Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand

Abstract

Background No data are available on the feasibility of pre-exposure prophylaxis (PrEP) delivered by trained key population (KP) community health workers. Herein we report data from the KP-led Princess PrEP program serving men who have sex with men (MSM) and transgender women (TGW) in Thailand. Methods: From January 2016 to December 2017, trained MSM and TGW community health workers delivered same-day PrEP service in community health centres, allowing clients to receive one PrEP bottle to start on the day of HIV-negative testing. Visits were scheduled at Months 1 and 3, and every 3 months thereafter. Uptake, retention and adherence to PrEP services and changes in risk behaviours over time are reported. Results: Of 1467 MSM and 230 TGW who started PrEP, 44.1% had had condomless sex in the past 3 months. At Months 1, 3, 6, 9 and 12, retention was 74.2%, 64.0%, 56.2%, 46.7% and 43.9% respectively (lower in TGW than MSM at all visits; P<0.001), with adherence to at least four PrEP pills per week self-reported by 97.4%, 96.8%, 96.5%, 97.5% and 99.5% of respondents respectively (no difference between MSM and TGW). Logistic regression analysis identified age >25 years, being MSM and having at least a Bachelors degree significantly increased retention. Condomless sex did not change over the 12-month period (from 47.2% to 45.2%; P=0.20). New syphilis was diagnosed in 4.9% and 3.0% of PrEP clients at Months 6 and 12 (cf. 7.0% at baseline; P=0.007). Among PrEP adherers and non-adherers, there were one and six HIV cases of seroconversion respectively, which resulted in corresponding HIV incidence rates (95% confidence interval) of 0.27 (0.04–1.90) and 1.36 (0.61–3.02) per 100 person-years. Conclusion: Our KP-led PrEP program successfully delivered PrEP to MSM and TGW. Innovative retention supports are needed, especially for TGW and those who are young or with lower education levels. To scale-up and sustain KP-led PrEP programs, strong endorsement from international and national guidelines is necessary.

Linkages to HIV confirmatory testing and antiretroviral therapy after online, supervised, HIV self‐testing among Thai men who have sex with men and transgender women

“…These findings indicated that decentralization of ART service to non‐conventional service delivery sites, such as a KP‐led CBO where non‐judgemental services including HIV testing, PrEP and PEP are delivered by lay providers who are familiar with lifestyles and needs of these subgroups of KP, has high potential to support the roll‐out of HIV self‐testing . PrEP uptake among Online Group participants was comparable to previously reported uptake among MSM and TGW in Thailand . More than two‐thirds of our participants in the Offline and Online groups received services at the CBOs.…”

“…A study in Vietnam also demonstrated that linkages to HIV confirmatory testing and ART among MSM self‐testers, with support from MSM lay providers, could be as high as 91% and 90% respectively . These findings indicated that decentralization of ART service to non‐conventional service delivery sites, such as a KP‐led CBO where non‐judgemental services including HIV testing, PrEP and PEP are delivered by lay providers who are familiar with lifestyles and needs of these subgroups of KP, has high potential to support the roll‐out of HIV self‐testing . PrEP uptake among Online Group participants was comparable to previously reported uptake among MSM and TGW in Thailand .…”

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

“…Six articles had an exclusive focus on MSM as a target group [39][40][41][42][43][44]. Five articles had a focus on the combination of MSM and TGW [45][46][47][48][49]. One study focused exclusively on TGW [50], one on female sex workers (FSW) [51], one on men and women in a serodiscordant relationship [52], one on pregnant or postpartum women [53] and one study focused exclusively on youth (11-24 years old) at risk of HIV acquisition [54].…”

“…providing care adapted to the needs and demands of the community. These often included services for sexual health in general, including PrEP, and targeted TGW, MSM, FSW and youth in particular [49][50][51]54]. In policy reports of Kenya, Zimbabwe and South Africa, CHCs were mentioned as a possible PrEP delivery site tting their decentralisation strategy for the provision of PrEP [25,28,32,37].…”

“…One model in Thailand also described how peer lay providers screened for eligibility, sampled lab specimens, and provided PrEP regimens to users all at once [49]. The involvement of community workers or peers in PrEP delivery was therefore relatively more prevalent in records from LMICs.…”