HIV SELF-TESTING IN VIETNAM: FROM PILOT TO SCALE UP

Abstract

While the World Health Organization strongly recommends HIV self-testing (HIVST) as an approach to HIV testing services, scale up has been minimal in low- and middle-income countries. Vietnam has successfully delivered HIVST at scale for key populations (KP), including men who have sex with men, transgender women, people who inject drugs, female sex workers and their partners. We reviewed data from the USAID/PATH Healthy Markets (2014-2021), including consumer surveys, HIVST usability and performance assessments, and service data to summarize the five stages of HIVST scale-up in Vietnam: 1) Assessing HIVST acceptability, preferences, and willingness to pay (WTP); 2) Piloting HIVST; 3) Developing HIVST policies and assessing products; 4) Facilitating HIVST market authorization; and 5) Implementing differentiated service models. A ‘5A’ approach was employed to shape HIVST markets, i.e., improving affordability, enhancing availability, assuring quality, ensuring appropriate design, and boosting awareness and demand. We assessed key factors related to HIVST supply and demand. In terms of supply, the median price people were willing to pay was US$4.3 per test. HIVST products with stringent regulatory approval successfully obtained free sale certificate registration, and blood-based HIVST products were highly accurate (99%-99.8%). Differentiated HIVST distribution models played a significant role in scaling-up HIVST and ensuring uninterrupted access to essential HIV services, e.g., pre-exposure prophylaxis monitoring during COVID-19 lock-downs. Related to demand and testing uptake, the majority of KPs accessing HIVST were first time HIV testers. Creative online-to-offline behavior change communication increased client awareness, trust, and use of HIVST. HIVST was successful in reaching first-time testers who may not otherwise test or seek facility-based care. HIVST is an effective strategy for reaching undiagnosed individuals and is accepted and preferred by KPs. HIVST scale-up requires enabling policy, intensive demand generation efforts, and differentiated service models.