Population Size Estimation of Men Who Have Sex with Men in Ho Chi Minh City and Nghe An Using Social App Multiplier Method.

This study aims to estimate the number of men who have sex with men (MSM) in Ho Chi Minh City (HCMC) and Nghe An province, Viet Nam, using a novel method of population size estimation, and to assess the feasibility of the method in implementation. An innovative approach to population size estimation grounded on the principles of the multiplier method, and using social app technology and internet-based surveys was undertaken among MSM in two regions of Viet Nam in 2015. Enumeration of active users of popular social apps for MSM in Viet Nam was conducted over 4 weeks. Subsequently, an independent online survey was done using respondent driven sampling. We also conducted interviews with key informants in Nghe An and HCMC on their experience and perceptions of this method and other methods of size estimation. The population of MSM in Nghe An province was estimated to be 1765 [90% CI 1251-3150]. The population of MSM in HCMC was estimated to be 37,238 [90% CI 24,146-81,422]. These estimates correspond to 0.17% of the adult male population in Nghe An province [90% CI 0.12-0.30], and 1.35% of the adult male population in HCMC [90% CI 0.87-2.95]. Our size estimates of the MSM population (1.35% [90% CI 0.87%-2.95%] of the adult male population in HCMC) fall within current standard practice of estimating 1-3% of adult male population in big cities. Our size estimates of the MSM population (0.17% [90% CI 0.12-0.30] of the adult male population in Nghe An province) are lower than the current standard practice of estimating 0.5-1.5% of adult male population in rural provinces. These estimates can provide valuable information for sub-national level HIV prevention program planning and evaluation. Furthermore, we believe that our results help to improve application of this population size estimation method in other regions of Viet Nam.

Criteria for prioritization of HIV programs in Viet Nam: a discrete choice experiment.

BACKGROUND: With the decline in funding for Viet Nam's response to the HIV epidemic, there is a need for evidence on the criteria to guide the prioritization of HIV programs. There is a gap in the research on the relative importance of multiple criteria for prioritizing a package of interventions. This study elicits preferences and the trade-offs made between different HIV programs by relevant stakeholders and decision-makers in Viet Nam. It also pays attention to how differences in social and professional characteristics of stakeholders and their agency affiliations shape preferences for HIV program criteria in Viet Nam. METHODS: This study uses self-explicated ranking and discrete choice experiments to determine the relative importance of five criteria - effectiveness, feasibility, cost-effectiveness, rate of investment and prevention/treatment investment ratio - to stakeholders when they evaluate and select hypothetical HIV programs. The study includes 69 participants from government, civil society, and international development partners. RESULTS: Results of the discrete choice experiment show that overall the feasibility criterion is ranked highest in importance to the participants when choosing a hypothetical HIV program, followed by sustainability, treatment to prevention spending ratio, and effectiveness. The participant's work in management, programming, or decision-making has a significant effect on the importance of some criteria to the participant. In the self-explicated ranking effectiveness is the most important criterion and the cost-effectiveness criterion ranks low in importance across all groups. CONCLUSIONS: This study has shown that the preferred HIV program in Viet Nam is feasible, front-loaded for sustainability, has a higher proportion of investment on prevention, saves more lives and prevents more infections. Similarities in government and civil society rankings of criteria can create common grounds for future policy dialogues between stakeholders. Innovative models of planning should be utilized to allow inputs of informed stakeholders at relevant stages of the HIV program planning process.

Investigating the effectiveness of web-based HIV self-test distribution and linkage to HIV treatment and PrEP among groups at elevated risk of HIV in Viet Nam provinces: a mixed-methods analysis of implementation from pilot to scale-up.

INTRODUCTION: In Viet Nam, key populations (KPs) face barriers accessing HIV services. Virtual platforms can be leveraged to increase access for KPs, including for HIV self-testing (HIVST). This study compares reach and effectiveness of a web-based HIVST intervention from pilot to scale-up in Viet Nam. METHODS: A mixed-methods explanatory sequential design used cross-sectional and thematic analysis. The pilot launched in Can Tho in November 2020, followed by Hanoi and Nghe An in April 2021. Scale-up included Can Tho and Nghe An, with 21 novel provinces from April to December 2022. After risk assessment, participants registered on the website, receiving HIVST (OraQuick®) by courier, peer educator or self-pick-up. Test result reporting and completing satisfaction surveys were encouraged. Intervention reach was measured through numbers accessing the testing, disaggregated by demographics, and proportion of individuals reporting self-testing post-registration. Effectiveness was measured through numbers reporting self-test results, testing positive and linking to care, and testing negative and using HIVST to manage pre-exposure prophylaxis (PrEP) use. Thematic content analysis of free-text responses from the satisfaction survey synthesized quantitative outcomes. RESULTS: In total, 17,589 participants registered on the HIVST website; 11,332 individuals ordered 13,334 tests. Participants were generally young, aged <25 years (4309/11,332, 38.0%), male (9418/11,332, 83.1%) and men who have sex with men (6437/11,332, 56.8%). Nearly half were first-time testers (5069/11,332, 44.9%). Scale-up participants were two times more likely to be assigned female at birth (scale-up; 1595/8436, 18.9% compared to pilot; 392/3727, 10.5%, p < 0.001). Fewer test results were reported in scale-up compared with pilot (pilot: 3129/4140, 75.6%, scale-up: 5811/9194, 63.2%, p < 0.001). 6.3% of all tests were reactive (pilot: 176/3129, 5.6% reactive compared to scale-up: 385/5811, 6.6% reactive, p = 0.063); of which most linked to care (509/522, 97.5%). One-fifth of participants with a negative test initiated or continued PrEP (pilot; 19.8%, scale-up; 18.5%, p = 0.124). Thematic analysis suggested that community delivery models increased programmatic reach. Live chat may also be a suitable proxy for staff support to increase result reporting. CONCLUSIONS: Web-based self-testing in Viet Nam reached people at elevated risk of HIV, facilitating uptake of anti-retroviral treatment and direct linkage to PrEP initiations. Further innovations such as the use of social-network testing services and incorporating features powered by artificial intelligence could increase the effectiveness and efficiency of the approach.

Estimation of the Population Size of Men Who Have Sex With Men in Vietnam: Social App Multiplier Method.

BACKGROUND: Although the prevalence of HIV among men who have sex with men (MSM) in Vietnam has been increasing in recent years, there are no estimates of the population size of MSM based on tested empirical methods. OBJECTIVE: This study aimed to estimate the size of the MSM population in 12 provinces in Vietnam and extrapolate from those areas to generate a national population estimate of MSM. A secondary aim of this study was to compare the feasibility of obtaining the number of users of a mobile social (chat and dating) app for MSM using 3 different approaches. METHODS: This study used the social app multiplier method to estimate the size of MSM populations in 12 provinces using the count of users on a social app popular with MSM in Vietnam as the first data source and a questionnaire propagated through the MSM community using respondent-driven sampling as the second data source. A national estimation of the MSM population is extrapolated from the results in the study provinces, and the percentage of MSM reachable through online social networks is clarified. RESULTS: The highest MSM population size among the 12 provinces is estimated in Hanoi and the lowest is estimated in Binh Dinh. On average, 37% of MSM in the provinces surveyed had used the social app Jack'd in the last 30 days (95% CI 27-48). Extrapolation of the results from the study provinces with reliable estimations results in an estimated national population of 178,000 MSM (95% CI 122,000-512,000) aged 15 to 49 years in Vietnam. The percentage of MSM among adult males aged 15 to 49 years in Vietnam is 0.68% (95% CI 0.46-1.95). CONCLUSIONS: This study is the first attempt to empirically estimate the population of MSM in Vietnam and highlights the feasibility of reaching a large proportion of MSM through a social app. The estimation reported in this study is within the bounds suggested by the Joint United Nations Programme on HIV/AIDS. This study provides valuable information on MSM population sizes in provinces where reliable estimates were obtained, which they can begin to work with in program planning and resource allocation.

National health information systems for achieving the Sustainable Development Goals.

OBJECTIVES: Achieving the Sustainable Development Goals will require data-driven public health action. There are limited publications on national health information systems that continuously generate health data. Given the need to develop these systems, we summarised their current status in low-income and middle-income countries. SETTING: The survey team jointly developed a questionnaire covering policy, planning, legislation and organisation of case reporting, patient monitoring and civil registration and vital statistics (CRVS) systems. From January until May 2017, we administered the questionnaire to key informants in 51 Centers for Disease Control country offices. Countries were aggregated for descriptive analyses in Microsoft Excel. RESULTS: Key informants in 15 countries responded to the questionnaire. Several key informants did not answer all questions, leading to different denominators across questions. The Ministry of Health coordinated case reporting, patient monitoring and CRVS systems in 93% (14/15), 93% (13/14) and 53% (8/15) of responding countries, respectively. Domestic financing supported case reporting, patient monitoring and CRVS systems in 86% (12/14), 75% (9/12) and 92% (11/12) of responding countries, respectively. The most common uses for system-generated data were to guide programme response in 100% (15/15) of countries for case reporting, to calculate service coverage in 92% (12/13) of countries for patient monitoring and to estimate the national burden of disease in 83% (10/12) of countries for CRVS. Systems with an electronic component were being used for case reporting, patient monitoring, birth registration and death registration in 87% (13/15), 92% (11/12), 77% (10/13) and 64% (7/11) of responding countries, respectively. CONCLUSIONS: Most responding countries have a solid foundation for policy, planning, legislation and organisation of health information systems. Further evaluation is needed to assess the quality of data generated from systems. Periodic evaluations may be useful in monitoring progress in strengthening and harmonising these systems over time.

Brief behavioural surveys in routine HIV sentinel surveillance: a new tool for monitoring the HIV epidemic in Viet Nam.

In this report we describe a new approach in HIV sentinel surveillance that was piloted in Viet Nam in 2009 and is currently being rolled out in all provinces. It comprises a brief behavioural questionnaire added to the HIV sentinel surveillance surveys conducted routinely among people who inject drugs, female sex workers and men who have sex with men. Timely reporting of data from this system has resulted in improvements to HIV prevention efforts for most at-risk populations.