Journal Article

Lay provider HIV testing: A promising strategy to reach the undiagnosed key populations in Vietnam

Hung Tran, Minh, Thi Thu Phan, Huong, Bao, An, Hong Doan, Anh, Vu, Bao Ngoc, Hong Dang, Linh, Thi Tra Ha, Giang, Green, Kimberly Elizabeth, Minh Ngo, Trang, Van Ngo, Huu, Hai Vo, Son

2018

Overview

In Vietnam, reaching the remaining one-third of undiagnosed people living with HIV and facilitating their antiretroviral therapy (ART) enrollment requires breakthrough approaches. We piloted lay provider HIV testing as an innovative approach to reach at-risk populations that never or infrequently HIV test at facility-based services. We conducted a cross-sectional survey and analysis of routine program data in two urban provinces (Hanoi and Ho Chi Minh City) and two rural mountainous provinces (Nghe An and Dien Bien) from October 2015 through September 2017. Acceptability of lay provider testing was defined as the proportion of first-time HIV testers utilizing the service, and effectiveness was measured by HIV positivity and ART initiation rates. Univariate and multivariate analyses were used to determine lay provider testing preference and factors associated with that preference. Among 1,230 individuals recruited for face-to-face interviews, 74% belonged to key populations: people who inject drugs accounted for 31.4%; men who have sex with men, 60.4%; and female sex workers, 8.2%. Most clients (67%) reported being first-time HIV testers, and the majority (85.8%) preferred lay provider testing to facility-based testing. Multivariate analysis found that clients in urban areas (adjusted odds ratio [aOR] = 2.50; 95% confidence interval [CI]: 1.30-4.90) and those who had a university or higher education (aOR = 1.83; 95% CI: 1.05-3.20) were more likely to prefer lay provider testing. Lay provider testing yielded a higher HIV positivity rate (4.1%), particularly among first-time testers (6.8%), compared to facility-based testing (nationally estimated at 1.6% in 2016) and had a high ART initiation rate (91%). Our findings suggest that lay provider HIV testing is an effective approach to reach previously unreached at-risk populations, and, therefore, a critical addition to accelerating Vietnam's attainment of the Joint United Nations Programme on HIV/AIDS 90-90-90 goals.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adolescent / Adult / AIDS / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / At risk populations / Biology and Life Sciences / Clients / Colleges & universities / Confidence intervals / Counseling / Drug therapy / Education / Emergency medical care / Female / Gays & lesbians / Health Personnel / Health risks / Health services / HIV / HIV Seropositivity - epidemiology / HIV-1 / Human immunodeficiency virus / Humans / Laboratories / Male / Mass Screening / Medical diagnosis / Medical tests / Medicine and Health Sciences / Mens health / Multivariate analysis / People and Places / Performance evaluation / Population / Populations / Prostitution / Rural Population / Sex / Sexually transmitted diseases / Social Sciences / STD / Systematic review / Urban areas / Urban Population / Vietnam - epidemiology / Workers