Correlates of nonadherence to key population-led HIV pre-exposure prophylaxis services among Thai men who have sex with men and transgender women

Pich Seekaew, Ezie Nguyen, Thanthip Sungsing, Jureeporn Jantarapakde, Supabhorn Pengnonyang, Deondara Trachunthong, Pravit Mingkwanrungruang, Waraporn Sirisakyot, Pattareeya Phiayura, Phubet Panpet, Phathranis Meekrua, Nanthika Praweprai, Fonthip Suwan, Supakarn Sangtong, Pornpichit Brutrat, Tashada Wongsri, Panus Rattakittvijun Na Nakorn, Stephen Mills, Matthew Avery, Ravipa Vannakit, Praphan Phanuphak, Nittaya Phanuphak, Pich Seekaew, Ezie Nguyen, Thanthip Sungsing, Jureeporn Jantarapakde, Supabhorn Pengnonyang, Deondara Trachunthong, Pravit Mingkwanrungruang, Waraporn Sirisakyot, Pattareeya Phiayura, Phubet Panpet, Phathranis Meekrua, Nanthika Praweprai, Fonthip Suwan, Supakarn Sangtong, Pornpichit Brutrat, Tashada Wongsri, Panus Rattakittvijun Na Nakorn, Stephen Mills, Matthew Avery, Ravipa Vannakit, Praphan Phanuphak, Nittaya Phanuphak

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: HIV prevention; Key population-led; MSM; PrEP adherence; Pre-exposure prophylaxis; Transgender women.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Research Committee/ Institutional Review Board (IRB) at Chulalongkorn University, Faculty of Medicine, Bangkok, Thailand. For this study, verbal consent was obtained from the participants upon enrollment of the Princess PrEP Program. Verbal consent was obtained instead of written consent, which was approved by the IRB, as HIV testing and PrEP dispensing were part of routine services provided by these community-based organizations. To ensure that the participants were adequately informed, each participant had to do the survey assessing their willingness and knowledge about PrEP. Participants with satisfactory results were provided PrEP. Clients who were not ready and/or declined any of the services were recorded, and did not received such services.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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