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.
IHRI has been a strong advocate of U=U, translating strong evidence-based facts into advocacy work. With the recent U=U backlash in Thailand, IHRI has received tremendous support from the International AIDS Society, UNAIDS and Ministry of Public Health in endorsing U=U messaging. As viral load testing remains low, IHRI plans to produce communication materials to increase viral load literacy among PLHIV as a strategy for clients to help providers routinely test for HIV viral load.
Differentiated service delivery for ART (DSD-ART) is a client-centered concept for ART refill services that aims to enhance ART retention and improve quality of life of clients living with HIV, as well as to allow more efficient use of healthcare resources for those clients who need more medical attention. It is a part of the strategy to achieve the last 90 of the UNAIDS’ 90-90-90 target in which 90% of clients who have initiated ART are virally suppressed by 2020.
Many DSD-ART models are already available in Thailand to meet the various needs and preferences of people living with HIV, including a fast-track model for ART pick-up, a pick-up center model, and mailing models.
Overall, 94.8% of stable clients who have been on ART for at least 6 months, from 5 partnered hospital in 3 provinces, have chosen to receive ART through DSD-ART services. Of these, 71.0% preferred hospital-based models while 10.1% preferred community-based models and 13.7% preferred to received ART thought mailing models.