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

Pich Seekaew, Nittaya Phanuphak, Nipat Teeratakulpisarn, Sorawit Amatavete, Sita Lujintanon, Somsong Teeratakulpisarn, Tippawan Pankam, Oranuch Nampaisan, Pintip Jomja, Chotika Prabjunteuk, Prapaipan Plodgratoke, Reshmie Ramautarsing, Praphan Phanuphak, Pich Seekaew, Nittaya Phanuphak, Nipat Teeratakulpisarn, Sorawit Amatavete, Sita Lujintanon, Somsong Teeratakulpisarn, Tippawan Pankam, Oranuch Nampaisan, Pintip Jomja, Chotika Prabjunteuk, Prapaipan Plodgratoke, Reshmie Ramautarsing, Praphan Phanuphak

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.

Keywords: key and vulnerable populations; linkage to care; retention; treatment; viral suppression.

© 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

Figures

Figure 1
Figure 1
Flow of same‐day ART service at the Thai Red Cross Anonymous Clinic. All clients screened reactive for anti‐HIV were confirmed with two additional confirmatory anti‐HIV tests. Abbreviations: ART, antiretroviral therapy; CMV, cytomegalovirus; Crypto Ag, cryptococcal antigen; TB, tuberculosis.
Figure 2
Figure 2
Same‐day ART service cascade and time to ART initiation. Same‐day ART service cascade with total clients (n = 2427) as the denominator.
Figure 3
Figure 3
Time to ART initiation among eligible clients who accepted ART. Note: Time to ART initiation was measured as the time from seeing navigators and receiving confirmatory anti‐HIV results (care engagement) to ART initiation. The denominator was all eligible clients who accepted ART (n= 1729). The p‐value assessed the difference in duration of time to ART initiation between MSM, TGW and heterosexual clients. Abbreviations: MSM, men who have sex with men; TGW, transgender women.
Figure 4
Figure 4
Retention. Note: Screened clients were individuals who tested positive with the first anti‐HIV test (n=2427). Information regarding the screened clients is provided in Table A1. ART‐initiated clients were eligible individuals who accepted SDART service and initiated ART (n=1904 for month 3; n=1899 for month 6; and n=1898 for month 12). Abbreviations: M3, month 3; M6, month 6; M12, month 12.

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Source: PubMed

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