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Integrating viral hepatitis and PrEP services through KP-led clinics in Vietnam: an opportunity to achieve dual elimination of HIV and viral hepatitis by 2030

Title
Integrating viral hepatitis and PrEP services through KP-led clinics in Vietnam: an opportunity to achieve dual elimination of HIV and viral hepatitis by 2030
Presenter
Bao Vu Ngoc
Authors
B. Vu Ngoc * (1), L. Tran Khanh (1), N. Ngo Thi Thuy (1), K. Green (2), C. Pham Van (1), T. Le Minh (3), T. Tran Le Viet (3), K. Do Quang (4), P. Nguyen Anh (5), T. Nguyen Van (6), T. Ngo Minh (7), L. Basu (7), H. Phan Thi Thu (8), A. Doan Hong (1), T. Tran Thi (1), H. Van (9), B. Luong Quoc (9), L. La Thi (10), A. Tran Khanh (1), V. Nguyen Minh (11), B. Nguyen Van (1), P. Tran Van Anh (11)
Institutions
(1) PATH, SE Asia, Hanoi, Vietnam, (2) PATH, Primary Health Care, Hanoi, Vietnam, (3) Glink Clinic, Ho Chi Minh City, Vietnam, (4) Galant Clinic, Ho Chi Minh City, Vietnam, (5) My Home Clinic, Ho Chi Minh City, Vietnam, (6) Bien Viet Clinic, Hanoi, Vietnam, (7) USAID, Vietnam, Hanoi, Vietnam, (8) Ministry of Health, Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam, (9) Ho Chi Minh City Center for Disease Control, Ho Chi Minh City, Vietnam, (10) Hanoi Center for Disease Control, Hanoi, Vietnam, (11) PATH, SE Asia, Ho Chi Minh City, Vietnam

BACKGROUND: In Vietnam, 21% of people living with hepatitis B (HBV) and 8% of people living with hepatitis C (HCV) are diagnosed, and only 5% of eligible people are treated. At the same time, the government of Vietnam (GVN) committed to enrolling 72,000 people in pre-exposure prophylaxis (PrEP) by 2025 to prevent HIV. USAID/PATH Healthy Markets partnered with GVN and key population (KP)-led clinics to pilot one-stop shop (OSS) integrative care model.
DESCRIPTION: Five KP-led clinics in Hanoi and Ho Chi Minh City implemented the OSS model, providing a suite of health services for KPs at high risk of HIV and viral hepatitis, including men who have sex with men (MSM), transgender people (TG), female sex workers (FSW), people who inject drugs (PWID), and sero-discordant couples (SDC). The service package includes HIV testing, PrEP, HBV/HCV testing, sexually transmitted infections , non-occupational post-exposure prophylaxis, antiretroviral therapy, mental health, and gender affirming care. Clients seeking for PrEP or non-PrEPwere offered HBV and HCV testing, and non-PrEP clients were counseled and enrolled on PrEP.
LESSONS LEARNED: From October 2020 to March 2021, 5,202 KP clients received care at OSSs. Among 1,395 PrEP users, HBV infection was higher in TG (18.4%) than MSM (3.9%) and SDC (1.6%), and HCV infection was higher in TG (18.4%) than MSM (1%) and SDC (1.6%). HBV and HCV infection were exceptionally high (20.7% and 15.8%, respectively) among non-PrEP users, including PWID (90.5% and 89.7%), SDC (45.5% and 35.7%), FSW (30% and 22.2%), TG (18.2% and 18.2%), and MSM (5.4% and 2.8). Among non-PrEP clients tested for HBV (1975) and HCV (1945) 64% and 65%, respectively transferred to PrEP uptake. Out of 109 anti-HCV positive cases, 5.5% received a confirmatory test and none initiated treatment. Out of 178 HBsAg positive cases, 24.1% received confirmatory testing, and 83.7% received PrEP or HBV treatment.
CONCLUSIONS: OSS integrative care is an effective approach to increase uptake of PrEP and viral hepatitis services, but more work needs to be done to improve linkage to confirmatory testing and treatment for HBV and HCV. Integrating viral hepatitis and PrEP provides a tremendous opportunity to accelerate HIV and viral hepatitis elimination.