Prepped for PrEP : A pilot intervention to assess the acceptability, feasibility and sustainability of pre-exposure prophylaxis in men who have sex with men, transgender women and discordant couples in Ho Chi Minh City, Vietnam

Background: HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) in Vietnam is high while 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 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 enrolled in P4P. Average monthly PrEP enrolment increased five-fold from the first three months (March-June 2017) to the last three months of active enrolment (March-June 2018). Self-reported PrEP adherence was greater than 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 while for TGW it was 87.1%, 54.8% and 52.8%, respectively. Multivariable regression identified that MSM with lower than average income (aOR 2.38 (95% CI:1.59-3.54), p=0.000); older than 30 years of age (aOR 2.03 (95% CI:1.30-3.40), p=0.007); and with increasing number of sex partners (ExpB: 1.06 (1.01-1.11), p=0.011) had greater odds of remaining on PrEP. For TGW being older than 30 years of age 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 age 30 or younger 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 five years.