Pre-Exposure Prophylaxis Care Continuum among Men Who Have Sex with Men in Vietnam

BackgroundPre-exposure Prophylaxis (PrEP) is effective in preventing HIV acquisition and therefore is a key priority to ending the HIV/AIDS epidemic. Men who have sex with men (MSM) can largely benefit from the program because they are disproportionately affected by the epidemic. There is a paucity of studies conducted in Vietnam investigating barriers of PrEP uptake as well as the PrEP care continuum. The study aims to identify the challenges of PrEP implementation from the perspective of MSM and from the perspective of service providers working in antiretroviral therapy (ART) clinics, and to inform interventions to improve PrEP implementation. Methods A mixed-method design was used in the study. Sub-study 1 utilized the existing data of a cohort study of MSM and the ongoing PrEP-program data of an MSM-focused clinic in Hanoi, Vietnam to identify factors associated with PrEP initiation. Sub-study 2 was in-depth interviews of 30 discontinued MSM to explore multi-level challenges related to PrEP discontinuation. Sub-study 3 was a cross-sectional survey of service providers working in ART clinics in Hanoi, Ho Chi Minh, and Hai Phong Cities in Vietnam to investigate the association between service providers’ acceptability of the PrEP program and concern about PrEP use. Results Study 1 found that 43% of HIV-negative MSM initiating PrEP. Four factors associated with increased PrEP initiation were revealed, that were, reported gender identity, no ATS use in the past three months or never, having more than two sexual partners in the last month, and ever tested for HIV in the last 12 months. Study 2 reported the challenges related to PrEP discontinuation in three levels: 1) Individual-level challenges were risk behaviors and risk perception, pill burden, side effects, and lack of motivation to treatment, 2) Institutional-level challenges were PrEP accessibility and logistical difficulties, 3) Structural-level challenges included cost due to the medication, stigma toward PrEP use, and the impact of the COVID-19 pandemic. Additionally, the study found that long-acting injectable PrEP was highly acceptable among discontinued MSM and that side effects and pain due to intramuscular injection were two major challenges related to injectable PrEP. Study 3 presented the high acceptability of PrEP implementation among ART service providers. The association between PrEP acceptability and concern about PrEP use was not observed, however, higher awareness of PrEP-related information, lower stigma toward MSM, and higher job satisfaction were correlated with increased PrEP acceptability. Conclusion MSM faces multi-level challenges to initiate PrEP and to remain in the PrEP program. Interventions targeting the multi-level challenges should be developed and need to be delivered in a comprehensive package