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
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.
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