Hepatitis B prevalence and associated factors in adults presenting for infection screening in northern Thailand

Background and aims: Hepatitis B is a leading cause of morbidity and mortality worldwide. In view of the World Health Organization 2030 targets, effective screening of chronic infection is crucial. We have assessed the prevalence and risk factors of hepatitis B surface antigen in adults presenting for screening. Methods: Free-of-charge and anonymous services for simultaneous hepatitis B, hepatitis C, human immunodeficiency virus and syphilis screening and counseling were provided in four facilities in northern Thailand. Analyses were performed separately in clients born before integration into the 1992 hepatitis B vaccine Thailand's Expanded Program on Immunization and in clients born afterwards. Results: Between October 2015 and August 2020, hepatitis B surface antigen prevalence was 7.2 % (185/2578) in clients born before 1992 (95 % confidence interval [CI] = 6.2%–8.2 %). In the multivariable analysis, characteristics independently associated with a higher risk of infection were being born male (adjusted odds ratio [aOR] = 1.49, 95 % CI = 1.10–2.01) and being part of a hill tribe (aOR = 1.65, 95 % CI = 1.01–2.70). Forty-two percent were unaware of their infection. In clients born in 1992 or afterwards, prevalence was 1.5 % (43/2933) (95 % CI = 1.1%–2.0 %) and characteristics independently associated with a higher risk were being born between 1992 and 1995 (aOR = 1.90, 95 % CI = 1.00–3.61), being born male (aOR = 2.60, 95 % CI = 1.34–5.07), being part of a hill tribe (aOR = 5.09, 95 % CI = 2.52–10.26) and having ever injected drugs (aOR = 4.33, 95 % CI = 1.23–15.24). Conclusions: Risk factor-based screening would miss many chronic hepatitis cases. Screening all adults once in their lifetime may be beneficial until the second generation of immunized infants have reached adult age

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 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

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 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

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