Assessment of needs, use, preferences and willingness to pay for hiv-related health services among key and general populations in four provinces in Vietnam

Background
Recent changes by the Vietnamese government have allowed investors to launch private hospitals and clinics, introducing additional and improved services for a premium. The willingness of people to seek out services for a fee rather than to rely on state-run clinics and hospitals has demonstrated an appetite to pay for services and may represent an opportunity for other health care providers, such as key population-led community-based organizations (CBOs) and social enterprises (SEs). In aggregate, about 45% of health care spending per person is out of pocket (OOP) and this figure is projected to nearly triple in amount over the next decade, and remain a significant proportion of overall health spending moving forward. However, it is unknown how this OOP spending is represented by key populations and the general population in dense, urban or peri-urban provinces. In addition, while Vietnam has made progress in universal health coverage (UHC) and primary health care (PHC), it is still far from its desired target of over 80% coverage. 
CBOs and SEs are critical for delivering care to people affected by and living with HIV, and their sustainability is key to sustained HIV prevention, care, and treatment as external donor funding declines. The Vietnam INVEST project seeks to analyze this sector and support the introduction of new models through an assessment of market-based, scalable models for CBOs and SEs to deliver financially sustainable PHC services that contribute to overall access to UHC.
The purpose of the consumer study was to provide information that informs business and investment planning of key population CBOs/SEs to help them grow and sustain their businesses in the long run.  The study also explored consumer perceptions of the current quality and capacity of assessed CBOs and SEs and assessed what types of services are needed and how needs and preferences varied across populations and geographies. 

Objectives
The specific objectives of the study were to:
1)    Measure willingness to pay for health services and commodities among key populations (KP) and the general population (GP). 
2)    Measure utilization of commercial health services and commodities among KPs and the GP.
3)    Define specific KP and GP consumer preferences related to health services and commodities.
4)    Develop sub-group consumer profiles among KP and GP based on purchasing behaviors, socio-economic status, age, sex, product preferences.
5)    Examine awareness, brand equity, and perceived quality of assessed CBOs and SEs in Hanoi, Ho Chi Minh City, Dong Nai, and Can Tho.
6)    Explore the reasons for using and/or not using specific CBO/SE delivered healthcare services among study participants.
7)    Inform business and investment planning of key population CBOs/SEs based on the findings from objectives 1-6. 

Study design
The study employed a cross-sectional survey design with quantitative and qualitative data collection methods including in-person interviews using CAPI and focus group discussions (FGDs). The sample included key population groups (men who have sex with men-MSM, transgender women - TGW, female sex workers - FSW, and people who inject drugs - PWID) and the general population.

Sample size
Quantitative sample
The provincial quota for each key population group was 60 MSM, 30 TGW, 30 FWS and 30 PWID, and 60 members of the GP (about 50% female) and this sample were drawn from people living in project areas.  Convenience sampling was applied to recruit participants for this study. Finally, there were 862 people interviewed.
Qualitative sample
A total of 16 focus group discussions were carried out in Hanoi, Ho Chi Minh, Dong Nai and Can Tho. On average, 4 focus group discussions per province were conducted and each focus group discussion consisted 6 to 8 persons from general population or from key population.
Study time and location
The consumer study was carried out by Institute of Social and Medical Studies from December 2020 to January 2021 in Ha Noi, Ho Chi Minh, Dong Nai and Can Tho