As the country is approaching the target deadline for UNAIDS’ 90-90-90 goals in 2020, HIV treatment uptake is still a challenge for Thailand, with only 74% of individuals who are aware of their HIV-positive status receiving treatment. Multiple preparatory visits and the transferring of an assigned hospital based on health benefit scheme are among the factors contributing to this gap. The Thai Red Cross Anonymous Clinic has begun offering the country’s first same-day antiretroviral therapy initiation (Same-Day ART) in July 2017, aiming to increase ART coverage by initiating ART to individuals who are tested HIV positive at the clinic upon the day of HIV diagnosis and offering services that link the clients to a preferable sustained ART site.

Thus far, 4,082 people have received treatment through Same-Day ART services, and 93.8% of individuals who received viral load testing are virally suppressed, or ‘undetectable’ after 6 months. Achieving the undetectable status means that these individuals cannot transmit the virus to others. At the AIDS conference in Amsterdam in 2018, we showed that clients through Same-Day ART were 3.9 times more likely to start HIV treatment and 2.2 times more likely to be virally suppressed. With these promising results, we have worked with local community health centers and governmental officials, and have scaled up Same-Day ART to 10 other hospitals in 5 provinces in Thailand. The data from partnered hospitals and TRCAC show that using only symptomatic screening and chest x-ray result can facilitate faster ART initiation when compared to using CD4 and/or safety laboratory results, with no increase in severe adverse events and even less deaths.