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ORIGINAL RESEARCH article
Front. Reprod. Health
Sec. HIV and STIs
Volume 6 - 2024 |
doi: 10.3389/frph.2024.1439461
This article is part of the Research Topic Accelerating to 2030 – Doubling Down on HIV Prevention to End HIV/AIDS as a Public Health Threat View all articles
Effectiveness of private sector engagement in scaling up HIV preexposure prophylaxis in Vietnam
Provisionally accepted
Bao N. Vu
1*
Kimberly Green
1
Huong Phan
2
Long Tran
1
Phuong Phan
1
Tham Tran
1
Linh Doan
2
Yen Vu
1
Chau Pham
1
Dao Nguyen
3
Anh Doan
3
Trang Ngo
3
Phuong Tran
4
Vuong Nguyen
4
Bieu Nguyen
1
Thai Phan
4
Ha Nguyen
1- 1 PATH, Hanoi, Vietnam
- 2 Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
- 3 United States Agency for International Development (vietnam), Hanoi, Vietnam
- 4 PATH, Ho Chi Minh City, Vietnam
Background: Although pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, PrEP uptake remains limited. Vietnam introduced PrEP in 2017 and scaled up from 2019. Private sector engagement (PSE) in PrEP service delivery is a scaling-up strategy. We assessed the effectiveness of this approach to inform ongoing efforts to accelerate ending AIDS by 2030.We implemented a process evaluation with longitudinal design using retrospective programmatic data collected and uploaded onto a secure online system (HMED) from 23 public and 17 private PrEP clinics in Hanoi, Ho Chi Minh City (HCMC), and Dong Nai. We measured the effectiveness of PrEP service delivery by PrEP initiation/reinitiation, uptake, persistence, discontinuation, and HIV seroconversion. We used the Kaplan-Meier time-to-event approach to estimate PrEP persistence and mixed-effects logistic regression analysis to assess factors associated with the PrEP persistence.Results: From October 2017 to September 2023, we started PrEP for 29,944 individuals, of which private clinics accounted for four times higher initiations than public clinics (79.3% vs. 20.7%, respectively). The median persistence of PrEP users at private clinics was significantly longer than that at public clinics (268 vs. 148, respectively). Mixed-effects logistic regression analysis results indicated a significant association between PrEP persistence for at least three months and initiating PrEP at private clinics (adjusted odds ratio [aOR] = 4.28; 95% confidence interval [CI]: 2.96-6.19), opting for TelePrEP (aOR = 3.42; 95%CI: 2.12-5.53), or being a client at 20 years and older (aOR = 1.86; 95%CI: 1.62-2.13). HIV seroconversion was significantly lower among PrEP users at private clinics compared to public clinics (0.03 vs. 0.13 per 100 person-years, respectively; p<0.01).Private sector PrEP service delivery is an effective approach to scaling up PrEP.Private-sector service providers play a pivotal role in increasing PrEP uptake and coverage and achieving HIV prevention goals.
Keywords: hiv prevention, pre-exposure prophylaxis, Private sector engagement, Key populations, Vietnam
Received: 28 May 2024; Accepted: 27 Sep 2024.
Copyright: © 2024 Vu, Green, Phan, Tran, Phan, Tran, Doan, Vu, Pham, Nguyen, Doan, Ngo, Tran, Nguyen, Nguyen, Phan and Nguyen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Bao N. Vu, PATH, Hanoi, Vietnam
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