1. PrEP Implementation in VietnamBy
Dr. Nguyen Hoang Long, Director General, Vietnam Authority of HIV/AIDS Control (VAAC)
Dr. Kimberly Green, Director, HIV & TB, PATH

2. Content . . . HIV epidemic and why PrEP in Vietnam
PrEP implementation progress
PrEP and STIs
What’s next

3. HIV/AIDS Epidemic in Vietnam
96 millions pop
250,000 PLWH
Concentrated epidemic: PWID (14%), MSM (12%), FSWs (3,6%)
Reduce 2/3 during last 10 years.
Targets:

4. WHY PrEP? MSM: Large size: 180,000 MSM, mainly in urban areas.
High prevalence: 12%.
High NEW infection: 35% among MSM HIV+ in Hanoi, 2017 (Recency testing).
High incidence: 1.7%, much higher than PWID (0.8%) and FSW (0.24%).
 Quick INCREASE.
WHY PrEP?

5. MSM: 21% of PLHIV detected in 2017  Can be nearly 40% in 2025.
Projection
MSM

6. PrEP Progress in Vietnam: From pilot to national program
2016
2017
2018
2019
2020
Mar 2016
Dec 2016
Sep 2016
Mar 2017
Jun 2017
Dec 2017
National PrEP technical workshops and community dialogues (VAAC & USAID/PATH)
PrEP pilot protocol approved by VAAC/MOH
PrEP study tour to BKK (VAAC & USAID/PATH)
First PrEP dispensing in HCMC (USAID/PATH)
National launch of PrEP Pilot
National guidelines on PrEP approved
PrEP in 2 cities
(HCMC & Hanoi)
PrEP scale up in
11 provinces
[PEPAR]
PrEP scale up in 26 provinces and other as needed (PF, GF, WHO, UNAIDS…)
Nov 2018
Launch of national PrEP scale-up plan
Oct 2017
PrEP research (n=200) in HCMC (VinaPrEP, UNAIDS)
May 2018
PrEP rollout mid-term review
(VAAC & USAID/PATH)

7. PrEP Scale-up plan in Vietnam (Donors and Domestic funding)
General objective: Reduction of new HIV infections among key populations (MSM, TGW, FSW…).
: pilot in 8 clinics
2019
5,600 clients, 43 clinics
2020
7,300 clients
2021
15,300 clients

8. PrEP Agencies in PrEP model
CBOs,PEs, Grass-root healthcare: Access KP groups, risk screening, introduce to PrEP clinics, support PrEP continuation
VAAC, Prov CDC/DOH, DONORS/IPs: Policy, plans, guidelines, TA, ARV supply, program management and coordination
PrEP CLINICS (public/private): Testing, counseling, PrEP initiation and continuation support

9. Cumulative and current uptake (March 2017 to May 2019)
Cumulative enrollment
USAID/PATH: 2,753
CDC: ,027
UNAIDS:
USAID/FHI 360: 96
Other (Commercial): 232

10. Distribution of current PrEP clients in 10 provinces

11. PrEP continuation by month Rolling cohort study in Ho Chi Minh City (n=1,342), March 2017-April 2019
Source: USAID/PATH Healthy Markets. Preliminary results from an intervention evaluation in Ho Chi Minh City, June 2019.

12. STIs & PrEP: Supply and demand challenges
Lack of sufficient investment in STI services
STIs owned by several, not a single, MOH department
Molecular testing for CT/NG is expensive
Supply challenges
Social stigma and discrimination
Inadequate information or awareness building on STIs and the benefits of screening and treatment.
Demand challenges

13. PrEP services schedule
Enrollment
Follow up
Clinical consultation x
1st month and quarterly
Counseling and adherence support
HIV testing
PrEP drug pick-up
STI screening, diagnosis and treatment (syphilis, gonorrhea, chlamydia)
Serum creatinine
Semi-annually
HCV antibody test
Annually

14. Serodiscordant partner (100% female)
STIs at PrEP enrollment (MSM, TWG, HIV-negative discordant partner): 3 private clinics, HCMC: Jan 2018-May 2019 (USAID/PATH)
STIs at baseline
screening
Chlamydia
(ABON)
Gonorrhoea
Syphilis
Syphilis (Alere Duo)
Hepatitis C
(SD Bioline) #
Screened
Diagnosed (+)
Treated (Tx)
# Screened Dx Tx
MSM
1,163 45
(3.9%) 40
(88.9%)
266 48
(18.0%)
(100%)
2,029
199
(9.8%)
196
(98.5%)
919 3
(0.3%) 2
(66.7%)
TGW
(6.3%) 11
(27.3%) 85 7
(8.2%) 38
Serodiscordant partner (100% female)
173
(4.0%)
(27.5%)
302 58
(19.2%)
137 1
(0.7%)
Total
1,384 55
50 (91%)
317
62 (19.6%) 62
2,415
264
(10.9%)
261
(99%)
1,094 4
(0.4%)
(50%)

15. What’s next for PrEP scale-up and STI management?
Urgently scale-up PrEP uptake for greater impact
Low coverage of PrEP among MSM (6%)
STI guidelines and training
Finalize STI management protocols for PrEP services and roll out training later this year
Improved diagnosis for CT/NG and STI partner notification
Trial pooled sampling, offer STI-PNS as part of PrEP services
Long-term sustainable financing for PrEP
PrEP is cost-effective but more work needs to be done to identify local sources of financing for PrEP

16. THANK YOU!
Bich Dong, Vietnam