Tele-PrEP during the Delta COVID-19 outbreak in Vietnam: Use of remote client engagement and home-delivery of pre-exposure prophylaxis and HIV self-test kits to maintain client access during lockdown

Title

Tele-PrEP during the Delta COVID-19 outbreak in Vietnam: Use of remote client engagement and home-delivery of pre-exposure prophylaxis and HIV self-test kits to maintain client access during lockdown

Presenter

Kimberly Green

Authors

K. Green * (1), H.A. Doan (1), P.T. Thu Huong (2), T. Le Minh (3), P. Nguyen Anh (4), T. Nguyen Minh (5), K. Quang Do (6), T. Ngo Minh (7), B. Vu Ngoc (1), T. Tran Thi (1), L. Khanh Tran (1), V. Nguyen Minh (8)

Institutions

(1) PATH, Hanoi, Viet Nam, (2) VAAC, Hanoi, Viet Nam, (3) Glink, Ho Chi Minh City, Viet Nam, (4) My Home Clinic, Ho Chi Minh City, Viet Nam, (5) AloCare, Ho Chi Minh City, Viet Nam, (6) Galant, Ho Chi Minh City, Viet Nam, (7) USAID Vietnam, Hanoi, Viet Nam, (8) PATH, Ho Chi Minh City, Viet Nam

BACKGROUND: The COVID-19 Delta variant surged in Vietnam from July through October 2021 overwhelming healthcare services leading to rapid closure of in-person healthcare and restricted ability to travel, directly impeding PrEP access among 12,300 individuals on pre-exposure prophylaxis (PrEP) in Hanoi, Ho Chi Minh City and Dong Nai province.
DESCRIPTION: In response, the USAID/PATH Healthy Markets project worked closely with the Ministry of Health (MOH) to define emergency guidance for remote PrEP counseling and home-delivery of three-month PrEP prescriptions and HIV self-test kits (INSTI) for client-led HIV monitoring. Providers from 31 clinics (12 key population(KP)-led, 1 private and 18 public) were rapidly supported to put in place systems for remote PrEP and were equipped with adequate HIVST kits to enable sustained remote PrEP services. Remote PrEP was available to those continuing on PrEP from end of July to end of October, 2021 when lockdowns were lifted.
LESSONS LEARNED: Through this rapid, pragmatic adaptation of PrEP service delivery, we found that during the worst part of the lockdown (August-September), that 84% (n=3086), 49% (n=795) and 28% (n=388) of clients in Ho Chi Minh City (HCMC), Dong Nai and Hanoi respectively switched to remote PrEP, and that the degree of switching aligned with the relative severity of lockdown in these localities (with HCMC being the worst and Hanoi the least). PrEP prescriptions and HIVST kits were primarily delivered by KP peers or clinic staff (84% in HCMC, 93% in Dong Nai and 100% in Hanoi) but delivery via post, family/friends and Grab were also used in HCMC and Dong Nai. Overall, clients and clinicians reported ease in applying the tele-PrEP model ' a rapid quality assurance survey (n=68) found that 96% were willing to use tele-medicine because it felt more convenient (65.1%) and safer (46.5%) than face-to-face care.
CONCLUSIONS: Tele-PrEP including HIVST enabled PrEP services to continue during a severe COVID-19 lockdown. Both clients and clinicians reported acceptability of the model. Offering tele-PrEP and HIVST for remote client-led HIV status monitoring as a part of routine service delivery may make PrEP accessible to a greater number of potential PrEP users in Vietnam, further increasing uptake and use.

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