Same‐day antiretroviral therapy initiation hub model at the Thai Red Cross Anonymous Clinic in Bangkok, Thailand: an observational cohort study

Abstract

Introduction WHO has recommended rapid antiretroviral therapy (ART) initiation, including same‐day ART (SDART). However, data on the feasibility in real‐world settings are limited. We implemented a cohort study at a stand‐alone HIV testing centre to examine its applicability and effectiveness. Methods Data were collected from the Thai Red Cross Anonymous Clinic in Bangkok, Thailand, between July 2017 and July 2018 from clients who were ART‐naïve and could return for follow‐up visits. Baseline laboratory tests and chest X‐ray were performed according to national guidelines, and clinical eligibility was determined based on physical examination and chest X‐ray findings. Primary outcomes were retention in care and viral load suppression at 3, 6 and 12 months. Results During the study period, 2427 people tested HIV positive. Of these, 2107 (2207/2427, 86.8%) met logistical criteria, and 1904 (1904/2427, 78.5%) agreed to SDART. One thousand seven hundred and twenty‐nine (1729/2427, 71.2%) were placed on ART, with 1257 received same‐day initiation and 1576 initiated ART within 7 days; 1198 clients were successfully referred to free, sustained ART sites. Retention among eligible clients who accepted SDART service at months 3, 6 and 12 was 79.8%, 75.2% and 75.3%, respectively. Conclusions Same‐day ART initiation hub model at a stand‐alone HIV testing centre in an urban setting in Bangkok, Thailand, is highly feasible and has a potential for scaling up. Clinical Trial Number NCT04032028

The Impact of Timing of Antiretroviral Therapy Initiation on Retention in Care, Viral Load Suppression and Mortality in People Living with HIV: A Study in a University Hospital in Thailand

“… 4 , 5 In our a university hospital setting, the timing of ART initiation with a median time from HIV diagnosis to ART initiation of 18 days resulted in a high proportion of HIV viral load undetectable of approximately 80% and higher than those in the same-day clinical trial in Thailand. 11 As mentioned, the proportion of individuals with HIV viral load suppression varies across the studies. In the setting with a high percentage of PLHIV with HIV viral load suppression, the effect of timing of ART initiation (eg, same-day or early) trends not to increase the proportion of individuals with HIV viral load suppression after same-day ART initiation.…”

“…It is comparable with the proportion of PLHIV who retained in care in the same-day ART initiation group in randomized controlled trials, and it is higher than those of the same-day ART initiation model in Thailand. 3 – 5 , 11 Additionally, in particular, clinical settings such as antenatal care, HIV testing, counseling, and ART service in the same site were more critical than same-day ART initiation. 12 Therefore, same-day ART initiation may not improve retention in every HIV care setting.…”

Key population-led community-based same-day antiretroviral therapy (CB-SDART) initiation hub in Bangkok, Thailand: a protocol for a hybrid type 3 implementation trial

“…The CB-SDART initiation hub model allows ART-naïve people living with HIV who are willing and clinically ready to start ART on the same day of HIV diagnosis or confirmatory test at the CBOs. CB-SDART has been adapted from the SDART initiation hub model at the Thai Red Cross Anonymous Clinic (TRCAC), implemented by the same study team [ 4 , 5 , 9 , 16 – 19 ]. The core components of SDART as shown in Table 1 remain the same, while the periphery components are modified to suit the community setting.…”

“…This EBP has proven to be efficient, with increased antiretroviral therapy (ART) uptake [ 2 , 4 ], virologic suppression, and retention in care [ 1 – 4 , 8 ]. While Thailand has implemented SDART initiation in several healthcare facilities since 2017 [ 4 , 5 , 9 ], only 80% of Thai people living with HIV were on ART [ 10 ], with an even lower percentage of 62% in Bangkok in 2019 [ 11 ]. Linkage to care gaps particularly exists in community settings.…”

“…A task-shifted, community-based approach in which the trained key population lay providers lead ART initiation under the supervision of physicians is a novel solution. While the effectiveness data of community-based ART initiation is emerging [ 15 ], most evidence of SDART implementation pertains to clinical outcomes [ 1 – 5 , 9 , 16 – 19 ], and evidence on implementation fidelity and intervention adoption variables that may influence the effects of SDART is lacking. Therefore, we designed a study to inform how to implement the community-based SDART (CB-SDART) initiation hubs at RSAT and SWING in order to improve acceptability and access to, increase uptake of, and overall accelerate ART initiation among key population living with HIV.…”