2. In the hands of the community: Accelerating key population-led HIV lay- and self-testing in Vietnam
Dr. Kimberly Green, PATH

3. Why HIV self-testing in Vietnam?
HIV epidemic concentrated in key populations: people who inject drugs, men who have sex with men, transgender women and female sex workers
Multiple barriers to testing = low annual key population uptake of HIV testing through conventional services (~30%)
Posing a significant challenge to reaching the Vietnam Ministry of Health goal by 2020
The MoH recognizes the potential of new testing strategies to accelerate case detection
Sources: Ministry of Health, 2014 HIV testing report, Hanoi, Vietnam; Vietnam Administration for HIV/AIDS Control (VAAC), HIV testing strategy, June, 2016; HIV/AIDS Plan, VAAC, December, 2015

4. Key strategies and steps
Forged partnerships: MoH/VAAC, WHO, USAID, CBOs++
Assessed viability: Measured acceptability, preferences, willingness to pay and local HIV RDT market
Staggered implementation: Started with lay testing (Dec 2015), integrated HIV self-testing (May 2016); partner notification and PrEP to start later this year
Generating demand: Campaign embedded through Facebook, MTV, radio, F2F communication
Fostering sustainability: Equipping CBOs and health system to provide and sustain services
Evaluating approach: On-going acceptability, feasibility study
Addressing policy and regulatory barriers: Registering RDTs, enabling non-health care workers to offer testing++
Evidence needed regarding key population acceptability of HIVST, test preferences and willingness to pay to inform pilot interventions and future guidelines.

5. Acceptability of HIVST
More than half of respondents reported intention to use an HIV self test when available
Primary reasons for opting for HIVST were privacy (74.4%), confidentiality (63.7%) and receiving a rapid result (49.5%)
Majority of MSM and FSW preferred oral HIVST, while majority of PWID preferred blood-based assay
Intention to use HIVST
“I like the convenience of self-testing and that it is completely confidential. I can know my status faster.” MSM, Ho Chi Minh City
Study aim: To assess acceptability, user preferences and willingness to pay for HIV self-testing among FSW, MSM and PWID in rural and urban areas of Vietnam
Study overview: The data reported here are from a larger cross-sectional study conducted from April - June 2015 assessing overall key population use, preferences and willingness to pay for HIV goods and services. The survey was conducted in six high HIV prevalence provinces, and included a smaller qualitative study that employed focus group discussions to explore perceptions related to HIV goods and services, including HIV self-testing.
Location: The study was conducted in Ho Chi Minh City, Cantho, Nghe An, Hanoi, Hai Phong, Dien Bien
Population and sample: Populations were recruited based on the epidemic profile of each province. PWID were recruited from all six provinces, while FSW and MSM were recruited from four provinces (Ho Chi Minh City, Cantho, Hanoi). The sample size was calculated for each utilizing size estimations. In total, 1,296 PWID, 1,248 FSW and 1,528 MSM were interviewed.
Recruitment and survey instrument: Participants were recruited using respondent-driven sampling. Eligible respondents were provided with standard information on HIVST and asked hypothetical questions including intention to use, test preferences, and willingness to pay.

6. Willingness to pay for HIVST
Majority of those intending to use HIVST were willing to pay for the test
Respondents living in urban areas were statistically significantly more likely to report willingness to pay (p<0.001)
MSM were willing to pay a significantly higher maximum price (US$5.4) for HIVST than FSW (US$4.3) and PWID (US$3.9) (p<0.001)
Willingness to pay for HIVST
Results: More than half of respondents reported intention to use an HIVST when available (55.6% FSW, 63.8% MSM, 69.3% PWID). Primary reasons for opting for HIVST were privacy (74.4%), confidentiality (63.7%) and rapid result (49.5%). The majority of those intending to use HIVST were WTP for the test (73.4% PWID, 82.0% FSW and 86.4% MSM). Respondents living in urban areas were statistically significantly more likely to report WTP (p<0.001). MSM were willing to pay a significantly higher maximum price (US$5.4) for HIVST than FSW (US$4.3) and PWID (US$3.9) (p<0.001). There were statistically significant differences in the HIVST type preferred by KP (blood-based versus oral fluid) (p<0.001): 49.0%/FSW, 46.7%/MSM and 28.3%/PWID stated preference for an oral HIVST; while 59.0%/PWID, 42.9%/FSW, and MSM/ 36.7% opted for the rapid blood-based assay.

7. HIV lay & self-testing pilot
Rural model
Site: Dien Bien and Nghe An
Population: PWID and sex partners, and FSW
Offered through: Village health care workers and peers with support from commune health stations
Urban model
Site: Ho Chi Minh City and Hanoi
Population: MSM, TGW, PWID and FSW
Offered through: CBOs with support from LNGOs and the provincial AIDS centres
“The program is responding to the real needs of a community that has been waiting for this a long time.” Nguyễn Công Hậu, G3VN lay tester

8. HIVST pilot in Vietnam

9. HIVST pilot in Vietnam
Offer assisted HIVST through CBOs, with choice of test (blood-based and oral fluid assays), and choice to CBO or at home
Started in May 2016
Five MSM and TGW CBOs in HCMC offering HIVST using Alere Determine HIV 1/2; OraQuick available early August
May - July, 377 individuals opted for self-testing; 6.9% were confirmed HIV positive and 100% enrolled in ART
HIVST users received F2F tutorial and pictorial instructions; majority opted to test with CBO staff present
Fee-based model established next year to foster sustainability

10. Demand generation
Advertising through Xóm Cầu Vồng Facebook page (120,000+ members), MTV and F2F

11. Cumulative tested and % reactive
Preliminary results
Cumulative tested and % reactive
Cumulative HIV confirmed and % enrolled in ART
Nationally, 1% test positive through conventional testing (VAAC, 2016)
96.9%
6.1%
MoH/VAAC average yield is 1%; overall 6% (3 % rural and over 8% urban)

12. Preliminary results HCMC = 45 Dien Bien = 120 Nghe An = 33 Total = 198
Source: PATH/USAID Healthy Markets. Lay and self-testing pilot evaluation: Preliminary results, June

13. From pilot to scale Lots of interest! Major public launch in August
National guidelines and SOPs
New RDT options and link to PrEP

14. Acknowledgements
Vietnam MoH/VAAC: Dr. Phan Thi Thu Huong, Dr. Vo Hai Son
USAID Vietnam: Ngo Minh Trang, Nguyen Thi Minh Huong, Dr. John Eyres, Mei Mei Peng, Mark Breda
PATH: Drs. Vu Ngoc Bao, Dr. Ngo Huu, Doan Hong Anh, Roger Peck, Tran Thi Tham, Thanh Tung (Hai Dang), Melissa Ludeke
WHO: Dr. Masaya Kato, Dr. Nguyen Thi Thuy Van
NGOs: Life Centre, COHED, CCRD
CBOs: G3VN, G-Link, MfM, Aloboy, Color of Life, The Boy, Song That, Hai Dang, V-Smile
Provincial AIDS Centres: HCMC, Hanoi, Dien Bien and Nghe An
CCIHP: Dr Trang Hung Minh, Dr Vu Song Ha, Quach Thu Trang

15. Thank you!