How Vietnam is democratizing access to HIV care

December 14, 2022 by Zoe Humeau (Collaboration, Learning, and Action Coordinator), Nga Ngo (Health Services Team Lead, Vietnam), and Elizabeth Black (Editorial Copywriter)

Learn about the country’s first large-scale telehealth PrEP program and its innovative approaches to service delivery.

A provider at Glink, a key population–led primary care clinic headquartered in Ho Chi Minh City, provides pre-exposure prophylaxis counseling via video chat. Photo: Glink/Nguyen Thanh Hung.

A provider at Glink, a key population–led primary care clinic headquartered in Ho Chi Minh City, provides pre-exposure prophylaxis counseling via video chat. Photo: Glink/Nguyen Thanh Hung.

In Vietnam, the COVID-19 Delta surge overwhelmed health care systems and severely restricted travel outside of the home. This prevented key populations at high risk for HIV—including men who have sex with men and transgender women—from accessing lifesaving HIV care, such as pre-exposure prophylaxis (PrEP).

To ensure individuals could continue to receive care, the United States Agency for International Development (USAID)/PATH Healthy Markets project team worked closely with Vietnam’s Ministry of Health (MOH) to develop emergency guidance for the home delivery of PrEP drugs and remote HIV telehealth services.

Emergency COVID-19 measures lead to long-term change

In Hanoi, Ho Chi Minh City (HCMC), and Dong Nai Provinces, PATH helped providers in 31 clinics rapidly establish remote PrEP systems, bolster necessary supplies, and identify clients who wanted to continue PrEP during the lockdown. Clinic staff then arranged video, phone, and messaging communications with participating clients to provide support, answer questions, and organize home-delivery of PrEP drug refills and HIV self-test kits for client-led HIV monitoring.

During the worst of the 2021 Delta surge (August to September 2021), these adaptations enabled 64 percent of clients across the three provinces to receive remote PrEP drugs and services, preventing interruptions in care while maintaining safety, increasing convenience and confidentiality, and reducing costs. In fact, over 90 percent of clients receiving the service stated they’d like to continue receiving telemedicine PrEP services.

Now, through the newly launched USAID Support for Technical Excellence and Private Sector Sustainability in Vietnam (STEPS) project—funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)—PATH, the MOH Vietnam Administration for HIV/AIDS Control (VAAC), and partners are building off of that success with Vietnam’s first large-scale PrEP telemedicine pilot program, TelePrEP. The program will help inform permanent national telemedicine scale-up and advance Vietnam’s HIV epidemic control targets.

A groundbreaking service delivery model

PATH, through STEPS, played a central role in developing the TelePrEP pilot program—which specifies technical requirements for provider and clinic training, service delivery, standard operating procedures, options for lab testing and drug dispensing, and client considerations—and securing approval from the MOH.

Simultaneously, STEPS worked with an information technology (IT) company to develop a user-friendly mobile and web app that both clients and providers can use to book services, hold secure video calls, manage drug dispensing, and to seek or provide support. The platform also links to the national PrEP reporting system to capture and compare data on PrEP and TelePrEP visits, contributing to important national-level reporting on PrEP.

Following this development period, STEPS and VAAC officially launched the TelePrEP pilot model in June 2022 at four key population–led private clinics in Dong Nai and HCMC (Alo Care Dong Nai, Glink Dong Nai, Glink HCMC, and Galant HCMC) and one public PrEP clinic at the Dong Nai Center for Disease Control. The pilot is also being implemented at an additional 15 sites supported by other PrEP program partners, including the US Centers for Disease Control and FHI 360 (through the USAID Meeting Targets and Maintaining Epidemic Control [EpiC] project).

The pilot has already showed positive preliminary results at the five clinic pilot sites supported by STEPS. Out of 171 clients who have accepted TelePrEP services, 140 (82 percent) have transitioned to TelePrEP as of September 2022. In preliminary feedback about TelePrEP, clients cited increased convenience, reduced travel times, alignment with popular digital trends, and improved adherence to PrEP as key benefits of the model.

“I used to use PrEP; however … I could not attend the clinic for my regular re-examination… TelePrEP is a very convenient service for busy people like me.”
— Do Tay Ha, a transgender woman who uses TelePrEP services

“I used to use PrEP; however, due to my busy work schedule and distance from a clinic, I could not attend the clinic for my regular re-examination, so I stopped using it. Recently, I saw Glink clinic’s post on social media about TelePrEP. I sent the clinic a message and received a consultation. Now, I am receiving my PrEP services remotely. TelePrEP is a very convenient service for busy people like me,” said Do Tay Ha, a transgender woman who is one of the early adopters of TelePrEP services.

To rapidly spread the word and encourage uptake of TelePrEP services among potential users, STEPS partnered with key population influencers and clinics in launching a cross-platform TelePrEP campaign and distributing engaging informational and educational materials about TelePrEP.

Promotion for the TelePrEP campaign reads, “Receive a re-examination at home, get PrEP remotely!”

Promotion for the TelePrEP campaign reads, “Receive a re-examination at home, get PrEP remotely!”

Decreasing barriers, increasing access

The development, implementation, and initial results of this pilot mark a milestone in Vietnam’s efforts to increase the accessibility of PrEP, which historically has been difficult to access for people who live far from clinics, who lack availability to attend regular in-person appointments, or who have concerns around confidentiality or privacy when seeking HIV care at clinics.

The TelePrEP model, through home-based testing, remote PrEP counseling and clinical reviews, e-prescription, and the home delivery of PrEP prescriptions and HIV self-test kits, reduces these barriers, effectively democratizing access to HIV care and thus improving uptake and use among key populations. This is a critical step in preventing new HIV transmissions and reducing HIV incidence, in support of Vietnam’s goal of ending AIDS by 2030.

Dr. Thach Thi Ca, a provider at an HIV outpatient clinic involved in the TelePrEP pilot, noted that TelePrEP has enhanced clients’ experiences in using PrEP and supports better PrEP continuation and enrollment: “After the social distancing period, many of our clients wanted to continue receiving remote PrEP services. TelePrEP is now making PrEP more convenient for current PrEP clients and motivates new key populations to enroll in PrEP.”

“TelePrEP is now making PrEP more convenient for current PrEP clients and motivates new key populations to enroll in PrEP.”
— Dr. Thach Thi Ca, a health provider engaged in the TelePrEP pilot

Improving the user experience for further scale-up

PATH is working closely with VAAC, USAID, EpiC, and other implementation partners to improve the user experience and ensure that both providers and clients can use the platform easily and effectively, while maintaining quality of care, confidentiality, and flexibility.

Ongoing studies on the pilot’s efficacy and feasibility will continue to inform the scale-up of this model in other provinces around Vietnam, with the goal of boosting access to and uptake of lifesaving PrEP and HIV self-test kits.