Background: HIV prevalence among men who have sex with men (MSM) in Vietnam has increased in the past five years, from 3.9% to 12.2%. A 2016 pre-exposure prophylaxis (PrEP) acceptability study found that 96% of MSM in Ho Chi Minh City (HCMC) and Hanoi self-reported being at high risk of HIV and 84% said they intended to use PrEP when available.
Methods: From March 2017, PrEP services were offered to MSM and other key populations (KP) through a partnership between twelve KP-led organizations and four KP-owned or -friendly private clinics in HCMC and Hanoi. To inform national PrEP scale-up, we integrated an observational rolling-enrollment cohort study and collected routine client data from PrEP clinics to assess PrEP enrollment, retention and adherence trends over time. Univariable and multivariable analyses were conducted to identify factors associated with PrEP retention. Retention was defined as having returned for all scheduled re-fills at month 1, month 3 and quarterly thereafter. We measured adherence using as self-report of pills taken in the past 7-days.
Results: By December 2018, 1,925 MSM had ever initiated on PrEP, with 1,070 enrolling in the cohort study. Among cohort study participants, median age ever on PrEP was 26, 78.6% had partially or fully completed a university degree, and 81.7% had health insurance coverage. PrEP enrollment increased over time from an average of 39 MSM per month in the first 6-months (March-August 2017) to 154 per month in the last 6-months (July-December 2018). PrEP retention and self-reported adherence (4 doses or more/week) at month 3 was 88.7% and 91.4%, respectively. Multivariable analyses identified the following factors associated with greater odds of persisting on PrEP: being >30 years old (aOR 1.46; p=0.01), having a lower income (aOR 1.43; P=0.001), attaining an education beyond secondary school (aOR 1.42; p=0.005), and reporting a higher number of condomless receptive anal sex events (aOR 1.04; p=0.001).
Conclusions: KP providers are successfully offering PrEP to MSM that tend to have lower income and are at higher risk of HIV. Better systems and tools are needed to support younger MSM and/or those with less formal education to remain on PrEP.