Implementation of a Test, Treat, and Prevent HIV program among men who have sex with men and transgender women in Thailand, 2015-2016

Ongwandee, Sumet; Lertpiriyasuwat, Cheewanan; Khawcharoenporn, Thana; Chetchotisak, Ploenchan; Thiansukhon, Ekkachai; Leerattanapetch, Niramon; Leungwaranan, Banlang; Manopaiboon, Chomnad; Phoorisri, Thanongsri; Visavakum, Prin; Jetsawang, Bongkoch; Poolsawat, Monsicha; Nookhai, Somboon; Vasanti-Uppapokakorn, Monthinee; Karuchit, Samart; Kittinunvorakoon, Chonticha; Mock, Philip A.; Prybylski, Dimitri; Sukkul, A.; Roels, Thierry H.; Martin, Michael

doi:10.1371/journal.pone.0201171

Cited by 29 publications

(33 citation statements)

References 23 publications

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“…Nonetheless, these alternative protection methods were not widespread and well known during the time of the study (2015 to 2016). [28][29][30][31] For MSM, having never tested for HIV and having a positive attitude toward PLHIV were associated with RD. This could be that, in the era of ART, life expectancy of people living with HIV is not severely shortened, and it is seen as a chronic condition, instead of a terminal illness [32].…”

Section: Discussionmentioning

confidence: 99%

Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment

et al. 2019

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Introduction Low uptake of HIV testing and services, including pre‐exposure prophylaxis (PrEP), in Thai men who have sex with men (MSM) and transgender women (TGW) may be due to the inaccuracy in self‐risk assessment. This study investigated the discordance between self‐perceived HIV risk and actual risk. Methods Data were obtained between May 2015 and October 2016 from MSM and TGW enrolled in key population‐led Test and Treat study in six community health centres in Thailand. Eligible participants were at least 18 years old, Thai national, had sex with men, had unprotected sex with a man in the past six months or had at least three male sex partners in the past six months, and were not known to be HIV positive. Baseline demographic behavioural characteristics questionnaires, including self‐perceived HIV risk, were self‐administered. Participants received HIV/STI (syphilis/gonorrhoea/chlamydia) testing at baseline. Participants who self‐perceived to have low risk, but engaged in HIV‐susceptible practices were categorized as having risk discordance (RD). Regression was conducted to assess factors associated with RD among MSM and TGW separately. Results Of the 882 MSM and 406 TGW participants who perceived themselves as having low HIV risk, over 80% reported at least one of the following: tested HIV positive, engaged in condomless sex, tested positive for a sexually transmitted infection sexually transmitted infection (STI; or used amphetamine‐type stimulants. Logistic regression found that living with a male partner (p = 0.005), having never tested for HIV (p = 0.045), and living in Bangkok (p = 0.01) and Chiang Mai (p < 0.001) were associated with increased risk discordance among MSM. Living with a male partner (p = 0.002), being less than 17 years old at sexual debut (p = 0.001), and having a low knowledge score about HIV transmission (p < 0.001) were associated with increased risk discordance among TGW. However, for TGW, being a sex worker decreased the chance of risk discordance (p = 0.034). Conclusions Future HIV prevention messages need to fill in the gap between self‐perceived risk and actual risk in order to help HIV‐vulnerable populations understand their risk better and proactively seek HIV prevention services.

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Section: Discussionmentioning

confidence: 99%

Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment

et al. 2019

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“…Sites were selected based on geographic prioritization of 4 of the 30 high HIV burden provinces in Thailand, 16 volume of MSM and TG clients, provision of HIV services, and willingness to participate in a Test, Treat, and Prevent Program that was implemented to increase HIV testing coverage and access to ART regardless of CD4 level among MSM and TG. 17 Eligible participants included Thai MSM and TG women aged ≥18 years, who were willing to participate, were not known to be HIV-infected, and who reported anal intercourse with a male or TG without a condom in the six months before enrollment. In the clinics trained study staff consented and enrolled participants who met the eligibility criteria.…”

Section: Methodsmentioning

confidence: 99%

HIV incidence among men who have sex with men and transgender women in four provinces in Thailand

Kritsanavarin¹,

Bloss²,

Manopaiboon³

et al. 2020

Int J STD AIDS

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The HIV epidemic in Thailand is concentrated in key populations, with the highest rates in men who have sex with men (MSM) and transgender women (TG). Previous studies of HIV incidence in these groups have been limited mostly to Bangkok. We measured HIV incidence in MSM and TG in four provinces and evaluated factors associated with incident infections to inform public health prevention efforts. An analysis was conducted using data collected during a prospective observational cohort study during April 2015–May 2018 in outpatient clinics in five hospitals across four provinces in Thailand. MSM and TG aged ≥18 years, who were not known to be HIV-infected, and who reported anal intercourse with a male or TG without a condom in the past six months were enrolled. Participants were followed-up every 6 months for 18 months with questionnaires and HIV testing. A total of 40 HIV seroconversions occurred during follow-up, resulting in an HIV incidence of 3.5 per 100 person-years (95% CI 2.5, 4.8). Multivariate analyses indicated that identifying as gay (adjusted hazard ratio [AHR] 4.9; 95% CI 1.7–14.2), having receptive anal sex in the past six months (AHR 3.6; 95% CI 1.4–9.5), using alcohol (AHR 3.3; 95% CI 1.3–8.3), and taking alkyl nitrites (AHR 4.4; 95% CI 1.7–11.2) in the past six months were all independently associated with HIV infection. Overall this study found a lower HIV incidence in the highest risk population in Thailand compared with similar studies in Bangkok. Accelerated prevention efforts are needed to make the goal of ‘zero new infections’ possible in Thailand.

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“…Between 2015 and 2016 another test-and-treat study was conducted at five hospitals that served MSM and TGW in four Thai provinces [39]. Many participants received HIV testing for the first time, revealing that a previously-unreached key population was being screened [40].…”

Section: Introductionmentioning

confidence: 99%

“…Many participants received HIV testing for the first time, revealing that a previously-unreached key population was being screened [40]. Among those with incident HIV infection, 86.1% initiated ART and 58.6% of ART initiators did so within 2 weeks of diagnosis [39]. Although ART uptake in this program was higher than had been reported from other areas in Thailand [41], it still fell short of the UNAIDS 90-90-90 target.…”

Section: Introductionmentioning

confidence: 99%

Leveraging early HIV diagnosis and treatment in Thailand to conduct HIV cure research

et al. 2019

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Thailand has the highest prevalence of HIV among countries in Asia but has also been a pioneer in HIV prevention and treatment efforts in the region, reducing the incidence of new infections significantly over the last two decades. Building upon this remarkable history, Thailand has set an ambitious goal to stop the AIDS epidemic in the country by 2030. A key component of the strategy to achieve this goal includes scale-up of HIV screening programs to facilitate early HIV diagnosis and investment in mechanisms to support immediate initiation of antiretroviral therapy (ART). Initiation of ART during early or acute HIV infection not only reduces viremia, thereby halting onward transmission of HIV, but also may facilitate HIV remission by reducing the size of the latent HIV reservoir and preserving immune function. In Thailand, many efforts have been made to reduce the time from HIV infection to diagnosis and from diagnosis to treatment, especially among men who have sex with men and transgender women. Successfully identifying and initiating ART in individuals with acute HIV infection has been leveraged to conduct groundbreaking studies of novel strategies to achieve HIV remission, including studies of broadly-neutralizing HIV-specific monoclonal antibodies and candidate therapeutic vaccines. These efforts have mostly been deployed in Bangkok and future efforts should include other urban and more rural areas. Continued progress in HIV prevention, screening, and treatment will position Thailand to substantially limit new infections and may pave the way for an HIV cure.

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Implementation of a Test, Treat, and Prevent HIV program among men who have sex with men and transgender women in Thailand, 2015-2016

Cited by 29 publications

References 23 publications

Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment

Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment

HIV incidence among men who have sex with men and transgender women in four provinces in Thailand

Leveraging early HIV diagnosis and treatment in Thailand to conduct HIV cure research

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