Country-wide implementation of pre-exposure prophylaxis (PrEP) for key affected populations in Thailand is well under way and providing important data about the sub-populations that are struggling to adhere to this important HIV prevention initiative.
PrEP is a course of antiretroviral treatment targeted at HIV-negative individuals at a high-risk of HIV infection. It has proven to be a powerful tool for the HIV response, but it’s effectiveness as an intervention relies on people being able to adhere to treatment as prescribed.
Thailand have introduced several cost-reduced and free PrEP programmes targeted at populations most at risk of HIV in order to reduce new infections in these groups. Some 44.4% of new infections from 2012 to 2016 were among men who have sex with men, transgender women, and male sex workers.
The ‘Princess PrEP’ programme in Thailand – the first initiative under royal patronage led by the target populations themselves – provides free rapid HIV testing and PrEP administered by trained community health workers at seven Thai community organisations in Bangkok, Chonburi, Chiang Mai, and Songkhla provinces. The programme had successful enrolment, but there remain key challenges around care retention and adherence to services. Read more via Avert
Seekaew, Pich, et al. "Correlates of nonadherence to key population-led HIV pre-exposure prophylaxis services among Thai men who have sex with men and transgender women." BMC public health 19.1 (2019): 328.
Background
Based on government estimates from the Asian Epidemic Model, new infections among men who have sex with men (MSM) and transgender women (TGW) in Thailand are forecast to proportionally increase over time. Daily oral Pre-exposure prophylaxis (PrEP) protects against HIV acquisition when used as prescribed. The “Princess PrEP” program is the first key population-led (PrEP) initiative under Thai royal patronage with an aim to scale up countrywide implementation of PrEP.
Methods
Retention in and adherence to key population-led HIV PrEP services among HIV-uninfected Thai MSM and TGW was examined in four provinces: Bangkok, Chonburi, Chiang Mai, and Songkhla. HIV, HBsAg, creatinine tests, and self-administered questionnaires were performed during baseline measures. Participants were followed up after month 1, at month 3, then every 3 months. Correlates of nonadherence and loss to follow up at 1 month were assessed using linear regression models.
Results
37.4% of the participants reported low adherence to services (≤ 3 pills/week or missed clinic schedule at month 1). Factors associated with low adherence included younger age (25 years and under) (adjusted odds ratio (aOR): 1.49, 95% confidence interval (95% CI: 1.01–2.21, p = 0.044), being a TGW (aOR: 2.2, 95% CI: 1.27–3.83, p = 0.005), and whether the participant had not previously accessed services at the clinic (aOR = 1.68, 95% CI: 1.03–2.76, p = 0.04). Additionally, participants in Chonburi (the only TGW site) showed significantly lower adherence than those in the other three provinces (aOR: 2.91, 95% CI: 1.55–5.45, p = 0.001).
Conclusion
Urgent, innovative interventions for early PrEP adherence support among vulnerable sub-populations such as younger users, TGW, and new clients are needed to maximize prevention strategy in Thailand.