Viet Nam announces rollout of PrEP

Associate Professor Phan Thi Thu Huong, Deputy Director General of the Viet Nam Authority of HIV/AIDS Control

Associate Professor Phan Thi Thu Huong, Deputy Director General of the Viet Nam Authority of HIV/AIDS Control talks about the PrEP roll-out in Viet Nam.

February 2019 – On the eve of World AIDS Day 2018, Viet Nam’s Ministry of Health announced a national plan to scale up pre-exposure prophylaxis (PrEP) for the prevention of HIV. Under this plan for 2018–2020, PrEP will be made available to at least 7300 people in at least 11 provinces by 2020. With this announcement, Viet Nam becomes the 4th country in the Asia-Pacific region – after Thailand, Australia and New Zealand – and the second country in Asia to provide PrEP as part of a wider national approach. The national plan was supported by evidence from in-country trials implemented by the United States Agency for International Development (USAID)/Path Healthy Markets and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Dr Heather-Marie Schmidt, WHO/UNAIDS Regional PrEP Advisor for Asia and the Pacific, spoke to Associate Professor Phan Thi Thu Huong, Deputy Director General of the Viet Nam Authority of HIV/AIDS Control, about PrEP in Viet Nam.

Congratulations on the announcement that PrEP will be rolled out across 11 provinces in Viet Nam. What does this mean for people at substantial risk of HIV in Viet Nam?

Firstly, the implementation of PrEP services in Viet Nam, in accordance with WHO guidelines, aligns completely with the current context and HIV epidemic in Viet Nam. In recent years, the transmission of HIV in Viet Nam has changed significantly. Specifically, transmission through sexual behaviours is increasing, especially among men who have sex with men.

Viet Nam, in collaboration with WHO, UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), is going to roll out PrEP services from 2 piloted provinces to 11 provinces across the country with financial support from international donors.

To achieve the target of 7300 people using PrEP by 2020, Viet Nam is working to provide PrEP services using local budgets in other provinces that do not have international funding.

What do you think are the key factors allowing Viet Nam to roll out PrEP nationally?

Firstly: WHO recommendations; international scientific evidence; and the pilot results in Viet Nam showing no new HIV infections among 2000 clients who used PrEP in Ho Chi Minh city over the past 2 years.

Secondly: antiretroviral drugs that are used for PrEP are already licensed in Viet Nam. This will ensure a sustainable drug supply that is capable of meeting client demand, without having to depend on international donors. This is important since importation issues, when relying on international donors, can lead to intermittent drug supply. This can, in turn, limit clients’ access to drugs, and cause them to discontinue PrEP use.

Thirdly: there is high demand for PrEP among key populations, as well as a demonstrated willingness to pay. Many individuals from target populations in provinces that have not yet been provided with PrEP services have already sent queries about PrEP and expressed their wish to enrol in the programme. Some have even travelled to provinces providing PrEP services just to enrol.

We have been advocating for national guidelines and standard operating procedures on PrEP. These guidelines are applicable to all kinds of health facilities, whether they are public, private, or led by community-based organizations. PrEP services provided at community level are always friendly and easy to access.

In your opinion, what challenges is Viet Nam facing with PrEP implementation?

Although antiretroviral drugs for PrEP are already licensed in Viet Nam, there are currently only 2 types available, which limits price negotiations. The cost of these drugs is much higher than many people within high-risk populations can afford to pay.

Furthermore, PrEP coverage is still limited. Implementation of the newly issued guidelines and standard operating procedures is not yet consistent. The linkages from training to health providers and the community are yet to be consistently implemented or meet the needs of key populations. There are also gaps in information and communication on PrEP, meaning certain groups are not yet aware of PrEP services.

Moreover, some clients’ knowledge on PrEP and prevention is not yet adequate. For example, they stop using condoms, which may lead to increased risks of sexually transmitted infections (STIs) and hepatitis.

If you could give one piece of advice to other countries considering implementing PrEP, what would it be?

For countries with generalized or concentrated epidemics, PrEP services should be rolled out as soon as possible, without waiting for the full legal or technical foundation. Policy and technical documents can be developed, adapted and revised simultaneously.

Given the demonstrated effectiveness of PrEP programmes, countries should study the programme’s cost–effectiveness, so they can work towards including the PrEP budget in the national budget or health insurance in order to stop AIDS by 2030.

In addition, pharmaceutical companies should be encouraged to register for and import more antiretroviral drugs for PrEP use to bring down the cost for those who need PrEP most.

Thanks, that’s good advice! Is there anything else you’d like to mention?

I would like to thank WHO for their constant support of Viet Nam’s HIV/AIDS programme, and for giving us the opportunity to apply new recommendations and guidelines in HIV prevention and control activities.

I would also like to highlight my recommendation that UNAIDS and WHO, with their leading voices, advocate for major donors such as The Global Fund and PEPFAR to prioritize their multilateral and bilateral donor funding to the PrEP programmes.