Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Institute of HIV Research and Innovation, Bangkok, Thailand.
J Int AIDS Soc. 2023 Feb;26(2):e26062. doi: 10.1002/jia2.26062.
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.
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.
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).
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.
在泰国，艾滋病毒流行集中在关键人群（KPs）中，特别是男男性行为者（MSM）和跨性别女性（TGW），因此试点了一种针对 KPs 的艾滋病毒服务提供模式。本研究评估了接受和拒绝 KP 主导的艾滋病毒治疗服务的客户的可接受性和保留率。
使用来自泰国三个社区组织（CBO）和三个医院的二级数据进行回顾性队列研究。KP 一线服务提供者接受培训，以提供艾滋病毒治疗服务，在此服务中，HIV 感染者 MSM 和 TGW 在 CBO 接受咨询和三个月的抗逆转录病毒治疗（ART）供应。年龄至少 18 岁、接受 ART 治疗至少 6-12 个月、无合并症/合并感染且病毒抑制的泰国 MSM 和 TGW 有资格并提供该服务。那些拒绝接受该服务的人通过医院提供的其他服务模式接受 ART 治疗，并作为对照组。
在 2019 年 2 月至 2020 年 2 月期间筛查的 220 名患者中，72%（159/220）符合条件，其中 146 名为 MSM，13 名为 TGW。总体而言，45%（72/159）接受了 KP 主导的服务。那些拒绝接受服务的人中有 98%（85/87）更喜欢在医院看医生。在 12 个月的随访后，接受治疗的患者中有 57%在 CBO 接受治疗，32%被转介回医院并在其他服务模式下接受治疗，10%成功转至其他医院，1%失访（LTFU）；那些拒绝接受治疗的患者中有 92%在医院提供的任何服务模式下接受治疗，5%成功转至其他医院，2%失访，1%死亡（p 值<0.001）。
尽管接受 KP 主导服务的患者对护理的可接受性和保留率中等，但总体而言，几乎所有患者都接受了护理。应提供多种服务模式，以满足 HIV 感染者的偏好和需求，以优化他们的护理参与度。
