Acceptability and retention of the key population‐led HIV treatment service for men who have sex with men and transgender women living with HIV in Thailand

Abstract

Introduction In Thailand, where the HIV epidemic is concentrated among key populations (KPs), particularly men who have sex with men (MSM) and transgender women (TGW), an HIV service delivery model tailored to KPs was piloted. This study evaluated the acceptability and retention of clients who accepted and declined the KP‐led HIV treatment service. Methods A retrospective cohort study was conducted using secondary data from three community‐based organizations (CBOs) and three hospitals in Thailand. KP lay providers were trained to lead HIV treatment service in which MSM and TGW living with HIV received counselling and a 3‐month antiretroviral therapy (ART) supply at CBOs. Thai MSM and TGW who were at least 18 years, on ART for at least 6–12 months, without co‐morbidities/co‐infections, and virally suppressed were eligible and offered the service. Those who declined received ART via other service models offered by the hospitals and served as a comparison group. Results Of 220 clients screened between February 2019 and February 2020, 72% (159/220) were eligible of which 146 were MSM and 13 were TGW. Overall, 45% (72/159) accepted the KP‐led service. Of those who declined, 98% (85/87) preferred to see the physician at the hospital. After 12 months of follow‐up, among those accepted, 57% were in care at the CBO, 32% were referred back to and in care in other service models offered by the hospital, 10% were successfully transferred out to other hospital and 1% were lost to follow‐up (LTFU); among those declined, 92% were in care in any service models offered by the hospital, 5% were successfully transferred out to other hospital, 2% were LTFU and 1% died ( p ‐value<0.001). Conclusions Despite moderate acceptability and retention in care at the CBO among the clients accepting the KP‐led service, almost all clients were engaged in care overall. Multiple service models that meet the preferences and needs of KPs living with HIV should be available to optimize engagement in care.

Differentiated service delivery for HIV treatment models in Thailand: A cross‐sectional assessment of real‐world implementation and uptake

“…The clinic managed approximately 3000 registered ART clients. HY has worked with a KP‐led community‐based organisation (CBO), Rainbow Sky Association of Thailand, under the key population‐led health service model [14–16].…”

Leaving no one behind? Addressing inequitable HIV outcomes by attending to diversity: A qualitative study exploring the needs of LGBTQI+ young people living with HIV in Zimbabwe

“…Although HIV prevalence data and other measures are underestimated due to the inaccessibility of services [4], key populations, and especially young people within these groups, are exposed to higher risk across each stage of the HIV care cascade (testing, early treatment, viral suppression) [8][9][10]. While there has been considerable research worldwide, reflecting the rich regional variability of issues that contribute to poor HIV-related health outcomes for adult key populations [11][12][13][14], there are comparatively fewer dedicated qualitative studies focusing on the different challenges and experiences of young people.…”

Community Preparedness, Acceptability, and Uptake of UTT Services in PHC Facilities

“…El-Sadr & Goosby [4] report that evidence indicates that there has been a decrease in morbidity and mortality and a reduction in new infection cases in the most severely affected countries, as more than 20 million people who are living with HIV have access to HIV treatment. Additionally, the UTT strategy has been seen as acceptable and held well among transgender women and men having sex with men at community-based organizations [1,5].…”