Growing a client-centered HIV market in Vietnam

In 2014, gaps in HIV service delivery and financing thwarted access to key HIV prevention, testing, and treatment services. These gaps included a reduction in donor funding for HIV-related programs, limited domestic investment in affordable HIV goods and services, a lack of enabling policies to support community-based care, ongoing stigma and discrimination, and limited community engagement in the national HIV program.

As a result, the needs of key populations (KP) at the highest risk of contracting and spreading HIV—people who inject drugs, men who have sex with men, transgender women, and female sex workers—were not being adequately met. Sustained HIV community transmission occurred in underserved areas and among underserved populations due to ongoing barriers in accessing care.

PATH worked alongside the Vietnam Administration for HIV/AIDS Control (VAAC) within the Ministry of Health (MOH) to bolster investment, demand, and supply of HIV-related goods and services in Vietnam and to help achieve the country’s 90–90–90 targets by 2020 and 95–95–95 targets by 2030.

Recognizing the absence of accessible, affordable community-based HIV care, PATH and its partners developed groundbreaking interventions to generate demand for HIV care, increase access to HIV products and services, engage KP communities to co-create and strengthen local markets to meet needs, and promote positive, healthy behaviors for KPs at risk of contracting or spreading HIV.

Funded by US President’s Emergency Plan for AIDS Relief (PEPFAR) through US Agency for International Development (USAID) from April 2014 to December 2021, the Healthy Markets (HM) project was revolutionary in part because it increased access to high-quality HIV care led by and for the KPs it aims to serve. By introducing a total market approach that engaged the private sector and contributed to key policy and legal wins to support this caliber of care, PATH and its partners helped Vietnam advance a more sustainable HIV response, reduce new HIV infections, and pioneer innovative HIV prevention models.

PATH is a trusted partner in Vietnam with globally recognized technical expertise in HIV and in market entry and expansion of health goods and services. Among international nongovernmental organizations, we have one of the longest-standing relationships with the Vietnam Ministry of Health, and we’ve cultivated strong, transparent partnerships with in-country private sector actors and civil society organizations. After decades of working directly with communities, governments, and the private sector in Vietnam, we have a nuanced understanding of the country context and the needs of KPs. Our track record of developing strategic solutions that operate within and strengthen existing established networks has allowed us to implement complex, integrated HIV, total market approach, and private-sector engagement (PSE) projects that advance progress on HIV prevention and treatment.

The HM project adopted human-centered design to facilitate and improve the market for accessible and equitable HIV goods and services.

This shared-value, total market approach was centered around three objectives:

INVESTMENT

PATH worked to increase private-sector and local investment in condoms and other HIV-prevention goods and services by advocating for and enforcing policies and incentives that enable greater PSE, supporting the establishment and growth of KP-led HIV care providers, and driving market innovations and disruptions to sustain equitable care.

Success story: In November 2018, evidence-based advocacy conducted by HM and consumer research into testing preferences and willingness to pay led to the revision of two decrees enabling community-based testing providers to offer and charge for testing services. The following year, HM advocated for the reclassification of HIV self-test (HIVST) kits as “normal goods” (much like condoms). At the same time, the project provided technical assistance to bioLytical Laboratories (a Canadian-based manufacturer) to apply for approval of its INSTI® HIV Self Test and partner with local distributers and retailers. By the end of the project, two HIVST products—both bioLytical’s INSTI HIV Self Test and Atomo Diagnostics’ Mylan HIV Self Test—were available for commercial sale in 50-plus private pharmacy outlets, on e-commerce platforms, and at KP-led clinics and social enterprises alongside OraSure Technologies’ OraQuick® HIV Self Test. These advancements have been critical for enabling more community- and market-based approaches to HIV testing in line with clients’ preferences.

DEMAND

Driving demand for condoms and other HIV-related goods and services is critical for improving HIV prevention, testing, and treatment. HM created a total reform in HIV demand generation approaches by leveraging digital media, social media, offline strategies, and communities themselves to produce and promote dynamic and KP-focused demand generation content. Through informational social media campaigns, chatbot support, HIV risk calculators, pre-exposure prophylaxis (PrEP) enrollment events, learning platforms, KP influencer engagement, and more, PATH and its partners were able to better reach KPs to promote and improve HIV prevention, testing, and treatment.

Success story: Crowdsourcing and community empowerment are vital strategies for ensuring HIV demand generation content effectively reaches KP groups who face persistent barriers in accessing HIV services, such as transgender women (TGW). In 2021, HM assisted the Vietnam Network of Transgender People and Bien Viet clinic in designing a virtual “PrEP Ambassadors 2021” campaign aimed at boosting PrEP promotion among TGW and other KP during Vietnam’s severe fourth wave of COVID-19. The campaign—which was Vietnam’s first-ever online PrEP campaign co-created and co-implemented with TGW—reached more than 80,000 viewers over two months and demonstrated the power of leveraging communities and innovative technologies for creating and disseminating meaningful PrEP promotional content.

SUPPLY

Prior to 2015, options for receiving affordable, high-quality HIV care were limited. To ensure KPs could get the care they needed and preferred, PATH worked to expand private- and commercial-sector supply of condoms and other HIV-related goods and services by implementing differentiated service delivery models and fostering strategic partnerships. This helped HM introduce exciting new approaches for HIVST and lay testing, PrEP, and integrative primary health care models at one-stop shop clinics. It also helped grow the market for key HIV prevention commodities like condoms, lubricants, low dead-space syringes (LDSSs), and rapid diagnostic tests (RDTs).

Success story: In 2017, HM and the MOH launched the first-ever PrEP pilot in Vietnam, Prepped for PrEP. Over the past five years, HM has developed and implemented several differentiated PrEP service delivery models—including PrEP provision at pharmacies, in mobile vehicles, and online—to adapt to clients’ needs and preferences and enable PrEP initiation for over 15,000 people across 3 provinces. In addition, HM forged strategic private-sector partnerships to make PrEP more affordable and available, and implemented hyper-focused PrEP demand generation campaigns to ensure demand met supply. A number of HM’s differentiated PrEP models have been adopted by VAAC, supporting Vietnam on its journey to de-medicalize and simplify PrEP services for greater uptake.

Throughout its eight-year duration, the HM project disrupted the status quo and redefined community and private-sector engagement in HIV programming. Several key results from the project include:

• Increased the availability and choice of HIV service providers by bolstering private-sector engagement and enabling community members to become active health service providers, supporting growth and establishment of KP-led organizations, and defining new service delivery models.
• Introduced and scaled a commercial market for lifesaving HIV goods and services, such as condoms, PrEP and nonoccupational post-exposure prophylaxis (nPEP), lay testing, HIVST, and antiretroviral therapy (ART).
• Achieved trailblazing policy and legal achievements, including revisions to the National HIV Law, 2020; the National Strategy to End the AIDS Epidemic by 2030; national guidelines on HIV community-based and self-testing; and national guidelines on HIV care and treatment, along with the establishment of the country’s first-ever guidelines on HIV prevention for transgender people and men who have sex with men (MSM).
• Pioneered an online and offline demand generation strategy, creating a new norm for how private-sector, community, and government partners reach and engage those living with or at risk for HIV.

Combined, these results contributed to a 57 percent decrease in new HIV infections between 2010 and 2020 and a 36 percent decrease in AIDS-related deaths in the country.

Through the five-year USAID/PATH Support for Technical Excellence and Private Sector Sustainability in Vietnam (STEPS) project, PATH will continue to expand shared-value partnerships with public, private, and community partners and implement fresh, scalable solutions to support Vietnam in reaching 95–95–95 targets and HIV epidemic control by 2030.

Our focuses include:

• Balancing and expanding total markets for HIV goods and services (like HIV self-testing and PrEP) for greater equity, access, choice, and sustainability.
• Facilitating expanded KP-led social enterprise and health business development, maturation, and independence through a proven package of technical assistance.
• Growing Global Virus Network stewardship and improving policy frameworks to enable stronger PSE and investment in the HIV response.