Background: 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 center using initiation hub model to examine its applicability and effectiveness. Methods: We collected data from the Thai Red Cross Anonymous Clinic in Bangkok, Thailand, from clients who were ART-naïve and could return for follow-up visits (logistical criteria). Baseline laboratory tests and chest x-ray were performed according to national guidelines, and clinical eligibility was determined based only on physical examination and chest x-ray finding. Acceptability and care linkage were assessed, as well as viral load (VL) suppression and retention in care three, six, and 12 months after ART initiation. Historical data from clients at the same venue between February 2015 to June 2017 were used to compare ART initiation after HIV diagnosis and VL suppression with SDART clients by using Cox proportional-hazards model. Findings: Between July 2017 and July 2018, 2,427 people tested HIV-positive at the clinic, and 2,107 met logistical criteria. Of these, 1,904 (90·4%) agreed to SDART. 1,624 (85·3%) were placed on ART, and 77·4% (1,251/1,624) received same-day initiation. 92·8% (1,198/1,291) were successfully referred to sustained ART sites. Retention at month three, six, and 12 was 93·3% (1,211/1,289), 89·0% (757/851), and 92·1% (70/76), respectively. When compared to historical data, the hazard ratios to ART initiation after HIV diagnosis and viral load suppression among SDART clients were 3·6 (95%CI:3·4-3·8;p<0·001), and 2·1 (95%CI:1·8- 2·3;p<0·001), respectively. Interpretation: Same-Day ART at a stand-alone HIV testing center in an urban setting in Bangkok, Thailand, is highly feasible, and improves ART uptake and viral load suppression. Funding Statement: The United States Agency for International Development (USAID), the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and the Thai Red Cross AIDS Research Centre. Declaration of Interests: All authors declare no competing interests related to this work.Ethics Approval Statement: This study was approved by the Institutional Review Board of Chulalongkorn University.
The World Health Organization (WHO) launched universal strategy in HIV prevention in 2012 called "Test & treat HIV prevention". (TATF) Test and Treat Follow-up is proposed to be a follow-up platform to support the follow-up of HIV carriers by integrating information technology approaches in fields of database, communication, and mobile application. TATF consists of three main modules: 1) The clinical module; 2) The laboratory module; and 3) The follow-up module that transfer data with each other on computer network. The Clinical module is a front office to collect a client data and medical record form registration process. The risk assessment data is fed into database by consulting process. The Laboratory module is scientific machine section to perform testing Anti-body HIV and CD4 testing with international standard to complete medical data. Follow-up module is a back office to contract to all HIV carriers using mobile technology under privacy policy. It is important to take standardize follow-up HIV carriers by using information technology platform. The TATF is intended to implement all HIV carriers in order to reduce new HIV infection and get into prompt medical treatment.
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
BACKGROUND: Since 2014, Thailand has recommend initiation of antiretroviral therapy (ART) immediately after HIV diagnosis, regardless of CD4 count.HIV treatment can prevent illnesses and deaths, avert new infections, and save costs.Achieving UNAIDS 90-90-90 targets by 2020 will enable Thailand to end the AIDS epidemic by 2030.Therefore, patients immediate consent to treatment to immediate ART treatment in people recently diagnosed with HIV are key to successful ART initiation and long-term adherence.We studied factors associated with acceptance of ART initiation among Thai people promptly after their HIV diagnoses.OBJECTIVES: To examine the prevalence and associated factors of consent to immediate initiation of antiretroviral therapy after HIV diagnosis among HIV-positive Thai patients.DESIGN: A cross-sectional descriptive study.SETTING: Anonymous Clinic, Thai Red Cross AIDS Research Centre.MATERIAL AND METHODS: This research is combination of quantitative and qualitative cross-sectional data collected for the purpose of identifying acceptance levels and associated factors with the initiation of ART treatment among people infected.A total of 216 participants were included in the study.Self-administered questionnaire and in-depth interviews were used to collect data from clients 18 years.Binary logistic regression was performed to assess factors related to immediate ART acceptance.RESULTS: Enrollment of participants was 216 and 95.40% indicating they were prepared to start ART immediately and had demonstrated acceptance of their condition and 4.60% chose to defer.61% were men who have sex with men, 31% were heterosexual, 2% were transgender women and 6% were bisexual men.Median (IQR) age was 29 (24-36) years; median (IQR) CD4 count was 274 (168-396) cells per cubic millimeter.72% had unprotected sex over the past 6 months, and 9% had HIV-associated symptoms/AIDS-defining illness.Median (IQR) HIV knowledge score was 12 out of 15 (11-13.5),74% were aware of possible adverse health outcomes and 85% knew about resistance development as a result of poor ART adherence.Multivariable analysis showed that education equal or higher than bachelor's degree increased acceptance of immediate ART initiation (aOR 0.71, 95%CI 0.008-0.645,P = 0.01).Having STI (aOR 7.822, 95%CI 1.374-44.534,P = 0.02) and obligation (aOR 0.157, 95%CI 0.032-0.770,P = 0.02) were significantly associated with ART acceptance.CONCLUSION: Acceptance of immediate ART after HIV diagnosis was very high among newly diagnosed HIV-positive clients at the Thai Red Cross Anonymous Clinic.Education, experience of STI and obligation consequences influenced ART acceptance.
