The impact of Thailand's public health response to the HIV epidemic 1984–2015: understanding the ingredients of success

Siraprapasiri, Taweesap; Ongwangdee, Sumet; Benjarattanaporn, Patchara; Peerapatanapokin, Wiwat; Sharma, Mukta

doi:10.1016/s2055-6640(20)31093-1

Cited by 38 publications

(18 citation statements)

References 22 publications

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“…[10] In terms of treatment, the National Access to Antiretrovirals Program for People Living with HIV/AIDS (NAPHA) and the use of antiretroviral therapy (ART) combinations since the early 2000s has decreased viral transmission and increased the quality of life among HIVinfected patients by providing free of charge ART. [11][12][13][14][15][16] In the early 2000s, the heterosexual transmission had been contained resulting in a significant decline in the national incidence of HIV infection. [12] However, HIV transmission among MSM is growing rapidly.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15][16] In the early 2000s, the heterosexual transmission had been contained resulting in a significant decline in the national incidence of HIV infection. [12] However, HIV transmission among MSM is growing rapidly. In 2005, this transmission route contributed 22.6% of new infections and would be 33% in 2010 and 43% by 2015.…”

Section: Introductionmentioning

confidence: 99%

“…In 2005, this transmission route contributed 22.6% of new infections and would be 33% in 2010 and 43% by 2015. [17] A significant increase in the estimated HIV incidence among MSM was observed from 4.1% in 2003 to 7.7% in 2007 [12,18] to 9.2% in 2014 [12]. In 2015, six community-based clinics in the provinces of Bangkok, Chiang Mai, Chonburi and Songkhla, catering to MSM and transgender women, reported the prevalence of HIV infection among MSM at 15% and transgender women at 8.8%.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of HIV infection and related risk factors among young Thai men between 2010 and 2011

et al. 2020

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Introduction Understanding the current epidemiology of human immunodeficiency virus (HIV) infection in Thailand will facilitate more effective national HIV prevention programs. This study aimed to determine the prevalence and risk factors for HIV infection among young Thai men. Methods A total survey was conducted of Royal Thai Army new conscripts, participating in the national HIV surveillance in November 2010 and May 2011. Behavioral risk factors for HIV infection were determined using a standardized survey questionnaire in the total study population and men who have sex with men (MSM) subgroup. Results A total of 301 (0.5%) HIV infected young Thai men were identified from the total study population (63,667). Independent risk factors associated with HIV infection among the total study population included being single (adjusted Odds Ratio [AOR] 1.6, 95% Confidence Interval [CI] 1.1–2.2), having no formal education (AOR 6.5, 95% CI 2.3–18.4) or a bachelor’s degree (AOR 1. 8, 95% CI 1.0–3.0), engaging in bisexual (AOR 3.7, 95% CI 2.4–5. 6) or exclusively homosexual activity (AOR 14.4, 95% CI 10.4–19.8), having a history of Sexually Transmitted Infection (STI) (AOR 2.3, 95% CI 1.6–3.3) and having sex in exchange for gifts/money (AOR 2.0, 95% CI 1. 5–2.8). A total of 4,594 (7.9%) MSM were identified, of which 121 (2.6%) were HIV infected. The prevalence of HIV infection among MSM in urban (2.8%) and rural (2.4%) areas were relatively comparable ( p -value = 0.44). Of the identified MSM, 82.5% reported having sexual desire with females only. Risk factors associated with HIV infection in the MSM subgroup included living in the western region (AOR 3.5, 95% CI 1.2–10.4), having a bachelor’s degree (AOR 2.7, 95% CI 1.2–5.7), having a history of exclusive receptive (AOR 3.6, 95% CI 1.6–7.7) or versatile anal sex (AOR 4.7, 95% CI 3.0–7.5) and history of having sex in exchange for gifts/money (AOR 2.3, 95% CI 1.5–3.5). Conclusion The prevalence of HIV infection among young Thai men has continued to be below 0.5% in 2010 and 2011. High risk sexual activity, including MSM, played a major role in the HIV epidemic among this population. Effective HIV prevention programs should cover MSM who have heterosexual desire as well as having sex in exchange for gifts/money and be implemented in both urban and rural areas.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of HIV infection and related risk factors among young Thai men between 2010 and 2011

et al. 2020

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“…Access to medicine for HIV patients was improved when the universal ART program was implemented in 2006 [7] with the capacity of the Thai Government Pharmaceutical Organization (GPO) to produce generic ARVs [31]. The free and universal ART program for all PLHIV has arguably been one of the biggest contributors to preventing HIV/AIDS-related death in the past two decades, averting between 31,000 and 55,000 deaths per year between 2001-2014 [6].…”

Section: Discussionmentioning

confidence: 99%

“…The successes seen in combatting this disease come from the various rigorous policies adopted by the government since the 1990s, causing Thailand to be heralded as a leader in the prevention and treatment of HIV [6].…”

Section: Introductionmentioning

confidence: 99%

The Impact of HIV Spending on Health Outcomes in Thailand

Viriyathorn¹,

Sachdev²,

Wanwong³

et al. 2021

WJA

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Background: The Sustainable Development Goals commitment to Ending HIV/ AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. Methods: A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. Results: HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across uppermiddle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. Conclusion: Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.

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Molecular epidemiology of a primarily MSM acute HIV‐1 cohort in Bangkok, Thailand and connections within networks of transmission in Asia

et al. 2018

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IntroductionThailand plays a substantial role in global HIV‐1 transmission of CRF01_AE. Worldwide, men who have sex with men (MSM) are at elevated risk for HIV‐1 infection. Hence, understanding HIV‐1 diversity in a primarily Thai MSM cohort with acute infection, and its connections to the broader HIV‐1 transmission network in Asia is crucial for research and development of HIV‐1 vaccines, treatment and cure.MethodsSubtypes and diversity of infecting viruses from individuals sampled from 2009 to 2015 within the RV254/SEARCH 010 cohort were assessed by multiregion hybridization assay (MHAbce), multiregion subtype‐specific PCR assay (MSSPbce) and full‐length single‐genome sequencing (SGS). Phylogenetic analysis was performed by maximum likelihood. Pairwise genetic distances of envelope gp160 sequences obtained from the cohort and from Asia (Los Alamos National Laboratory HIV Database) were calculated to identify potential transmission networks.Results MHAbce/MSSPbce results identified 81.6% CRF01_AE infecting strains in RV254. CRF01_AE/B recombinants and subtype B were found at 7.3% and 2.8% respectively. Western subtype B strains outnumbered Thai B′ strains. Phylogenetic analysis revealed one C, one CRF01_AE/CRF02_AG recombinant and one CRF01_AE/B/C recombinant. Asian network analysis identified one hundred and twenty‐three clusters, including five clusters of RV254 participants. None of the RV254 sequences clustered with non‐RV254 sequences. The largest international cluster involved 15 CRF01_AE strains from China and Vietnam. The remaining clusters were mostly intracountry connections, of which 31.7% included Thai nodes and 43.1% included Chinese nodes.ConclusionWhile the majority of strains in Thailand are CRF01_AE and subtype B, emergence of unique recombinant forms (URFs) are found in a moderate fraction of new HIV‐1 infections. Approaches to vaccine design and immunotherapeutics will need to monitor and consider the expanding proportion of recombinants and the increasing genetic diversity in the region. Identified HIV‐1 transmission networks indicate ongoing spread of HIV‐1 among MSM. As HIV‐1 epidemics continue to expand in other Asian countries, transmission network analyses can inform strategies for prevention, intervention, treatment and cure.

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The impact of Thailand's public health response to the HIV epidemic 1984–2015: understanding the ingredients of success

Cited by 38 publications

References 22 publications

Prevalence of HIV infection and related risk factors among young Thai men between 2010 and 2011

Prevalence of HIV infection and related risk factors among young Thai men between 2010 and 2011

The Impact of HIV Spending on Health Outcomes in Thailand

Molecular epidemiology of a primarily MSM acute HIV‐1 cohort in Bangkok, Thailand and connections within networks of transmission in Asia

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