The HIV epidemic in Vietnam is concentrated, with high prevalence estimates among injection drug users and commercial sex workers. Socio-demographics, substance use and clinical correlates of antiretroviral therapy non-adherence were studied in 100 HIV-1 infected drug users (DUs) receiving antiretroviral therapy (ART) for at least 6 months in Hanoi, Vietnam. All study participants were men with a mean age of 29.9 ± 4.9 years. The median duration on ART was 16.2 ± 12.7 months. 83% reported ‘very good’ or ‘perfect’ adherence in the past 30 days on a subjective one–item Likert scale at time of study enrollment. 48% of participants reported drug use within the previous 6 months, with 22% reporting current drug use. Injection drug use with or without non-injection drug use in the past 6 months (95% C.I. 2.19, 1.30-3.69) and years on ART (95% C.I. 1.43, 1.14-1.78) were correlated with suboptimal adherence. These findings support Vietnam’s ongoing scale-up of harm reduction programs for injection drug users and their integration with ART delivery. Moreover, results highlight the need to identify and implement new ways to support high levels of ART adherence as duration on ART increases.

Increasing the volume, strengthening the quality, and proactively using data of human immunodeficiency virus (HIV) load testing are pivotal to limiting the threat of HIV drug resistance (HIVDR) accumulation, and allow for optimal case-based HIVDR surveillance. Triangulation of viral load (VL) and HIVDR testing data could be pursued to answer key questions and translate data and results for program and public policy. Identification of virologic failure and early management mitigates the greater risk of HIVDR. Routine VL monitoring and evaluation systems are necessary, and countries should consider reviewing system requirements, structural needs, and procedural and technical factors for the entire VL cascade, with special emphasis on post-test result use.