How does KPLHS model fill the gap in HIV services?

Gaps in traditional HIV servicesKPLHS
Accessibility
  • Public health facilities are located in inconvenient locations and have limited service hours, which do not match the lives of KPs
  • Community-based organizations located in hotspot areas
  • Flexible service hours suitable for KPs and provide one-stop service
Availability
  • Limited staff at public health facilities to respond to the needs of KPs, such as offering HIV services through mobile clinics
  • No retention strategies to ensure that HIV-positives have initiated ART or HIV-negatives are engaged in HIV-prevention and testing services
  • Available services are not based on a client-centered approach and therefore often lack hormone monitoring, STIs or harm reduction services
  • Sufficient staff and different health services for KPs
  • Employ needs-based and client-approach to provide services that are appropriate and acceptable to KPs, such as hormone
Quality
  • Healthcare providers often lack skills and understanding of KP issues, which often results in stigma and discrimination against sex workers and people who inject drugs
  • Some healthcare providers are still reluctant to offer PrEP as an alternative to condom use because of cultural stigma associated with sexual practices
  • Well-trained and certified KP-community health workers (KP-CHWs) provide services that are friendly and accessible to KPs, resulting in a stigma and discrimination free environment
Acceptability
  • Public health facilities are unable to provide services across the RRTTPR cascade
  • Received capacity building to ensure that KP-CHWs can provide HIV services in accordance with national standards by public health sectors
  • Trained KP-CHWs can provide tailored services along the HIV cascade

Implementation Sites

Advocacy success

IHRI has actively aimed to establish, sustain and expand the KPLHS model to HIV-burdened cities nationwide. Led by the United States Agency for International Development (USAID) Community Partnership, in collaboration with three leading CBOs in Thailand, the Rainbow Sky Association of Thailand (RSAT), the Service Workers in Group Foundation (SWING) and the Mplus Foundation and with the support of the United States President’s Emergency Plan for AIDS Relief (PEPFAR), IHRI has provided technical assistance to enable key population (KP) lay providers to perform certain HIV services and ultimately to certify them using a legal accreditation system.

The efforts were realized in June 2019, when the Ministry of Public Health (MOPH), the Department of Disease Control (DDC), and professional councils finally endorsed a ministerial regulation, which legalizes KP lay providers to cater HIV services under the purview of the Councils of Medical Professionals, Medical Technologists and Pharmacists. The regulation was formally endorsed on June 6, 2019 by the former Minister of Public Health, Clinical Professor Emeritus Dr. Piyasakol Sakolsatayathorn.

This accomplishment marks an official start for the DDC and related organizations to develop and implement all relevant guidelines to support the regulation. The quality standards for HIV/STIs service delivery in communities has been developed and launched nationally in April 2020.  Moreover, a national operation plan for KP-lay provider certification has been developed.  In addition, the regulation will also enable lay providers to receive financial support from the government which will subsequently lead to sustainability of community-based organizations’ HIV work.

References:

Vannakit R, Andreeva V, Mills S, Cassell MM, Jones MA, Murphy E, Ishikawa N, Boyd MA, Phanuphak N. Fast-tracking the end of HIV in the Asia Pacific region: domestic funding of key population-led and civil society organisations. Lancet HIV 2020; 7(5): e366-e72.

Vannakit R, Janyam S, Linjongrat D, Chanlearn P, Sittikarn S, Pengnonyang S, Janamnuaysook R, Termvanich K, Ramautarsing R, Phanuphak N, Phanuphak P. Give the community the tools and they will help finish the job: key population-led health services for ending AIDS in Thailand. J Int AIDS Soc 2020; 23(6): e25535.

Wongkanya R, Pankam T, Wolf S, Pattanachaiwit S, Jantarapakde J, Pengnongyang S, Thapwong P, Udomjirasirichot A, Churattanakraisri Y, Prawepray N, Paksornsit A, Sitthipau T, Petchaithong S, Jitsakulchaidejt R, Nookhai S, Lertpiriyasuwat C, Ongwandee S, Phanuphak P, Phanuphak N. HIV rapid diagnostic testing by lay providers in a key population-led health service programme in Thailand. J Virus Erad. 2018;4(1):12-15.