Sita Lujintanon

Johns Hopkins University

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Co-Authors

Nittaya Phanuphak

HIV Netherlands Australia Thailand Research Collaboration

Praphan Phanuphak

HIV Netherlands Australia Thailand Research Collaboration

Pich Seekaew

HIV Netherlands Australia Thailand Research Collaboration

Reshmie Ramautarsing

HIV Netherlands Australia Thailand Research Collaboration

Sorawit Amatavete

HIV Netherlands Australia Thailand Research Collaboration

Stephen Mills

Georgetown University

Sumitr Tongmuang

HIV Netherlands Australia Thailand Research Collaboration

Matthew Avery

Family Health International 360

Supakarn Sangtong

Thai Health Promotion Foundation

Sujittra Suriwong

HIV Netherlands Australia Thailand Research Collaboration

Cooperative Institutions

HIV Netherlands Australia Thailand Research Collaboration

Thai Red Cross Society

Johns Hopkins University

Chulalongkorn University

Institut de Recherche et d’Innovation

Bloomberg (United States)

University of California, San Francisco

Ministry of Public Health

University of Toronto

Washington University in St. Louis

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Differentiated service delivery for HIV treatment models in Thailand: A cross‐sectional assessment of real‐world implementation and uptake

Tropical Medicine & International Health (2023)

Sita Lujintanon Sorawit Amatavete Nuttawoot Photisan Sujittra Suriwong Preudtipong Noopetch

First, to describe the antiretroviral therapy (ART) delivery models available in Thailand to understand differentiated service delivery for further service system optimization and expansion of best practices; second, to determine the client characteristics associated with model uptake.Across-sectional assessment using secondary data was conducted to describe ART models implemented as routine services at four public hospitals in three major provinces with a high-HIV burden in Thailand. From April to October 2020, ART clients were screened consecutively according to the inclusion criteria: Thai, aged ≥18 years, and on ART for ≥6 months. HIV treatment models were categorised based on the service type, location, provider, and frequency. Logistic regression was used to identify the associated factors.Seven individual ART delivery models were identified: four were facility-based and three were out-of-facility. No group models were identified. Of 3,366 records of ART clients reviewed, 3,213 (95.5%) met the study criteria and received ART through the following models: conventional (32.6%), nurse-led clinical consultation (10.0%), fast-track refill (29.0%), after-hours clinic (10.6%), pharmacist-led pickup center (3.6%), key population-led community-based organisation (2.7%), and mailing (11.5%). Age, population, duration on ART, and viral load were associated with the uptake of certain alternative service models when compared to the conventional model.Among the variety of ART delivery approaches available in Thailand, facility-based models remain the most prevalent. Future work should investigate the role of client preference and choice in choosing service models and service utilisation patterns over time, and assess the acceptability and effectiveness of these models.

Cross-sectional study

10.1111/tmi.13872

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Perspectives of Transgender Women Toward Study Recruitment and Retention: Thematic Analysis from Thailand

Sexuality Research and Social Policy (2021)

Pich Seekaew Rena Janumnuaysook Sita Lujintanon Praditporn Pongtriang Siriporn Nonnoi

Thematic Analysis

10.1007/s13178-021-00579-6

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Citations (2)

Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment

Journal of the International AIDS Society (2019)

Pich Seekaew Supabhorn Pengnonyang Jureeporn Jantarapakde Ratchadaporn Meksena Thanthip Sungsing

Abstract Introduction Low uptake of HIV testing and services, including pre‐exposure prophylaxis (PrEP), in Thai men who have sex with men (MSM) and transgender women (TGW) may be due to the inaccuracy in self‐risk assessment. This study investigated the discordance between self‐perceived HIV risk and actual risk. Methods Data were obtained between May 2015 and October 2016 from MSM and TGW enrolled in key population‐led Test and Treat study in six community health centres in Thailand. Eligible participants were at least 18 years old, Thai national, had sex with men, had unprotected sex with a man in the past six months or had at least three male sex partners in the past six months, and were not known to be HIV positive. Baseline demographic behavioural characteristics questionnaires, including self‐perceived HIV risk, were self‐administered. Participants received HIV/STI (syphilis/gonorrhoea/chlamydia) testing at baseline. Participants who self‐perceived to have low risk, but engaged in HIV‐susceptible practices were categorized as having risk discordance (RD). Regression was conducted to assess factors associated with RD among MSM and TGW separately. Results Of the 882 MSM and 406 TGW participants who perceived themselves as having low HIV risk, over 80% reported at least one of the following: tested HIV positive, engaged in condomless sex, tested positive for a sexually transmitted infection sexually transmitted infection (STI; or used amphetamine‐type stimulants. Logistic regression found that living with a male partner ( p = 0.005), having never tested for HIV ( p = 0.045), and living in Bangkok ( p = 0.01) and Chiang Mai ( p < 0.001) were associated with increased risk discordance among MSM. Living with a male partner ( p = 0.002), being less than 17 years old at sexual debut ( p = 0.001), and having a low knowledge score about HIV transmission ( p < 0.001) were associated with increased risk discordance among TGW. However, for TGW, being a sex worker decreased the chance of risk discordance ( p = 0.034). Conclusions Future HIV prevention messages need to fill in the gap between self‐perceived risk and actual risk in order to help HIV‐vulnerable populations understand their risk better and proactively seek HIV prevention services.

Cross-sectional study

Transgender women

10.1002/jia2.25430

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Estimating the mortality risk correcting for high loss to follow-up among female sex workers with HIV in Durban, South Africa, 2018-2021

Annals of Epidemiology (2024)

Sita Lujintanon Harry Hausler Carly A. Comins Mfezi Mcingana Lillian Shipp

Female sex

10.1016/j.annepidem.2024.02.006

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THE ROLE OF LATE-LIFE SOCIAL PARTICIPATION IN THE RISK OF DEMENTIA: A LONGITUDINAL STUDY

Innovation in Aging (2024)

Xi Wang Sita Lujintanon Pablo Martinez Amezcua Jennifer Schrack

Abstract Social connectedness may prevent dementia in community-dwelling older adults. However, few studies have long-term follow-up and repeated assessments of social participation. We analyzed the data of adults aged 65 years and over in the United States from the National Health and Aging Trends Study (n = 5,893) from 2012 to 2019. We assessed social connectedness annually with questions about engagement in various activities (“Yes”/”No”), including visiting family/friends, attending religious services, organized activities, and going out for enjoyment. We created a binary composite variable indicating participation in at least one of the activities. Incident dementia was defined using the NHATS dementia algorithm (reported dementia diagnosis, AD8, and neurocognitive test results). We estimated the longitudinal association between social participation and dementia using generalized estimating equation models adjusted for characteristics measured in 2011 (one year before the first exposure assessment), including age, sex, race, marital status, educational attainment, household income, depressive symptoms, and self-rated health. Composite social participation was associated with lower odds of dementia (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.31, 0.54). Individually, visiting family/friends (0.53; [0.45, 0.63]), attending religious services (0.64 [0.55; 0.75]), participating in organized activities (0.74; [0.61, 0.89]), and going out for enjoyment (0.38; [0.32, 0.45]) were all associated with lower odds of dementia. Among community-dwelling older adults in the United States, multiple forms of social participation may be targets for dementia prevention interventions or serve as early markers of dementia risk.

Longitudinal Study

10.1093/geroni/igae098.3236

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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

Implementation Science Communications (2022)

Sita Lujintanon Sorawit Amatavete Supanat Thitipatarakorn Thanyawee Puthanakit Wipaporn Natalie Songtaweesin

Abstract Background Same-day antiretroviral therapy (SDART) initiation, in which people living with HIV (PLHIV) who are antiretroviral therapy (ART)-naïve, willing, and clinically eligible start ART on the same day of HIV diagnosis, has been implemented in several healthcare facilities in Thailand since 2017. This evidence-based practice has demonstrated increased ART uptake, virologic suppression, and retention in care. However, linkage to care gaps exist in community-based organizations (CBOs) in Bangkok whereby as much as 20% of key populations (KP), mainly men who have sex with men and transgender women, living with HIV were lost to follow-up pre-ART initiation. To increase access to and uptake of ART among these populations, this study proposes that trained KP lay providers should lead community-based ART (CB-SDART) initiation service. This protocol describes the combined use of the Proctor’s implementation outcome framework and the Consolidated Framework for Implementation Research to guide and evaluate the CB-SDART implementation. Methods This study follows the hybrid design type 3: it is an implementation trial that secondarily assesses service and client outcomes by comparative interrupted time series analysis. Five strategies have been formulated to meet three implementation outcomes (i.e., feasibility, fidelity, and sustainability): (1) developing stakeholder relationships by engaging the CBO leaderships, (2) training and educating KP lay providers, (3) adapting and tailoring SDART to CBO-specific context, (4) using evaluative and iterative strategies to assess adherence to standard operating procedures, and (5) developing stakeholder relationships by engaging external stakeholders. Teleconsultation with physicians and ART home delivery will be integrated as another ART initiation option for clients and allow service provision during the COVID-19 pandemic. A mixed-method assessment will be conducted on key stakeholders and PLHIV diagnosed at two implementing CBOs, Rainbow Sky Association of Thailand and Service Workers in Group Foundation, in Bangkok, Thailand. Discussion This implementation research may be the first to provide robust data at the implementation, service, and client levels to inform how to successfully task-shift SDART initiation service to trained KP lay providers and facilitate the expansion of CB-SDART in the future. Trial registration This trial was registered with the Thai Clinical Trial Registry as TCTR20210709004 on July 9, 2021.

10.1186/s43058-022-00352-9

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Citations (3)

Evaluation of the integration of telehealth into the same‐day antiretroviral therapy initiation service in Bangkok, Thailand in response to COVID‐19: a mixed‐method analysis of real‐world data

Journal of the International AIDS Society (2021)

Sorawit Amatavete Sita Lujintanon Nipat Teeratakulpisarn Supanat Thitipatarakorn Pich Seekaew

Abstract Introduction Same‐day antiretroviral therapy (SDART) initiation has been implemented at the Thai Red Cross Anonymous Clinic (TRCAC) in Bangkok, Thailand, since 2017. HIV‐positive, antiretroviral therapy (ART)‐naïve clients who are willing and clinically eligible start ART on the day of HIV diagnosis. In response to the first wave of the coronavirus disease 2019 (COVID‐19) outbreak in March 2020, telehealth follow‐up was established to comply with COVID‐19 preventive measures and allow service continuation. Here, we evaluate its implementation. Methods Pre‐COVID‐19 (until February 2020) clients who initiated SDART received a 2‐week ART supply and returned to the clinic for evaluation before being referred to long‐term ART maintenance facilities. If no adverse events (AEs) occurred, another 8‐week ART supply was provided while referral was arranged. During the first wave of COVID‐19 (March–May 2020), clients received a 4‐week ART supply and the option of conducting follow‐up consultation and physical examination via video call. Clients with severe AEs were required to return to TRCAC; those without received another 6‐week ART supply by courier to bridge transition to long‐term facilities. This adaptation continued post‐first wave (May–August 2020). Routine service data were analysed using data from March to August 2019 for the pre‐COVID‐19 period. Interviews and thematic analysis were conducted to understand experiences of clients and providers, and gain feedback for service improvement. Results Of 922, 183 and 321 eligible clients from the three periods, SDART reach [89.9%, 96.2% and 92.2% ( p = 0.018)] and ART initiation rates [88.1%, 90.9% and 94.9% ( p <0.001)] were high. ART uptake, time to ART initiation and rates of follow‐up completion improved over time. After the integration, 35.3% received the telehealth follow‐up. The rates of successful referral to a long‐term facility (91.8% vs. 95.3%, p = 0.535) and retention in care at months 3 (97.5% vs. 98.0%, p = 0.963) and 6 (94.1% vs. 98.4%, p = 0.148) were comparable for those receiving in‐person and telehealth follow‐up. Six clients and nine providers were interviewed; six themes on service experience and feedback were identified. Conclusions Telehealth follow‐up with ART delivery for SDART clients is a feasible option to differentiate ART initiation services at TRCAC, which led to its incorporation into routine service.

Telehealth

Thematic Analysis

Pandemic

10.1002/jia2.25816

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State-level variation in access to long-acting injectable antiretroviral therapy for HIV in the United States

Health Affairs Scholar (2025)

Lauren C. Zalla Tim Horn Sita Lujintanon Catherine R. Lesko

Abstract Long-acting injectable antiretroviral therapy (LAI-ART) is expected to improve health outcomes among persons with HIV. Yet, uptake has been slow and data on potential barriers to access are sparse. We used medication formulary data from state Medicaid and AIDS Drug Assistance Programs (ADAPs) to examine state-level variation in access to LAI-ART among uninsured and low-income persons with HIV. We identified substantial coverage gaps: cabotegravir/rilpivirine was not covered without prior authorization by 26 state Medicaid programs and not covered at all by 15 state ADAPs; lenacapavir was not covered without prior authorization by 32 Medicaid programs and not covered at all by 18 ADAPs. As a result of these gaps, many US persons with HIV are currently unable to access LAI-ART. Policies that increase access are needed to ensure the equitable distribution of LAI-ART. As states work to reduce supply and payment chain barriers, the US Department of Health and Human Services, notably its Centers for Medicare & Medicaid Services and the Health Resources and Services Administration, should provide increased federal assistance, guidance, and oversight to improve LAI-ART access among people with HIV.

Prior authorization

Expanded access

Formulary

Waiver

10.1093/haschl/qxaf016

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Client and provider preferences for HIV care: Implications for implementing differentiated service delivery in Thailand

Journal of the International AIDS Society (2021)

Sita Lujintanon Sorawit Amatavete Thanthip Sungsing Pich Seekaew Jitsupa Peelay

Abstract Introduction Differentiated service delivery (DSD) for antiretroviral therapy (ART) maintenance embodies the client‐centred approach to tailor services to support people living with HIV in adhering to treatment and achieving viral suppression. We aimed to assess the preferences for HIV care and attitudes towards DSD for ART maintenance among ART clients and providers at healthcare facilities in Thailand. Methods A cross‐sectional study using self‐administered questionnaires was conducted in September‐November 2018 at five healthcare facilities in four high HIV burden provinces in Thailand. Eligible participants who were ART clients aged ≥18 years and ART providers were recruited by consecutive sampling. Descriptive statistics were used to summarize demographic characteristics, preferences for HIV services and expectations and concerns towards DSD for ART maintenance. Results Five hundred clients and 52 providers completed the questionnaires. Their median ages (interquartile range; IQR) were 38.6 (29.8 to 45.5) and 37.3 (27.3 to 45.1); 48.5% and 78.9% were females, 16.8% and 1.9% were men who have sex with men, and 2.4% and 7.7% were transgender women, respectively. Most clients and providers agreed that ART maintenance tasks, including ART refill, viral load testing, HIV/sexually transmitted infection monitoring, and psychosocial support should be provided at ART clinics (85.2% to 90.8% vs. 76.9% to 84.6%), by physicians (77.0% to 94.6% vs. 71.2% to 100.0%), every three months (26.7% to 40.8% vs. 17.3% to 55.8%) or six months (33.0% to 56.7% vs. 28.9% to 80.8%). Clients agreed that DSD would encourage their autonomy (84.9%) and empower responsibility for their health (87.7%). Some clients and providers disagreed that DSD would lead to poor ART retention (54.0% vs. 40.4%), increased loss to follow‐up (52.5% vs. 42.3%), and delayed detection of treatment failure (48.3% vs. 44.2%), whereas 31.4% to 50.0% of providers were unsure about these expectations and concerns. Conclusions Physician‐led, facility‐based clinical consultation visit spacing in combination with multi‐month ART refill was identified as one promising DSD model in Thailand. However, low preference for decentralization and task shifting may prove challenging to implement other models, especially since many providers were unsure about DSD benefits. This calls for local implementation studies to prove feasibility and governmental and social support to legitimize and normalize DSD in order to gain acceptance among clients and providers.

Interquartile range

Cross-sectional study

10.1002/jia2.25693

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Citations (8)

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

Journal of the International AIDS Society (2021)

Pich Seekaew Nittaya Phanuphak Nipat Teeratakulpisarn Sorawit Amatavete Sita Lujintanon

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

10.1002/jia2.25869

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Citations (10)