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van Griensven F, Phanuphak N, Manopaiboon C, Dunne EF, Colby DJ, Chaiphosri P, Ramautarsing R, Mock PA, Guadamuz TE, Rangsin R, Benjamaneepairoj K, Na Nakorn P, Vannakit R, de Lind van Wijngaarden JW, Avery M, Mills S. HIV prevalence and incidence among men who have sex with men and transgender women in Bangkok, 2014-2018: Outcomes of a consensus development initiative. PLoS One 2022; 17:e0262694. [PMID: 35061803 PMCID: PMC8782340 DOI: 10.1371/journal.pone.0262694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
To reach its goal of ending AIDS by 2030, Thailand has adopted antiretroviral treatment as prevention and HIV pre-exposure prophylaxis for men who have sex with men (MSM) and transgender women (TGW) as its core HIV control strategy. However, in the absence of reliable epidemiologic indicators, the impact of these policies on the course of the HIV epidemic in these groups remains unknown. To help answer this question, we formulated an HIV epidemic consensus initiative for Bangkok, Thailand, to analyze epidemiologic and program data and reach agreement between experts and stakeholders on the evolving state of the HIV epidemic among MSM and TGW. A customized Delphi process was used to consult and consolidate viewpoints of experts and stakeholders. Experts presented and discussed HIV prevalence and incidence data from recent and ongoing studies among MSM and TGW in Bangkok (2014 to 2018) during a meeting with stakeholders representing government, donors, and civil society. Agreement about the course of the HIV epidemic among MSM and TGW was attained by voting consensus. Based on presented data, meeting participants agreed that HIV prevalence and incidence had decreased among Bangkok MSM from 2014 to 2018. Despite these declines, HIV prevalence and incidence were found to remain high. This was particularly the case among younger MSM. Participants agreed that there was no evidence for a decrease in HIV prevalence and incidence among Bangkok TGW. Introduction of antiretroviral treatment as prevention and HIV pre-exposure prophylaxis may have contributed to these declines. However, HIV prevalence and incidence remained high, and no signs of a decrease were reported among Bangkok TGW. At the current rate of new HIV infections in MSM and TGW, Thailand will not reach its goal of ending AIDS by 2030. This HIV consensus initiative may serve as a model for building agreement and advocacy on epidemiologic and program data and their implications for a large metropolitan city.
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Affiliation(s)
- Frits van Griensven
- Institute of HIV Research and Innovation and Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation and Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Chomnad Manopaiboon
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Eileen F. Dunne
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Donn J. Colby
- Institute of HIV Research and Innovation and Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Pannee Chaiphosri
- Division of AIDS, TB and STI, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Reshmie Ramautarsing
- Institute of HIV Research and Innovation and Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Philip A. Mock
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Thomas E. Guadamuz
- Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Ram Rangsin
- Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Panus Na Nakorn
- United States Agency for International Development, Regional Development Mission for Asia, Bangkok, Thailand
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Moise RK, Srithanaviboonchai K, Alsolami A, Soares MH, Elewonibi BR, Tolmasky ME, Wood MM. The Patient-Provider Continuum of Care: Narratives of People Living With Comorbid HIV and Diabetes in Northern Thailand. J Patient Exp 2020; 7:749-757. [PMID: 33294611 PMCID: PMC7705831 DOI: 10.1177/2374373519882226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Among South-East Asia Region countries, Thailand has a high prevalence of HIV with an increasing significant comorbidity of diabetes mellitus (DM). Objective: Guided by syndemics, the purpose of this qualitative study is to develop insight into the experience of patients living with comorbid HIV and DM in Northern Thailand for quality improvement. Methods: Interviews were conducted in 2 groups for content analysis: (1) people living with comorbid HIV and DM and (2) health-care staff providing care to patients living with the comorbidity. Results: Participants’ (N = 12) ages ranged from 42 to 56 (mean = 49). Health staff (N = 12) generated complementary narratives. All participants reported onset of diabetes after discovering they were HIV infected. Content analysis revealed emergent themes regarding (1) knowledge and perceptions and (2) management framed by syndemics and chronicity. Conclusion: Findings suggest routine training for patient education and provider integration of care. Macrosocial factors such as limited access and resources and biological factor such as drug interactions are noted as key considerations for future interventions and alterations in the care for patients with comorbid HIV and DM.
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Affiliation(s)
- Rhoda K Moise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ali Alsolami
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary H Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bilikisu Reni Elewonibi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Michele M Wood
- Department of Public Health, California State University, Fullerton, CA, USA
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3
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Kritsanavarin U, Bloss E, Manopaiboon C, Khawcharoenporn T, Harnlakon P, Vasanti-Uppapokakorn M, Kitwattanachai P, Naprasert S, Phiphatthananon T, Visavakum P, Jetsawang B, Mock PA. HIV incidence among men who have sex with men and transgender women in four provinces in Thailand. Int J STD AIDS 2020; 31:1154-1160. [PMID: 32903141 DOI: 10.1177/0956462420921068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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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Affiliation(s)
- Usanee Kritsanavarin
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Emily Bloss
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Chomnad Manopaiboon
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | | | | | | | | | | | | | - Prin Visavakum
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Bongkoch Jetsawang
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Philip A Mock
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
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Srithanaviboonchai K, Sitthi W, Musumari PM, Tangmunkongvorakul A, Rerkasem K, Techasrivichien T. Sexual Behavior and Attitudes Toward Sex of Older Adults Living with HIV. AIDS Behav 2020; 24:1825-1834. [PMID: 31820183 DOI: 10.1007/s10461-019-02756-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The number of older adults living with HIV (OALHIV) is increasing rapidly due to effective antiretroviral therapy. The current research describes sexual behavior, attitudes toward sex, and HIV transmission risk among OALHIV. Participants were HIV-infected persons aged 50 years and older enrolled from community hospitals in Chiang Mai Province, Northern Thailand. Of the 328 participants, 57.6% were women, and the average age was 58.8 years. The majority of participants (93.9%) had undetectable viral load. Most participants (77.1%) thought that it is ok/acceptable for PLHIV to have sex. About one-third of OALHIV participants were sexually active. Being male, younger, married, a previous smoker or a non-smoker, having a positive attitude toward sex, and not having a chronic health condition were independent predictors of having had sex in the last 12 months. Risk of HIV sexual transmission was likely low due to consistent condom use, undetectable viral load, and low instances of extramarital sex.
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Seekaew P, Nguyen E, Sungsing T, Jantarapakde J, Pengnonyang S, Trachunthong D, Mingkwanrungruang P, Sirisakyot W, Phiayura P, Panpet P, Meekrua P, Praweprai N, Suwan F, Sangtong S, Brutrat P, Wongsri T, Nakorn PRN, Mills S, Avery M, Vannakit R, Phanuphak P, Phanuphak N. 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 2019; 19:328. [PMID: 30898095 PMCID: PMC6429797 DOI: 10.1186/s12889-019-6645-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/11/2019] [Indexed: 11/18/2022] Open
Abstract
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. Electronic supplementary material The online version of this article (10.1186/s12889-019-6645-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pich Seekaew
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand.
| | - Ezie Nguyen
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Thanthip Sungsing
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Jureeporn Jantarapakde
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Supabhorn Pengnonyang
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Deondara Trachunthong
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Pravit Mingkwanrungruang
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Waraporn Sirisakyot
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Pattareeya Phiayura
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Phubet Panpet
- Rainbow Sky Association of Thailand, Bangkok, Thailand
| | | | | | - Fonthip Suwan
- Rainbow Sky Association of Thailand, Songkhla, Thailand
| | | | | | | | | | | | | | - Ravipa Vannakit
- Office of Public Health, U.S. Agency for International Development Regional Development Mission for Asia, Bangkok, Thailand
| | - Praphan Phanuphak
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Nittaya Phanuphak
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
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Holtz TH, Wimonsate W, Mock PA, Pattanasin S, Chonwattana W, Thienkrua W, Sukwicha W, Curlin ME, Chitwarakorn A, Dunne EF. Why we need pre-exposure prophylaxis: incident HIV and syphilis among men, and transgender women, who have sex with men, Bangkok, Thailand, 2005-2015. Int J STD AIDS 2019; 30:430-439. [PMID: 30626283 DOI: 10.1177/0956462418814994] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe incident human immunodeficiency virus (HIV) and syphilis trends in men who have sex with men (MSM) and transgender women (TGW) presenting for HIV voluntary counseling and testing (VCT) services and sexually transmitted infection (STI) management at the Silom Community Clinic, Bangkok, Thailand. Clients underwent rapid HIV testing and syphilis rapid plasma reagin (RPR) testing. For incidence analysis, we included clients with >1 follow-up visit. Initial negative HIV with subsequent positive HIV defined incident HIV infection; incident syphilis infection was defined as negative RPR followed by positive RPR (titer ≥1:8) and confirmatory anti- Treponema pallidum antibodies. Calculation of incidence using Poisson regression assumed a uniform probability distribution throughout the seroconversion interval. From 15 September 2005 to 31 December 2015, we tested 10,158 clients for HIV and 10,324 for syphilis. Overall, 7109 clients tested HIV-seronegative and contributed 7157 person-years (PY). Three-hundred forty-seven incident HIV infections resulted in an incidence rate of 4.8 per 100 PY (95% confidence interval [CI] 4.4-5.4). We found an inverted U-shape trend of HIV incidence over time with a peak of 6.4 per 100 PY in quarter 2/2011 ( p < 0.01) (Poisson with RCS function, p = 0.001). Overall, 8713 clients tested seronegative for syphilis and contributed 8623 PY. The incidence of syphilis infection was 4.4 per 100 PY (95% CI 3.9-4.8). Despite an apparent decline in HIV incidence among MSM and TGW attending VCT services, syphilis incidence rose and remained high. Evaluating temporal trends of HIV and syphilis incidence provides an opportunity to evaluate epidemic trajectories and target limited program funding. We recommend focused HIV and STI prevention interventions for MSM in Bangkok.
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Affiliation(s)
- T H Holtz
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,2 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Wimonsate
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - P A Mock
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - S Pattanasin
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - W Chonwattana
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - W Thienkrua
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - W Sukwicha
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - M E Curlin
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,2 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Chitwarakorn
- 3 Department of Disease Control, Thai Ministry of Public Health, Nonthaburi, Thailand
| | - E F Dunne
- 1 Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,2 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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van Griensven F, Mock PA, Benjarattanaporn P, Premsri N, Thienkrua W, Sabin K, Varangrat A, Zhao J, Chitwarakorn A, Hladik W. Estimating recent HIV incidence among young men who have sex with men: Reinvigorating, validating and implementing Osmond's algorithm for behavioral imputation. PLoS One 2018; 13:e0204793. [PMID: 30300373 PMCID: PMC6178382 DOI: 10.1371/journal.pone.0204793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/15/2018] [Indexed: 11/29/2022] Open
Abstract
HIV incidence information is essential for epidemic monitoring and evaluating preventive interventions. However, reliable HIV incidence data is difficult to obtain, especially among marginalized populations, such as young men who have sex with men (YMSM). Here we evaluate the reliability of an alternative HIV incidence assessment method, behavioral imputation, as compared to serologically estimated HIV incidence. Recent HIV incidence among YMSM (aged 18 to 21 and 18 to 24 years) enrolled in a cohort study in Bangkok from 2006 to 2014 was estimated using two mid-point methods for seroconversion: 1) between age of first anal intercourse and first HIV-positive test (without previous HIV-negative test) (behavioral imputation) and 2) between the date of last negative and first positive HIV test (serological estimation). Serologically estimated HIV incidence was taken as the "gold standard" to evaluate between-method agreement. At baseline, 314 YMSM age 18 to 21 years accumulated 674 person-years (PY) of follow-up since first anal intercourse. Considering that 50 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.4 per 100 PY. Of the remaining 264 HIV-negative men, 54 seroconverted for HIV infection during the study, accumulating 724 PY of follow-up and a serologically estimated HIV incidence of 7.5 per 100 PY. At baseline, 712 YMSM age 18 to 24 years (including 18 to 21-year-old men analyzed above) accumulated 2143 PY of follow-up since first anal intercourse. Considering that 151 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.0 per 100 PY. Of the remaining 561 HIV-negative men, 125 seroconverted for HIV infection during the study, accumulating 1700 PY of follow-up and a serologically estimated HIV incidence of 7.4 per 100 PY. Behavioral imputation and serological estimation are in good agreement when estimating recent HIV incidence in YMSM.
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Affiliation(s)
- Frits van Griensven
- Thai Red Cross AIDS Research Center, Bangkok, Thailand
- UCSF Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
| | - Philip A. Mock
- Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Nakorn Premsri
- Global Fund Principal Recipient Office, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Warunee Thienkrua
- Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Anchalee Varangrat
- Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Jinkao Zhao
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Anupong Chitwarakorn
- Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wolfgang Hladik
- US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Ongwandee S, Lertpiriyasuwat C, Khawcharoenporn T, Chetchotisak P, Thiansukhon E, Leerattanapetch N, Leungwaranan B, Manopaiboon C, Phoorisri T, Visavakum P, Jetsawang B, Poolsawat M, Nookhai S, Vasanti-Uppapokakorn M, Karuchit S, Kittinunvorakoon C, Mock P, Prybylski D, Sukkul AC, Roels T, Martin M. Implementation of a Test, Treat, and Prevent HIV program among men who have sex with men and transgender women in Thailand, 2015-2016. PLoS One 2018; 13:e0201171. [PMID: 30044867 PMCID: PMC6059477 DOI: 10.1371/journal.pone.0201171] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/10/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Antiretroviral therapy reduces the risk of serious illness among people living with HIV and can prevent HIV transmission. We implemented a Test, Treat, and Prevent HIV Program among men who have sex with men (MSM) and transgender women at five hospitals in four provinces of Thailand to increase HIV testing, help those who test positive start antiretroviral therapy, and increase access to pre-exposure prophylaxis (PrEP). Methods We implemented rapid HIV testing and trained staff on immediate antiretroviral initiation at the five hospitals and offered PrEP at two hospitals. We recruited MSM and transgender women who walked-in to clinics and used a peer-driven intervention to expand recruitment. We used logistic regression to determine factors associated with prevalent HIV infection and the decision to start antiretroviral therapy and PrEP. Results During 2015 and 2016, 1880 people enrolled. Participants recruited by peers were younger (p<0.0001), less likely to be HIV-infected (p<0.0001), and those infected had higher CD4 counts (p = 0.04) than participants who walked-in to the clinics. Overall, 16% were HIV-positive: 18% of MSM and 9% of transgender women; 86% started antiretroviral therapy and 46% of eligible participants started PrEP. A higher proportion of participants at hospitals with one-stop HIV services started antiretroviral therapy than other hospitals. Participants who started PrEP were more likely to report sex with an HIV-infected partner (p = 0.002), receptive anal intercourse (p = 0.02), and receiving PrEP information from a hospital (p<0.0001). Conclusions We implemented a Test, Treat, and Prevent HIV Program offering rapid HIV testing and immediate access to antiretroviral therapy and PrEP. Peer-driven recruitment reached people at high risk of HIV and people early in HIV illness, providing an opportunity to promote HIV prevention services including PrEP and early antiretroviral therapy. Sites with one-stop HIV services had a higher uptake of antiretroviral therapy and PrEP.
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Affiliation(s)
| | | | | | | | | | | | | | - Chomnad Manopaiboon
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
- * E-mail:
| | | | - Prin Visavakum
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Bongkoch Jetsawang
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Monsicha Poolsawat
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Somboon Nookhai
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | | | - Samart Karuchit
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Chonticha Kittinunvorakoon
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Philip Mock
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Dimitri Prybylski
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Ake-Chittra Sukkul
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Thierry Roels
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Michael Martin
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
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The finding of casual sex partners on the internet, methamphetamine use for sexual pleasure, and incidence of HIV infection among men who have sex with men in Bangkok, Thailand: an observational cohort study. Lancet HIV 2018; 5:e379-e389. [PMID: 29861202 DOI: 10.1016/s2352-3018(18)30065-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The finding of casual sex partners on the internet and methamphetamine use have been described as risk factors for HIV infection in men who have sex with men (MSM). However, the interplay between these factors has not been studied prospectively in one design. This study aims to determine the associations between finding casual sex partners on the internet and incident methamphetamine use and HIV infection. METHODS In this observational cohort study of Thai MSM, we recruited Bangkok residents aged 18 years or older with a history of penetrative male-to-male sex in the past 6 months. Baseline and follow-up visits were done at a dedicated study clinic in central Bangkok. Men were tested for HIV infection at every study visit and for sexually transmitted infections at baseline. Baseline demographics and HIV risk behaviour information were collected at every visit by audio computer-assisted self-interview. We used a descriptive model using bivariate odds ratios to elucidate the order of risk factors in the causal pathway to HIV incidence and methamphetamine use. We used Cox proportional hazard regression analysis to evaluate covariates for incident methamphetamine use and HIV infection. FINDINGS From April 6, 2006, to Dec 31, 2010, 1977 men were screened and 1764 were found eligible. 1744 men were enrolled, of whom 1372 tested negative for HIV and were followed up until March 20, 2012. Per 100 person-years of follow-up, incidence of methamphetamine use was 3·8 (128 events in 3371 person-years) and incidence of HIV infection was 6·0 (212 events in 3554 person-years). In our descriptive model, methamphetamine use, anal sex, and various other behaviours cluster together but their effect on HIV incidence was mediated by the occurrence of ulcerative sexually transmitted infections. Dual risk factors for both incident methamphetamine use and HIV infection were younger age and finding casual sex partners on the internet. Having ever received money for sex was predictive for incident methamphetamine use; living alone or with a housemate, recent anal sex, and ulcerative sexually transmitted infections at baseline were predictive for incident HIV infection. INTERPRETATION In MSM in Bangkok, casual sex partner recruitment on the internet, methamphetamine use, and sexually transmitted infections have important roles in sustaining the HIV epidemic. Virtual HIV prevention education, drug use harm reduction, and biomedical HIV prevention methods, such as pre-exposure prophylaxis, could help to reduce or revert the HIV epidemic among MSM in Bangkok. FUNDING US Centers for Disease Control and Prevention and the Johns Hopkins Fogarty AIDS International Training and Research Program.
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Sapsirisavat V, Phanuphak N, Keadpudsa S, Egan JE, Pussadee K, Klaytong P, Reuel Friedman M, van Griensven F, Stall R. Psychosocial and Behavioral Characteristics of High-Risk Men Who Have Sex with Men (MSM) of Unknown HIV Positive Serostatus in Bangkok, Thailand. AIDS Behav 2016; 20:386-397. [PMID: 27553027 DOI: 10.1007/s10461-016-1519-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV prevalence remains high in men who have sex with men (MSM) in Bangkok. Even though resources for HIV testing and treatment are available for all, a large proportion of MSM still do not get HIV tested. We studied high risk MSM who are unaware of their HIV status to help maximize effectiveness of our resources. Convenience sampling was conducted among MSM who came for HIV testing at the Thai Red Cross Anonymous Clinic and two popular drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, have not been tested positive for HIV, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection diagnosis. Audio-Computer-Assisted Self-Interview was used to assess psychosocial profile, sexual risks, and HIV testing patterns prior to being informed of their HIV positive status. Among 499 high-risk MSM enrolled, the median age was 24.8 years and 112 (22 %) tested HIV-positive. Among the HIV-positive participants, 92 % self-identified as gay (versus bisexual), 39 % attained a bachelors degree or higher, 65 % had monthly income 10,000-29,999 baht ($280-830 USD), 10 % had vaginal or anal sex with a woman in the past 12 months, 39 % had condomless receptive sex with men and 21 % went to Lat Phrao to find a sexual partner. Compared to HIV negative MSM, HIV-positive MSM had less HIV testing: 31 % had ever been tested for HIV, 12 % had been tested in the past 6 months; but were more likely to guess correctly their positive status (31 %). Regarding psychosocial variables among HIV-positive MSM, 7 % had regular methamphetamine use in the past 3 months, 10 % had >2 sources of discrimination, and 8 % had >2 sources of discrimination due to being MSM. In multivariable model, age<30 year old, self-identified as gay, had monthly income <50,000 baht ($1400 USD), had anal sex with men in past 12 months, had >2 sources of discrimination because of being MSM, did not get HIV test in past 6 months, and guess of positive HIV were significantly associated with HIV positive status. Young MSM with lower socioeconomic status (SES) should be prioritized for innovative approaches to promoting awareness and uptake of HIV testing. Societal stigmatization of MSM should be addressed as a potential barrier to uptake of voluntary HIV testing. Resilience factors among these marginalized MSM who still test frequently and remain HIV-negative despite residing in a context with community viral loads and discrimination should also be studied in order to curb the HIV epidemic in Bangkok.
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HIV epidemics among transgender populations: the importance of a trans-inclusive response. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.3.21259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Wolf RC, Adams D, Dayton R, Verster A, Wong J, Romero M, Mazin R, Settle E, Sladden T, Keatley J. Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance. J Int AIDS Soc 2016; 19:20801. [PMID: 27431472 PMCID: PMC4949319 DOI: 10.7448/ias.19.3.20801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/13/2016] [Accepted: 04/25/2016] [Indexed: 01/17/2023] Open
Abstract
Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools - supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups - provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now.
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Affiliation(s)
- R Cameron Wolf
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA;
| | - Darrin Adams
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robyn Dayton
- Linkages across the Continuum of HIV Services for Key Populations, FHI 360 Durham, NC, USA
| | - Annette Verster
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Joe Wong
- Asia Pacific Transgender Network, Bangkok, Thailand
| | | | - Rafael Mazin
- Pan American Health Organization, Washington, DC, USA
| | - Edmund Settle
- United Nations Development Programme, Bangkok, Thailand
| | - Tim Sladden
- United Nations Population Fund, New York, NY, USA
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, CA, USA
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Phanuphak N, Lo YR, Shao Y, Solomon SS, O'Connell RJ, Tovanabutra S, Chang D, Kim JH, Excler JL. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials. AIDS Res Hum Retroviruses 2015; 31:1060-76. [PMID: 26107771 DOI: 10.1089/aid.2015.0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.
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Affiliation(s)
| | - Ying-Ru Lo
- HIV, Hepatitis, and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sunil Suhas Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Robert J. O'Connell
- Department of Retrovirology, U.S. Army Medical Component, Armed Forces Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jean Louis Excler
- U.S. Military HIV Research Program, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Abstract
PURPOSE OF REVIEW To benefit very early treatment for an HIV cure, HIV infection must be diagnosed immediately after infection. We review potential strategies for expansion of HIV testing in preparation for a potential HIV cure in the distant future. RECENT FINDINGS Very early antiretroviral therapy (ART) initiated during acute or early HIV infection may result in long-term viral control. Such strategies will require programmatic systems for very early diagnosis and very early ART. Yet, most HIV-infected individuals start treatment late and presumably are diagnosed late. Operational issues will have to address the treatment cascade much earlier starting from HIV testing, test result notification, posttest counseling, immunological and clinical assessment and ultimately starting treatment. Well designed implementation research studies are needed to determine effective interventions to diagnose HIV as early as during acute and early HIV infection. SUMMARY Approaches for earlier HIV diagnosis and very early ART for a potential functional HIV cure remain elusive unless early HIV diagnosis can be radically expanded.
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Colby D, Srithanaviboonchai K, Vanichseni S, Ongwandee S, Phanuphak N, Martin M, Choopanya K, Chariyalertsak S, van Griensven F. HIV pre-exposure prophylaxis and health and community systems in the Global South: Thailand case study. J Int AIDS Soc 2015; 18:19953. [PMID: 26198342 PMCID: PMC4509899 DOI: 10.7448/ias.18.4.19953] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/27/2015] [Accepted: 04/15/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is recommended by the World Health Organization as an effective method of HIV prevention for individuals at risk for infection. In this paper, we describe the unique role that Thailand has played in the global effort to combat the HIV epidemic, including its role in proving the efficacy of PrEP, and discuss the opportunities and challenges of implementing PrEP in a middle-income country. DISCUSSION Thailand was one of the first countries in the world to successfully reverse a generalized HIV epidemic. Despite this early success, HIV prevalence has remained high among people who inject drugs and has surged among men who have sex with men (MSM) and transgender women (TGW). Two pivotal trials that showed that the use of oral antiretroviral medication as PrEP can reduce HIV transmission were conducted partially or entirely at Thai sites. Demonstration projects of PrEP, as well as clinical trials of alternative PrEP regimens, began or will begin in 2014-2015 in Thailand and will provide additional data and experience on how to best implement PrEP for high-risk individuals in the community. Financing of drug costs, the need for routine laboratory monitoring and lack of awareness about PrEP among at-risk groups all present challenges to the wider implementation of PrEP for HIV prevention in Thailand. CONCLUSIONS Although significant challenges to wider use remain, PrEP holds promise as a safe and highly effective method to be used as part of a combined HIV prevention strategy for MSM and TGW in Thailand.
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Affiliation(s)
- Donn Colby
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sumet Ongwandee
- Bureau of AIDS, TB and STI, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Nittaya Phanuphak
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Michael Martin
- Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | | | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Frits van Griensven
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Division of Preventive Medicine and Public Health, University of California - San Francisco San Francisco, CA, USA;
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Cáceres CF, Mayer KH, Baggaley R, O'Reilly KR. PrEP Implementation Science: State-of-the-Art and Research Agenda. J Int AIDS Soc 2015; 18:20527. [PMID: 26198351 PMCID: PMC4581083 DOI: 10.7448/ias.18.4.20527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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van Griensven F, Holtz TH, Thienkrua W, Chonwattana W, Wimonsate W, Chaikummao S, Varangrat A, Chemnasiri T, Sukwicha W, Curlin ME, Samandari T, Chitwarakorn A, Mock PA. Temporal trends in HIV-1 incidence and risk behaviours in men who have sex with men in Bangkok, Thailand, 2006-13: an observational study. Lancet HIV 2015; 2:e64-70. [PMID: 26424462 DOI: 10.1016/s2352-3018(14)00031-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND HIV-1 incidence in men who have sex with men (MSM) is often difficult to estimate. We therefore assessed temporal trends in HIV-1 incidence and behavioural risk factors in MSM in Bangkok, Thailand, from 2006 to 2013. METHODS In this observational study, we used data for clients attending the Silom Community Clinic for voluntary counselling and testing (VCT) services and from the Bangkok MSM Cohort Study (BMCS) to investigate trends in HIV incidence per 100 person-years per quarter in both cohorts. During VCT, basic demographic data were gathered at registration. However, no behavioural risk data were gathered. In the BMCS, we gathered demographic and behavioural data at baseline and at regular study visits using audio computer-assisted self-interviewing. Questions were included about potential risk factors such as drug use, sexual practices, and how often condoms were used. We also analysed behavioural risk factors in the BMCS cohort, using a restricted cubic spline function for time. FINDINGS From 2006 to 2013, 8176 MSM came for VCT; 1999 (24%) clients were initially seronegative and returned for another test. 235 (12%) individuals seroconverted. The overall HIV-1 incidence was 5.5 per 100 person-years (95% CI 4.8-6.3), with an increasing trend (adjusted p=0.02). In the BMCS, 1372 people were seronegative at baseline; 1259 (92%) had more than one follow-up test and 238 (17%) seroconverted. The overall HIV-1 incidence was 5.3 per 100 person-years (95% CI 4.7-6.1), with an increase and then a decline (inverted U-shaped curve, p=0.0001). Individuals aged 21 years and younger were at significantly higher risk of HIV infection than were those aged 30 years and older in the in the VCT (rate ratio 2.29, 95% CI 1.88-2.78, p<0.0001) and BMCS cohorts (1.99, 1.50-2.65, p<0.0001). Overall, drug use (p=0.03), drug use to enhance sex (p=0.0006), use of drugs for erectile dysfunction (p<0.0001), and 100% condom use (p<0.0001) increased over time, whereas the proportion of individuals reporting receptive anal intercourse decreased (p=0.004). INTERPRETATION With a sustained high HIV-1 incidence and increasing drug use in MSM in Bangkok, we urgently need innovative and acceptable HIV prevention interventions, especially for young MSM. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Frits van Griensven
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Preventive Medicine and Public Health, University of California, San Francisco, CA, USA
| | - Timothy H Holtz
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Warunee Thienkrua
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wannee Chonwattana
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wipas Wimonsate
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Supaporn Chaikummao
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Varangrat
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Tareerat Chemnasiri
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wichuda Sukwicha
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Marcel E Curlin
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Taraz Samandari
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anupong Chitwarakorn
- Department of Disease Control, Thai Ministry of Public Health, Nonthaburi, Thailand
| | - Philip A Mock
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
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Zablotska IB, Whittaker B, de Wit J, Kamarulzaman A, Ananworanich J, Wright E, Poynten IM, Mayer K. Bringing new HIV infections to zero - opportunities and challenges offered by antiretroviral-based prevention in Asia, the Pacific and beyond: An overview of this special issue. Sex Health 2014; 11:97-100. [PMID: 25017549 DOI: 10.1071/sh14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 11/23/2022]
Abstract
This editorial to the special issue of Sexual Health on antiretroviral-based prevention of HIV infection is dedicated to showcasing research and practice in this area. It aims to promote debate regarding the potential of new antiretroviral-based prevention approaches and the challenges encountered in moving prevention innovations into the community. This special issue covers the breadth of innovative HIV prevention research, including that undertaken in the fields of epidemiology, clinical research, social and behavioural science, public health and policy analysis, and with special emphasis on Asia and the Pacific region. Most importantly, it provides an indication of how the region is progressing towards embracing new prevention approaches to combat HIV epidemics across the region.
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Affiliation(s)
- Iryna B Zablotska
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Bill Whittaker
- National Association of People with HIV (NAPWA), Sydney, NSW 2042, Australia
| | - John de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur 59990, Malaysia
| | | | - Edwina Wright
- The Alfred Hospital and Burnet Institute, Melbourne, Vic. 3004, Australia
| | - Isobel Mary Poynten
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Kenneth Mayer
- Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
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