PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand.
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
BMC Public Health. 2019 Mar 21;19(1):328. doi: 10.1186/s12889-019-6645-0.
Based on government estimates from the Asian Epidemic Model, new infections among men who have sex with men (MSM) and transgender women (TGW) in Thailand are forecast to proportionally increase over time. Daily oral Pre-exposure prophylaxis (PrEP) protects against HIV acquisition when used as prescribed. The "Princess PrEP" program is the first key population-led (PrEP) initiative under Thai royal patronage with an aim to scale up countrywide implementation of PrEP.
Retention in and adherence to key population-led HIV PrEP services among HIV-uninfected Thai MSM and TGW was examined in four provinces: Bangkok, Chonburi, Chiang Mai, and Songkhla. HIV, HBsAg, creatinine tests, and self-administered questionnaires were performed during baseline measures. Participants were followed up after month 1, at month 3, then every 3 months. Correlates of nonadherence and loss to follow up at 1 month were assessed using linear regression models.
37.4% of the participants reported low adherence to services (≤ 3 pills/week or missed clinic schedule at month 1). Factors associated with low adherence included younger age (25 years and under) (adjusted odds ratio (aOR): 1.49, 95% confidence interval (95% CI: 1.01-2.21, p = 0.044), being a TGW (aOR: 2.2, 95% CI: 1.27-3.83, p = 0.005), and whether the participant had not previously accessed services at the clinic (aOR = 1.68, 95% CI: 1.03-2.76, p = 0.04). Additionally, participants in Chonburi (the only TGW site) showed significantly lower adherence than those in the other three provinces (aOR: 2.91, 95% CI: 1.55-5.45, p = 0.001).
Urgent, innovative interventions for early PrEP adherence support among vulnerable sub-populations such as younger users, TGW, and new clients are needed to maximize prevention strategy in Thailand.
基于政府对亚洲流行模型的估计，预计泰国男男性行为者（MSM）和跨性别女性（TGW）中的新感染病例将随着时间的推移呈比例增加。每日口服暴露前预防（PrEP）按规定使用可预防 HIV 感染。“Princess PrEP”计划是泰国皇家赞助的首个以关键人群为主导的（PrEP）倡议，旨在扩大全国范围内 PrEP 的实施。
在曼谷、春武里、清迈和宋卡四个省，对未感染 HIV 的泰国 MSM 和 TGW 参与关键人群主导的 HIV PrEP 服务的保留率和依从性进行了检查。在基线测量期间进行了 HIV、HBsAg、肌酐测试和自我管理问卷。参与者在第 1 个月、第 3 个月和每 3 个月后进行随访。使用线性回归模型评估第 1 个月时不依从和失访的相关因素。
37.4%的参与者报告服务依从性低（≤每周 3 片或第 1 个月错过诊所预约）。与低依从性相关的因素包括年龄较小（25 岁及以下）（调整后的优势比（aOR）：1.49，95%置信区间（95%CI：1.01-2.21，p=0.044）、跨性别女性（aOR：2.2，95%CI：1.27-3.83，p=0.005）和参与者是否之前未在诊所接受过服务（aOR=1.68，95%CI：1.03-2.76，p=0.04）。此外，在春武里（唯一一个 TGW 地点）的参与者表现出明显低于其他三个省的依从性（aOR：2.91，95%CI：1.55-5.45，p=0.001）。
需要针对年轻用户、跨性别女性和新客户等弱势群体开展紧急的、创新的早期 PrEP 依从性支持干预措施，以最大限度地提高泰国的预防策略效果。
