{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:26:38Z","timestamp":1792427198997,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"S5","license":[{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Although HIV prevalence among transgender women who have sex with men in Vietnam is high (16\u201318%), uptake of pre\u2010exposure prophylaxis (PrEP) is low compared to other populations. When PrEP was initiated in 2017, gender\u2010affirming healthcare was largely unavailable. Lack of access to competent, stigma\u2010free healthcare is a well\u2010documented barrier to transgender women's uptake of PrEP and primary healthcare (PHC). We aimed to demonstrate the utility of a PrEP quality improvement intervention in pinpointing and addressing barriers to PrEP use among transgender women in Vietnam.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We applied a real\u2010world participatory continuous quality improvement (CQI) and Plan\u2010Do\u2010Study\u2010Act (PDSA) methodology to ascertain barriers to PrEP uptake among transgender women and determine priority actions for quality improvement. A CQI team representing transgender women leaders, key population (KP)\u2010clinic staff, public\u2010sector HIV managers and project staff applied PDSA to test solutions to identified barriers that addressed the primary quality improvement outcome of the monthly change in PrEP uptake among transgender women and secondary outcomes, including month\u20103 PrEP continuation, the impact of offering PHC on PrEP uptake and unmet PrEP need. We utilized routine programmatic data and a descriptive cross\u2010sectional study enrolling 124 transgender women to measure these outcomes from October 2018 to September 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five key barriers to PrEP uptake among transgender women were identified and corresponding solutions were put in place: (1) offering gender\u2010affirming care training to KP\u2010clinics and community\u2010based organizations; (2) integrating gender\u2010affirming services into 10 KP\u2010clinics; (3) offering PHC through five one\u2010stop shop (OSS) clinics; (4) implementing a campaign addressing concerns related to hormone use and PrEP interactions; and (5) developing national HIV and transgender healthcare guidelines. New PrEP enrolment and month\u20103 PrEP continuation increased significantly among transgender women. Of 235 transgender women who initially sought healthcare other than PrEP at OSS clinics, 26.4% subsequently enrolled in PrEP. About one\u2010third of transgender women reported unmet PrEP need, while two\u2010thirds indicated an interest in long\u2010acting cabotegravir.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Offering gender\u2010competent, integrated PHC can increase PrEP enrolment and continuation, and can be an entry\u2010point for PrEP among those seeking care within PHC clinics. More work is needed to expand access to transgender women\u2010led and \u2010competent healthcare in Vietnam.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25996","type":"journal-article","created":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T05:49:20Z","timestamp":1665640160000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Caring for the whole person: transgender\u2010competent HIV pre\u2010exposure prophylaxis as part of integrated primary healthcare services in Vietnam"],"prefix":"10.1002","volume":"25","author":[{"given":"Anh H.","family":"Doan","sequence":"first","affiliation":[{"name":"PATH  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chau M. H.","family":"Vu","sequence":"additional","affiliation":[{"name":"Vietnam Network of Transgender People  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thu T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"My Home  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0848-8480","authenticated-orcid":false,"given":"Kimberly E.","family":"Green","sequence":"additional","affiliation":[{"name":"PATH  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huong T. T.","family":"Phan","sequence":"additional","affiliation":[{"name":"Vietnam Administration for HIV\/AIDS Control Ministry of Health  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena","family":"Janamnuaysook","sequence":"additional","affiliation":[{"name":"Institute of HIV Research and Innovation  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5529-5411","authenticated-orcid":false,"given":"Bao N.","family":"Vu","sequence":"additional","affiliation":[{"name":"PATH  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh M.","family":"Le","sequence":"additional","affiliation":[{"name":"Glink  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khang Q.","family":"Do","sequence":"additional","affiliation":[{"name":"Galant  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tham T.","family":"Tran","sequence":"additional","affiliation":[{"name":"PATH  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trang M.","family":"Ngo","sequence":"additional","affiliation":[{"name":"US Agency for International Development  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lopa","family":"Basu","sequence":"additional","affiliation":[{"name":"US Agency for International Development  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long K.","family":"Tran","sequence":"additional","affiliation":[{"name":"PATH  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Humeau","sequence":"additional","affiliation":[{"name":"PATH  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1574-8"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0133171"},{"key":"e_1_2_11_4_1","volume-title":"HIV sentinel surveillance report","author":"Vietnam Ministry of Health (MOH)","year":"2020"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000563"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/13691058.2011.630756"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(12)70315-8"},{"key":"e_1_2_11_8_1","unstructured":"Vietnam Ministry of Health (MOH).Guidelines on HIV\/AIDS prevention interventions for transgender people.Hanoi:Vietnam MOH;2020."},{"key":"e_1_2_11_9_1","unstructured":"Vietnam Administration for HIV\/AIDS Control Ministry of Health (MOH). 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