Share
Title
Mental health and pre-exposure prophylaxis (PrEP) service integration in Vietnam: an important opportunity to boost PrEP adherence, continuation and service quality
Presenter
Kimberly Green
Authors
K. Green1, N. Ngo1, H.T.T. Phan2, T.M. Le3, K.Q. Do4, P.A. Nguyen5, B.H. Nguyen6, L. Doan2, L. Basu7, B.N. Vu1, A.H. Doan7, D. Nguyen7, T.T. Tran1, L.K. Tran1, V.M. Nguyen1, Z. Humeau1
Institutions
1PATH, Hanoi, Vietnam, 2Vietnam Administration for HIV/AIDS Control, Vietnam Ministry of Health, Hanoi, Vietnam, 3Glink Social Enterprise, Ho Chi Minh City, Vietnam, 4Galant Social Enterprise, Ho Chi Minh City, Vietnam, 5My Home Clinic, Ho Chi Minh City, Vietnam, 6Bien Viet Clinic, Hanoi, Vietnam, 7USAID/Vietnam, Hanoi, Vietnam

BACKGROUND: Mental health (MH) issues may limit key populations’ (KP) uptake of and continuation on pre-exposure prophylaxis (PrEP) and reduce overall quality of life. The USAID/PATH STEPS Project integrated MH screening, assessment, and treatment at five KP-led one-stop shop clinics as part of an effort to advance comprehensive and person-centered PrEP services.
DESCRIPTION: PrEP users at five OSS clinics are screened for MH using an online form or provider-led tools including the DASS21, AUDIT-C and Functioning Suicide Risk screening, and ASSIST. Clients are triaged based on their screening results and offered counseling for any MH conditions identified. Clients with mild- and moderate-level MH conditions are counselled in-clinic and receive psychoeducation support. Clients with severe-level MH conditions are counselled and referred to expert psychiatric care, while continuing to receive counseling, PrEP, and other services at the clinics. During follow-up visits, PrEP clients are re-screened and supported with ongoing management of their MH conditions. PrEP behavior change campaigns incorporate information on MH to enhance awareness and service uptake among new and current PrEP users.
LESSONS LEARNED: From January—December 2022, 6,298 PrEP clients received MH screening, of whom 10.6% presented with a MH condition (7.3%, 7.0%, and 4.6% presenting clinical symptoms of stress, anxiety, and depression, respectively). MH morbidity was higher among partners of people living with HIV (18.9%) and transgender people (16.7%) compared to female sex workers (10.8%) and men who have sex with men (9.7%). PrEP clients with MH conditions were 50% more likely to drop out of PrEP after three months compared to those without MH conditions (OR = 1.5, p< 0.001, 95%CI 1.2-1.8). Of 667 PrEP clients with MH conditions, 235 (48.7%) received follow-up care at least once; of these, 78.7% exhibited a significant reduction in the severity of their MH symptoms when re-screened during follow-up.
CONCLUSIONS: We found significant association between MH morbidity and reduced PrEP continuation, indicating that integrative MH and HIV services may play an essential role in improving PrEP outcomes. Further scale-up of MH services within public and private PrEP sites will be undertaken to support greater quality of PrEP services and AIDS elimination by 2030.

Download the e-Poster (PDF)