Background HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) in Vietnam is high, whereas 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 the 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 were enrolled in P4P. Average monthly PrEP enrolment among MSM increased five-fold from the first 3 months (March–June 2017) to the last 3 months of active enrolment (March–June 2018), whereas for TGW, no increased trend in PrEP enrolment per quarter was seen. Self-reported PrEP adherence was >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, whereas for TGW, it was 87.1%, 54.8% and 52.8%, respectively. Multivariable regression identified that MSM with lower-than-average income (adjusted odds ratio (aOR) 2.38 (95% confidence interval (CI): 1.59–3.54), P = 0.000), aged >30 years (aOR 2.03 (95% CI: 1.30–3.40), P = 0.007) and with an increasing number of sex partners (aOR: 1.06 (1.01–1.11), P = 0.011) had greater odds of remaining on PrEP. For TGW, being aged >30 years 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 aged ≤30 years 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 5 years.

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Background There is limited population size estimation of female sex workers (FSWs) in Ho Chi Minh City (HCMC)—the largest city in Vietnam. Only 1 population size estimation among venue-based female sex workers (VFSWs) was conducted in 2012 in HCMC. Appropriate estimates of the sizes of key populations are critical for resource allocation to prevent HIV infection. Objective The aim of this study was to estimate the population size of the VFSWs from December 2016 to January 2017 in HCMC, Vietnam. Methods A multistage capture-recapture study was conducted in HCMC. The capture procedures included selection of districts using stratified probability proportion to size, mapping to identify venues, approaching all VFSWs to screen their eligibility, and then distribution of a unique object (a small pink makeup bag) to all eligible VFSWs in all identified venues. The recapture exercise included equal probability random selection of a sample of venues from the initial mapping and then approaching FSWs in those venues to determine the number and proportion of women who received the unique object. The proportion and associated confidence bounds, calculated using sampling weights and accounting for study design, were then divided by the number of objects distributed to calculate the number of VFSWs in the selected districts. This was then multiplied by the inverse of the proportion of districts selected to calculate the number of VFSWs in HCMC as a whole. Results Out of 24 districts, 6 were selected for the study. Mapping identified 573 venues across which 2317 unique objects were distributed in the first capture. During the recapture round, 103 venues were selected and 645 VFSWs were approached and interviewed. Of those, 570 VFSWs reported receiving the unique object during the capture round. Total estimated VFSWs in the 6 selected districts were 2616 (95% CI 2445-3014), accounting for the fact that only 25% (6/24) of total districts were selected gives an overall estimate of 10,465 (95% CI 9782-12,055) VFSWs in HCMC. Conclusions The capture-recapture exercise provided an estimated number of VFSWs in HCMC. However, for planning HIV prevention and care service needs among all FSWs, studies are needed to assess the number of sex workers who are not venue-based, including those who use social media platforms to sell services.

Background: HIV/AIDS program managers in Ho Chi Minh City (HCMC), Vietnam have always relied on the police reports and the UNAIDS Estimation and Projection Package for population size estimation of People Who Inject Drugs (PWID). Methods: We used Respondent-driven Sampling (RDS) to implement a two-source capture–recapture study to estimate the population size of PWID in HCMC in 2017. The study was implemented in seven out of 24 districts and included men and women ages 18 years and older who reported injecting illicit drugs in the last 90 days, and who had lived in the city for the past six months. Estimates of the PWID population size for each of the seven districts were calculated accounting for the RDS sampling design. These were then adjusted to account for the district sampling probabilities to give an estimate for HCMC. Chapman two-source capture–recapture estimates of population size, based on simple random sampling assumptions, were also calculated for comparison. Results: The estimates resulted in a population size for HCMC of 19,155 [95% Confidence Interval (CI): 17,006–25,039] using the RDS approach and 17,947 (95% CI: 15,968–19,928), using the Chapman approach. Conclusion: The two-survey capture–recapture exercise provided estimates of PWID in HCMC – based on Chapman estimator and RDS approach – are similar. For planning HIV prevention and care service needs among PWID in HCMC, both estimates may need to be taken into consideration together with size estimates from other sources.

Objective: To share Vietnam’s experiences piloting the integration of viral load (VL) testing into the national HIV sentinel surveillance (HSS) system to better understand the level of HIV viral transmission among people who inject drugs (PWID).Introduction: Vietnam initiated the HSS system in 1994 in selected provinces with high HIV burden. The surveillance has two components: monitor HIV sero-prevalence and risk behaviors among key population including PWID. However, no VL data were collected among HIV infected people. In 2016, Vietnam piloted an added component of VL testing to the existing HSS system. The purpose was to test the feasibility of adding VL testing to the HSS so that VL data among PWID would be available. The pilot was conducted in two provinces in southern Vietnam-Ho Chi Minh City and Long An. It was expected that adding the VL testing to the existing HSS would also save resources and help monitor HIV viral transmission among PWID in the community regardless if they are currently on anti-retroviral therapy (ART).Methods: Male PWIDs were enrolled into 2016 HSS+ following the standard operating procedure (SOP)[1]. Community-based sampling was based on random selection of wards/communes listed in the sampling frame. In each selected ward/commune, all eligible PWID were invited to voluntarily participate in the survey. Eligibility criteria were males 16 years of age or older, reporting injecting drug in the past month, and residing in the selected area. . The survey included an interview using a standardized questionnaire and 7ml blood drawn for HIV testing. Blood specimens were transferred from districts to provincial labs for plasma separation in the same day. Each plasma specimen was divided into three aliquots of 1ml each. One aliquot was used to test for HIV diagnosis at provincial labs, using the national HIV testing strategy III[2]. The remaining 2 aliquots were stored at provincial labs at 2-80C and within 5 days, were shipped to Pasteur Institute in Ho Chi Minh City (PIHCM) where the plasma specimens were stored at -800C. Processing of samples for VL testing was conducted at the end of the survey where all plasma specimen were transferred to PIHCM lab, which was 2 months since the collection of the first blood specimen. VL was undertaken on COBAS AMPLYPREP/COBAS TAQMAN 48, with identification threshold 20 cps/ml and specificity of 100% using Kit CAP-G/CTM HIV-1 V 2.0. The VL testing results were sent back to relevant Provicial AIDS Centers to return to respective participants, within 3 months.Results: Five hundred male PWID (HCMC: 300; LA: 200) were enrolled into 2016 HSS/HSS+ and agreed to provide blood specimen without any refusal. 84 tested positive for HIV (16.8%. HCMC: 15.0%; LA: 19.5%), 43 (51.2%) specimens had unsuppressed VL (>1000 copies/ml) (HCMC: 66.7%; LA: 33.3%), 35 (41.7%) specimens had undetected level (<50 copies/ml or undetected) (HCMC: 31.1%; LA: 53.9%), and 7.1% had VL that ranged from 50-1000 copies/ml (HCMC: 2.2%; LA: 12.8%). Among those who had VL < 1000 copies/ml, 22 (53.7%) had ever been on ART.Conclusions: The pilot survey has measured VL among male PWID, including those who were aware of their HIV status and those who did not know their status before. Findings indicate that a significant proportion of PWID do not have their VL suppressed leading to high-risk of HIV transmission from PWID to their sexual partners[3] in the community although level of unsuppressed viral load is not a direct measure of HIV viral transmission in itself. This pilot indicated that it was feasible to add VL testing into HSS and Vietnam government can add it as a routine practice in HSS and can be expanded in the coming years.