Caring for the whole person: transgender-competent HIV pre-exposure prophylaxis as part of integrated primary healthcare services in Vietnam.

INTRODUCTION: Although HIV prevalence among transgender women who have sex with men in Vietnam is high (16-18%), uptake of pre-exposure prophylaxis (PrEP) is low compared to other populations. When PrEP was initiated in 2017, gender-affirming healthcare was largely unavailable. Lack of access to competent, stigma-free healthcare is a well-documented barrier to transgender women's uptake of PrEP and primary healthcare (PHC). We aimed to demonstrate the utility of a PrEP quality improvement intervention in pinpointing and addressing barriers to PrEP use among transgender women in Vietnam. METHODS: We applied a real-world participatory continuous quality improvement (CQI) and Plan-Do-Study-Act (PDSA) methodology to ascertain barriers to PrEP uptake among transgender women and determine priority actions for quality improvement. A CQI team representing transgender women leaders, key population (KP)-clinic staff, public-sector HIV managers and project staff applied PDSA to test solutions to identified barriers that addressed the primary quality improvement outcome of the monthly change in PrEP uptake among transgender women and secondary outcomes, including month-3 PrEP continuation, the impact of offering PHC on PrEP uptake and unmet PrEP need. We utilized routine programmatic data and a descriptive cross-sectional study enrolling 124 transgender women to measure these outcomes from October 2018 to September 2021. RESULTS: Five key barriers to PrEP uptake among transgender women were identified and corresponding solutions were put in place: (1) offering gender-affirming care training to KP-clinics and community-based organizations; (2) integrating gender-affirming services into 10 KP-clinics; (3) offering PHC through five one-stop shop (OSS) clinics; (4) implementing a campaign addressing concerns related to hormone use and PrEP interactions; and (5) developing national HIV and transgender healthcare guidelines. New PrEP enrolment and month-3 PrEP continuation increased significantly among transgender women. Of 235 transgender women who initially sought healthcare other than PrEP at OSS clinics, 26.4% subsequently enrolled in PrEP. About one-third of transgender women reported unmet PrEP need, while two-thirds indicated an interest in long-acting cabotegravir. CONCLUSIONS: Offering gender-competent, integrated PHC can increase PrEP enrolment and continuation, and can be an entry-point for PrEP among those seeking care within PHC clinics. More work is needed to expand access to transgender women-led and -competent healthcare in Vietnam.

Secondhand smoke in public places in Vietnam: An assessment 5 years after implementation of the tobacco control law.

OBJECTIVES: This study quantified the secondhand smoke (SHS) concentration in a sample of public places in Vietnam to determine changes in SHS levels 5 years after a public smoking ban was implemented. METHODS: Two monitoring campaigns, one in 2013 (before the tobacco control law was implemented) and another in 2018 (5 years after the implementation of the law) were conducted in around 30 restaurants, cafeterias and coffee shops in major cities of Vietnam. Concentrations of PM2.5, as an indicator of SHS, were measured by portable particulate matter monitors (TSI SidePak AM510 and Air Visual Pro). RESULTS: The geometric mean PM2.5 concentration of all monitored venues was 87.7 µg/m3 (83.7-91.9) in the first campaign and 55.2 µg/m3 (53.7-56.7) in the second campaign. Pairwise comparison showed the PM2.5 concentrations in the smoking observed area was triple and double those in the non-smoking area and the outdoor environment. After adjusting for sampling locations and times, the SHS concentration 5 years after the implementation of the tobacco control law reduced roughly 45%. CONCLUSION: The study results indicate an improvement in air quality in public places in Vietnam via both the reduction in PM2.5 levels and the number of people observed smoking. However, greater enforcement of the free-smoke legislation is needed to eliminate SHS in public places in Vietnam.

Monitoring the levels of brominated and organophosphate flame retardants in passenger cars: Utilisation of car air filters as active samplers.

Filters in residential and office air conditioning (A/C) systems have been used as sampling devices for monitoring different pollutants. However, cabin air filters (CAFs) in the A/C system of passenger cars have not been utilised for this purpose. In this study, we collected 22 used CAFs from passenger cars in Hanoi, Vietnam to analyse for 8 polybrominated diphenyl ethers (PBDEs) and 10 organophosphate esters (OPEs). All the analytes were detected in more than 50% of samples with the exception of BDE153 and BDE154. The average concentrations of ∑10OPEs and ∑8BDEs in the captured dust were 2600 and 40 ng/g, respectively with Tris (1-chloro-2-propyl) phosphate (TCIPP) and BDE209 as the dominant congener in OPE and BDE groups, respectively. CAFs are a potential tool to qualitatively assess the levels of semi-volatile chemicals in suspended dust in cars as a screening step for exposure assessment of those chemicals.

Particulate air pollution in Ho Chi Minh city and risk of hospital admission for acute lower respiratory infection (ALRI) among young children.

High levels of air pollutants in Vietnam, especially particulate matters including PM2.5, can be important risk factors for respiratory diseases among children of the country. However, few studies on the effects of ambient air pollution on human health have been conducted in Vietnam so far. The aim of this study is to examine the association between PM2.5 and hospital admission due to acute lower respiratory infection (ALRI) among children aged < 5 years old in Ho Chi Minh city, the largest city of Vietnam. Data relating PM2.5 and hospital admission were collected from February 2016-December 2017 and a time series regression analysis was performed to examine the relationship between PM2.5 and hospital admission including the delayed effect up to three days prior to the admission. We found that each 10 µg/m3 increase in PM2.5 was associated with an increase of 3.51 (95%CI: 0.96-6.12) risk of ALRI admission among children. According to the analysis, male children are more sensitive to exposure to PM2.5 than females, while children exposed to PM2.5 are more likely to be infected with acute bronchiolitis than with pneumonia. The study demonstrated that young children in HCMC are at increased risk of ALRI admissions due to the high level of PM2.5 concentration in the city's ambient air.

Exploratory assessment of outdoor and indoor airborne black carbon in different locations of Hanoi, Vietnam.

Black carbon (BC) is a significant component of atmospheric particulate matter, especially in areas affected by combustion emissions. Despite the fact that air pollution is a great concern in Vietnam, there are no studies on the level of BC in the outdoor and indoor environment. In this exploratory study, an assessment of urban BC concentrations was conducted through monitoring of both outdoor and indoor BC concentrations in three households and one working office at different locations across Hanoi. PM2.5 and meteorology data were also obtained for this monitoring period to evaluate the association between them and the outdoor BC concentration. Overall, the mean indoor and mean outdoor BC concentrations by 30 second-logs for the monitoring period were 4.42 µg/m3 and 4.89 µg/m3, respectively. Time-series analysis of paired indoor and outdoor BC concentrations suggested that indoor BC level was usually influenced by outdoor BC level (r = 0.78, p < 0.001). In this study, we observed a significant positive association between outdoor BC and PM2.5 (r = 0.39, p < 0.001) while outdoor BC negatively correlated with wind speed (r = -0.34, p < 0.001). The level of outdoor BC in Hanoi measured in this study is relatively high and should be confirmed by further studies.