3.40), P = 0.007) and with an increasing number of sex partners (aOR: 1.06 (1.01–1.11), P = 0.011) had greater odds of remaining on PrEP. For TGW, being aged >30 years was associated with continuing on PrEP (aOR 5.62 (95% CI: 1.05–29.9), P = 0.043). Conclusions: We found PrEP to be highly acceptable among MSM and moderately acceptable among TGW. Continuation rates were relatively high for the first roll-out of PrEP; however, those aged ≤30 years were much more likely to discontinue services. Scaling-up PrEP through differentiated and community-led and engaged PrEP service delivery will be key to effectively increase access and uptake over the next 5 years.

Keywords: Asia, community-led health services, differentiated care, HIV prevention, key populations, key population-led health services, same-day pre-exposure prophylaxis, Vietnam, vulnerable populations.

References

[1] World Health Organization. Guidance on oral pre-exposure prophylaxis for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: recommendations for use in the context of demonstration projects. 2012. Available online at: https://apps.who.int/iris/bitstream/handle/10665/75188/9789241503884_eng.pdf;jsessionid=75B126F97A9C17C382B786AEA4D68FF7?sequence=1 [verified 27 December 2020].

[2] World Health Organization (WHO). Consolidated HIV prevention and treatment guidelines. Geneva: WHO; 2015.

[3] San Francisco Department of Public Health. HIV epidemiology annual report 2018. 2019. Available online at: https://www.sfdph.org/dph/comupg/oprograms/HIVepiSec/HIVepiSecReports.asp [verified 15 September 2020].

[4] Grulich AE, Guy R, Amin J, Jin F, Selvey C, Holden J, et al Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV 2018; 5 e629–37.
| Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 30343026PubMed |

[5] Koss CA, Havlir DV, Ayieko J, Kwarisiima D, Kabami J, Atukunda M, et al. OAC0805: lower than expected HIV incidence among men and women at elevated HIV risk in a population-based PrEP study in rural Kenya and Uganda: interim results from the SEARCH study. 23rd International AIDS Conference; 6–10 July 2020. Available online at: https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25547 [verified 27 December 2020].

[6] Vietnam Ministry of Health (MOH). HIV sentinel surveillance reports. Hanoi: MOH; 2011.

[7] Vietnam Ministry of Health (MOH). HIV sentinel surveillance reports. Hanoi: MOH; 2013.

[8] Vietnam Ministry of Health (MOH). HIV sentinel surveillance reports. Hanoi: MOH; 2015.

[9] Vietnam Ministry of Health (MOH). HIV sentinel surveillance reports. Hanoi: MOH; 2016.

[10] Vietnam Ministry of Health (MOH). HIV sentinel surveillance reports. Hanoi: MOH; 2017.

[11] Ministry of Health (MOH), National Institute of Hygiene and Epidemiology. HIV/STI integrated biological and behavioral surveillance (IBBS) in Vietnam: results from round III 2013 and trends across three rounds (2005–2009–2013) of surveys. 2014. Available online at: https://www.researchgate.net/publication/305471855_HIVSTI_Integrated_Biologcial_and_Behavioral_Surveillance_IBBS_in_Vietnam_-_Results_from_Round_III_and_Trends_Across_Three_Rounds_2005_-_2009_-_2013_of_Surveys [verified 5 September 2020].

[12] Vietnam Ministry of Health (MOH). HIV sentinel surveillance reports. Hanoi: MOH; 2018.

[13] Colby D, Nguyen NA, Le L, Toan T, Thien DD, Huyen HT, et al HIV and syphilis prevalence among transgender women in Ho Chi Minh City, Vietnam. AIDS Behav 2016; 20 379–85.
| HIV and syphilis prevalence among transgender women in Ho Chi Minh City, Vietnam.Crossref | GoogleScholarGoogle Scholar | 27435074PubMed |

[14] Pham QD, Wilson DP, Kerr CC, Shattock AJ, Do HM, Duong AT, et al Estimating the cost-effectiveness of HIV prevention programmes in Vietnam, 2006–2010: a modelling study. PLoS One 2015; 10 e0133171
| Estimating the cost-effectiveness of HIV prevention programmes in Vietnam, 2006–2010: a modelling study.Crossref | GoogleScholarGoogle Scholar | 26196290PubMed |

[15] Vu BN, Green K, Phan HT, Tran MH, Vo SH, Ngo HV, et al. Lay provider HIV testing: a promising strategy to accelerate 90–90–90 in Vietnam. MOPED1105. Presented at the 9th IAS Conference on HIV Science; 23–26 July 2017; Paris, France. Geneva: International AIDS Society (IAS); 2017.

[16] Green K, Vu BN, Phan HT, Tran MH, Vo SH, Ngo HV, et al. How acceptable and feasible is HIV self-testing among key populations in Vietnam? Preliminary results from an intervention evaluation study. TUPEC0844. Presented at the 9th IAS Conference on HIV Science; 23–26 July 2017; Paris, France. Geneva: International AIDS Society (IAS); 2017.

[17] Green KE, Vu BN, Phan HT, Tran MH, Ngo HV, Vo SH, et al From conventional to disruptive: upturning the HIV testing status quo among men who have sex with men in Vietnam. J Int AIDS Soc 2018; 21 e25127
| From conventional to disruptive: upturning the HIV testing status quo among men who have sex with men in Vietnam.Crossref | GoogleScholarGoogle Scholar | 30033557PubMed |

[18] Oldenburg CE, Biello KB, Colby D, Closson EF, Nguyen T, Trang NN, 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 |

[19] Oldenburg CE, Le B, Toan T, Thien DD, Huyen HT, Friedman MR, et al HIV pre-exposure prophylaxis indication and readiness among HIV-uninfected transgender women in Ho Chi Minh City, Vietnam. AIDS Behav 2016; 20 365–70.
| HIV pre-exposure prophylaxis indication and readiness among HIV-uninfected transgender women in Ho Chi Minh City, Vietnam.Crossref | GoogleScholarGoogle Scholar | 27435073PubMed |

[20] Oldenburg CE, Le B, Huyen HT, Thien DD, Quan NH, Biello KB, et al Antiretroviral pre-exposure prophylaxis preferences among men who have sex with men in Vietnam: results from a nationwide cross-sectional survey. Sex Health 2016; 13 465–473.
| Antiretroviral pre-exposure prophylaxis preferences among men who have sex with men in Vietnam: results from a nationwide cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |

[21] Green K. Prepped 4 PrEP! KP-led services in Vietnam. Paper presented at the 2nd Asia-Pacific Regional Consultation on PrEP Implementation; 16 Jan 2018; Bangkok, Thailand. 2018. Available online at: https://www.prevention‐trcarc.org/files/10.Kimberly%20Green‐%20Prepped%204%20PrEP!pdf [verified 5 March 2020].

[22] Vu BN, Le TM, Le S, Nguyen PA, Vu HB, Nguyen DAD, et al. Leading from the community: how key population organizations in Vietnam transformed from peer support groups to clinical service providers. Abstract presented at the 23rd IAS Conference (AIDS 2020); 6–10 July 2020; San Francisco, CA, USA. 2020. Available online at: http://www.differentiatedcare.org/Portals/0/adam/Content/xJSbv2c4Aka9DfjRMTOEHg/File/bao_vu_slides_vietnam_KP.pdf [verified 5 September 2020].

[23] Green K, Vu NB, Nguyen Thi PH, Do NT, Tran MH, Le TM, et al. Key population-delivered oral pre-exposure prophylaxis: initial enrollment, adherence and retention results among men who have sex with men in Vietnam. TUPEC409. Presented at the 10th IAS Conference on HIV Science; 21–24 July 2019; Mexico City, Mexico. 2019. Available online at: http://programme.ias2019.org/Abstract/Abstract/2551 [verified 5 September 2020].

[24] Viet Nam News. Oral HIV pre-exposure service launched. Viet Nam News, 14 June 2017. Available online at: http://vietnamnews.vn/society/378216/oral-hiv-pre-exposure-service-launched.html#FeWWmssZjmwhKF6a.97 [verified 14 November 2017].

[25] Colby D, Kongkabpan M, Teeratakulpisarn S, Teeratakulpisarn N, Pondet C, Pakam C, et al. PrEP or peril: rolling out PrEP in the private sector without subsidy or government support. Symposium presentation THSY0206 at XXII International AIDS Conference; 23–27 Jul 2018; Amsterdam, The Netherlands. 2018. Available online at: https://programme.aids2018.org/PAGMaterial/PPT/178_4840/PrEP%20or%20peril-Colby-AIDS18(26.07.18).pptx [verified 10 September 2020].

[26] United States Centers for Disease Control and Prevention (CDC). Preexposure prophylaxis for the prevention of HIV infection in the United States – 2014. Atlanta, GA: CDC; 2014.

[27] Phanuphak N, Sungsing T, Jantarapakde J, Pengnonyang S, Trachunthong D, Mingkwanrungruang P, et al Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand. Sex Health 2018; 15 542–55.
| Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand.Crossref | GoogleScholarGoogle Scholar | 30249317PubMed |

[28] Pyra MN, Haberer JE, Hasen N, Reed J, Mugo NR, Baeten JM. Global implementation of PrEP for HIV prevention: setting expectations for impact. J Int AIDS Soc 2019; 22 e25370
| Global implementation of PrEP for HIV prevention: setting expectations for impact.Crossref | GoogleScholarGoogle Scholar | 31456348PubMed |

[29] Lee SS, Kwan TH, Wong NS, Lee KCK, Chan DPC, Lam TTN, et al Piloting a partially self-financed mode of human immunodeficiency virus pre-exposure prophylaxis delivery for men who have sex with men in Hong Kong. Hong Kong Med J 2019; 25 382–91.
| 31619578PubMed |

[30] Vietnam Ministry of Health (MOH). National HIV care and treatment guidelines. Hanoi: MOH; 2017.

[31] Hai HN. Updated on PrEP implementation in Vietnam. Workshop for 15 Global Fund for AIDS, TB and Malaria funded provinces, 4 September 2020. Hanoi: Vietnam Ministry of Health; 2020.

[32] Long NH, Green K. PrEP scale up and STI management: country perspective: Vietnam. Paper presented at the 10th IAS Conference on HIV Science; 21–24 July 2019; Mexico City, Mexico. 2019. Available online at: http://programme.ias2019.org/Programme/Session/155 [verified 27 December 2020].

[33] Vietnam Ministry of Health (MOH). Five year PrEP scale-up plan, 2021–2025. Hanoi: MOH; 2020.