Implementation of a Test, Treat, and Prevent HIV program among men who have sex with men and transgender women in Thailand, 2015-2016

<div><p>Introduction</p><p>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).</p><p>Methods</p><p>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.</p><p>Results</p><p>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).</p><p>Conclusions</p><p>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.</p></div

Results of logistic regression analysis evaluating characteristics of HIV-uninfected participants in the test, treat, and prevent HIV program at Lerdsin and Thammasat University Hospitals who chose to start HIV pre-exposure prophylaxis (PrEP), Thailand, 2015–2016.

<p>Results of logistic regression analysis evaluating characteristics of HIV-uninfected participants in the test, treat, and prevent HIV program at Lerdsin and Thammasat University Hospitals who chose to start HIV pre-exposure prophylaxis (PrEP), Thailand, 2015–2016.</p

Knowledge and attitudes of test, treat, and prevent HIV program participants about HIV infection, antiretrovirals, and pre-exposure prophylaxis, Thailand, 2015–2016.

<p>Knowledge and attitudes of test, treat, and prevent HIV program participants about HIV infection, antiretrovirals, and pre-exposure prophylaxis, Thailand, 2015–2016.</p

Results of logistic regression analysis to evaluate characteristics of participants in the test, treat, and prevent HIV program associated with prevalent HIV infection, Thailand, 2015–2016.

<p>Results of logistic regression analysis to evaluate characteristics of participants in the test, treat, and prevent HIV program associated with prevalent HIV infection, Thailand, 2015–2016.</p

Results of logistic regression analysis evaluating characteristics of participants in the test, treat, and prevent HIV program with prevalent HIV infection who chose to start antiretroviral therapy (ART), Thailand, 2015–2016.

<p>Results of logistic regression analysis evaluating characteristics of participants in the test, treat, and prevent HIV program with prevalent HIV infection who chose to start antiretroviral therapy (ART), Thailand, 2015–2016.</p

Baseline characteristics of participants in the test, treat, and prevent HIV program, Thailand, 2015–2016.

<p>Baseline characteristics of participants in the test, treat, and prevent HIV program, Thailand, 2015–2016.</p

Mean duration of recency at cutoff ODn of 1.5 by subtype or geographic region as determined by bionomial regression method that uses all specimens without any exclusion criteria.

<p>Closed diamonds represent MDRI for different subtypes and vertical lines represent upper and lower 95% CI. The horizontal line represents overall mean MDRI of 130 days.</p

A: Changes in antibody avidity as measured by LAg-Avidity EIA post-seroconversion for all 259 seroconversion panels.

<p>For the purpose of these plots, midpoint of last negative and first positive dates for each panel was used as the seroconversion date to calculate days post-seroconversion (X-axis). B: Changes in avidity for 176 panels after exclusion of suboptimal panels as required by some methods. C: Changes in avidity as depicted for suboptimal panels that were excluded for some methods.</p

Summary of 7 different methods used for determination of mean duration of recent infection (MDRI, in days with 95% CI) at varying cutoffs on LAg-Avidity EIA with corresponding level of proportion false recent (PFR) classification.

<p>See Methods section for further details of different methods used^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0114947#t002fn002" target="_blank">*</a>}.</p><p>*Methods 1 = Balanced time & 0,w and w,365, midpoint SC; 2 = Balanced time & 0,w and w,365, uniform SC; 3 = Non-Parametric MLE; 4 = Linear Interpolation; 5 = Binomial Regression (A); 6 = Binomial Regression (B); 7 = Individual SC Panel Regression. See Methods section for further details.</p><p>Summary of 7 different methods used for determination of mean duration of recent infection (MDRI, in days with 95% CI) at varying cutoffs on LAg-Avidity EIA with corresponding level of proportion false recent (PFR) classification.</p

Country of origin, subtypes and specimens information for the seroconversion panels used in the study.

<p>Country of origin, subtypes and specimens information for the seroconversion panels used in the study.</p