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Title
Healthcare worker perspectives on anticipated barriers and facilitators to implementing long-acting injectable PrEP for HIV prevention in Vietnam
Presenter
Tra My Dang
Authors
T.M. Dang1,2, N.Y. Le3, S. Naz-McLean2,4, T.T.N. Vo1,2, T.P. Do3, T.P. Tran1,2, T.T.L. Doan5, T.N. Do5, T.M. Nguyen5, R. Bhatia6, L. Cosimi1,2,4, T.T.H. Phan5, T. Pollack1,2
Institutions
1Beth Israel Deaconess Medical Center, Boston, United States, 2The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam, 3Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Hanoi, Vietnam, 4Brigham and Women’s Hospital, Boston, United States, 5Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam, 6Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, United States

BACKGROUND: Long-acting injectable cabotegravir (CAB-LA) is recommended by the World Health Organization as an additional HIV prevention option for people at substantial risk of HIV transmission. However, there are limited data on the feasibility of implementing CAB-LA in low-middle-income settings, particularly in Asia. The study describes anticipated barriers and facilitators of implementing CAB-LA in Vietnam among healthcare workers and public health managers.
METHODS: From July-August 2022, in-depth interviews following a semi-structured questionnaire were conducted with key stakeholders in HIV program implementation at the national, provincial, and clinic levels across four provinces of Vietnam. Interviews were audio recorded and data were analyzed using a rapid thematic analysis approach.
RESULTS: Participants included healthcare providers (n=15) and provincial (n=6) and national-level (n=6) public health managers, with an average of 11.4 years working in HIV programming. Participants identified key facilitators to successful implementation of CAB-LA, including the perception that CAB-LA would be highly acceptable to clients and that nurses were already trained to administer injections. While some participants felt existing facilities were adequate, most agreed that clinical sites lack the necessary infrastructure and equipment for CAB-LA, including physical space and beds for injection procedures and anaphylaxis response kits. Participants expressed concern that more frequent appointments due to CAB-LA injection schedules would increase workload and necessitate additional nursing staff. At the provincial and national health systems level, perceived barriers included the need for separate reporting systems for injectable medication management and the lengthy regulatory procedures to obtain approval for new medications. Overall, participants agreed that the lack of clear guidelines on handling adverse reactions and client eligibility was also a barrier. Despite potential barriers, participants felt that CAB-LA could help Vietnam reach 95-95-95 targets.
CONCLUSIONS: Participants were optimistic about the benefit of CAB-LA on HIV prevention, though they acknowledged infrastructure, human resources, and systems barriers to implementation. Demonstration projects may be an important next step in order to develop real-world strategies that can be scaled to overcome these barriers and enable successful CAB-LA implementation in Vietnam.

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