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.

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.

HIV risk among drug-using men who have sex with men, men selling sex, and transgender individuals in Vietnam.

Knowledge about drug use and its association with HIV risk among men who have sex with men is limited. Although the HIV epidemic among this population in Vietnam is increasingly acknowledged, understanding the impact of drug use on the spread of HIV is largely lacking. Using qualitative data from in-depth interviews and focus group discussions with 93 drug users, 15 non-drug users and 9 community stakeholders, this analysis explores emerging patterns of drug use and risk factors for engaging in risk behaviours among drug-using men having sex with men, men selling sex and transgender individuals in Hanoi and Ho Chi Minh City. Findings revealed that drug use is shifting from heroin to ecstasy and ice. Drug users reported unsafe sex associated with drug use and men selling sex were particularly at elevated risk because of using drugs as a tool for sex work and trading sex for drugs. These findings are guiding development of programmes addressing unmet HIV-prevention needs in Vietnam.

Lay provider HIV testing: A promising strategy to reach the undiagnosed key populations in Vietnam.

BACKGROUND: In Vietnam, reaching the remaining one-third of undiagnosed people living with HIV and facilitating their antiretroviral therapy (ART) enrollment requires breakthrough approaches. We piloted lay provider HIV testing as an innovative approach to reach at-risk populations that never or infrequently HIV test at facility-based services. METHODS: We conducted a cross-sectional survey and analysis of routine program data in two urban provinces (Hanoi and Ho Chi Minh City) and two rural mountainous provinces (Nghe An and Dien Bien) from October 2015 through September 2017. Acceptability of lay provider testing was defined as the proportion of first-time HIV testers utilizing the service, and effectiveness was measured by HIV positivity and ART initiation rates. Univariate and multivariate analyses were used to determine lay provider testing preference and factors associated with that preference. RESULTS: Among 1,230 individuals recruited for face-to-face interviews, 74% belonged to key populations: people who inject drugs accounted for 31.4%; men who have sex with men, 60.4%; and female sex workers, 8.2%. Most clients (67%) reported being first-time HIV testers, and the majority (85.8%) preferred lay provider testing to facility-based testing. Multivariate analysis found that clients in urban areas (adjusted odds ratio [aOR] = 2.50; 95% confidence interval [CI]: 1.30-4.90) and those who had a university or higher education (aOR = 1.83; 95% CI: 1.05-3.20) were more likely to prefer lay provider testing. Lay provider testing yielded a higher HIV positivity rate (4.1%), particularly among first-time testers (6.8%), compared to facility-based testing (nationally estimated at 1.6% in 2016) and had a high ART initiation rate (91%). CONCLUSIONS: Our findings suggest that lay provider HIV testing is an effective approach to reach previously unreached at-risk populations, and, therefore, a critical addition to accelerating Vietnam's attainment of the Joint United Nations Programme on HIV/AIDS 90-90-90 goals.

Male sexuality in Vietnam: the case of male-to-male sex.

BACKGROUND: To implement effective behaviour change interventions for men who have sex with men, qualitative information was collected about the contexts and meanings of sex and relationships between men in Ho Chi Minh City. METHODS: Individual interviews and focus groups were conducted with 74 men aged 18 years or older who had had sex with another man in the previous 12 months. RESULTS: Findings reveal that sex between men exists and is associated with two common descriptors in Vietnam: bong lo for those who are feminised in public and bong kin for those who are not, and are often married. In sexual relationships, for both groups of men, there is a trade off between sexual pleasure and risk. Condoms may not be used, particularly when having sex with a partner who was considered to be good looking or perceived as 'clean'. CONCLUSIONS: The study highlights the need for HIV prevention programs which address issues of sexual meaning in male-to-male sexual relationships.