Retention of clients on daily oral HIV pre-exposure prophylaxis in Vietnam


BACKGROUND: Vietnam launched HIV pre-exposure prophylaxis (PrEP) in 2017 to prevent HIV acquisition among high-risk populations. Daily and event-driven PrEP are only effective when used in alignment with clinical guidelines. As most clients in Vietnam are on daily PrEP, they need to adhere to a daily pill. However, analysis of PrEP retention data is limited. We aimed to evaluate PrEP retention among daily PrEP clients in Ho Chi Minh City, Tay Ninh, and Tien Giang provinces.
METHODS: Retention among all new and existing PrEP clients was assessed between October 2020 and September 2021. Kaplan-Meier was used to analyze time from PrEP enrollment to discontinuation stratified by sex, province, age group, and key or priority population. Multivariable Cox regression was used to estimate a hazard ratio (HR) and associations between PrEP retention and other covariates.
RESULTS: Between October 2020 and September 2021, there were 791 clients in the Meeting Targets and Maintaining Epidemic Control (EpiC) PrEP program in three provinces: Tien Giang (326, 41.2%), Tay Ninh (282, 35.7%), and Ho Chi Minh City (183, 23.1%). Most clients were male (665, 84.1%). Men who have sex with men were the largest group of clients (539, 68.1%), followed by negative partners in serodiscordant couples (228, 28.8%). The most common reasons for discontinuation were loss to follow-up (259, 51.9%) and transfers (123, 24.7%).
Median retention was 120 days. Retention rates at three, six, and 12 months were 67.0%, 30.3%, and 8.3%, respectively. Female clients were retained longer than male clients (HR=0.6, p<0.005), regardless of population group. In the multivariable model, younger age was associated with PrEP discontinuation, and male clients from Tay Ninh province tended to have higher PrEP discontinuation rates than those from Tien Giang (HR=0.5, p<0.001) and Ho Chi Minh City (HR = 0.4, p<0.001).
CONCLUSIONS: More effort is needed to understand the underlying reasons for discontinuation, especially among males from different provinces and age groups. Targeted interventions designed for men and younger individuals, and tailored to provincial contexts, are needed to address barriers to PrEP retention.

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