Thailand is a rapidly growing middle income country located in south-east Asia. With a population of nearly 70 million and a per capita GDP of $7,808 (2019), Thailand has been able to improve health and welfare services significantly, but this economic growth also has produced marked inequalities in standards of living. The quality of life for many citizens declined in the 1990s in part owing to problems created by the AIDS epidemic, and further exacerbated by the economic crisis that began in 1997. Today, Thailand’s economy is recovering from slow growth during the years since the 2014 coup.
After East and Southern Africa, Asia & the Pacific is the region with the largest number of people living with HIV, with Thailand having a large proportion of the region’s HIV positive people. In 2019 there were an estimated 470,000 people living with HIV in Thailand. According to UNAIDS, there are approximately 24,000 young people aged 15–24 years living with HIV in the country, accounting for nearly half of the 6,400 new HIV infections in 2019. Thailand’s HIV epidemic is concentrated among certain key populations, with those most affected being men who have sex with men sex workers, transgender people, migrants, prisoners and people who inject drugs.
While Thailand has made great strides in its AIDS response, such as providing antiretroviral therapy as part of universal health coverage, adolescents and young people living with HIV often fall out of care or do not receive the full support they need to remain on treatment. In Thailand, more than 1,000 hospitals around the country can provide HIV testing and treatment; however, access to these health services for key populations (KPs) is still very challenging due to stigma and discrimination in health care facilities. Targeted mobile outreach testing and community-based testing for KPs are recognized as effective methods to improve access to testing among KPs, but current evidence suggests relatively low HIV positive yields at a relative high cost.
Targeted Programmatic Support Across Countries (CDC1950)
(2020 – Present)
In September 2019, the U.S. Centers for Disease Control and Prevention (CDC) awarded AIHA a five-year grant, providing a vehicle by which AIHA can assist the CDC at the global and country level, in support of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. So far, this project has operated in 10 countries including the Dominican Republic, the Philippines, Haiti, Laos, Kenya, Tanzania, Nigeria, Zambia, and Guatemala, as well as Thailand.
HIV testing service (HTS) is a key entry point for those who are HIV positive to link to ARV initiation and care and to prevent further transmission; it also serves as a touch point for at-risk populations who are HIV negative to receive prevention packages such as PrEP. Successful HTS to test and identify new people living with HIV (PLHIV), link them to care, and/or provide at-risk populations with prevention packages requires increasing testing sites and finding effective testing modalities to reach them.
Partner and couple testing are encouraged among pregnant women. Data show that the testing rate is high, especially among steady partners. With great improvement for HTS globally, finding especially hard to reach people or KPs remains a challenge. WHO strongly recommends voluntary assisted HIV partner notification and testing services (APS) to be offered as part of a comprehensive package of testing and care to enhance testing efficiency and increase the treatment coverage. Improving APS has become the initial focus of AIHA’s activities in Thailand.
Activities completed to date include:
- An assessment of current approaches to partner index testing (APS) including highlighting barriers to and recommendations for conducting index testing in an ethical manner was completed in February at the Udon Thani Provincial Hospital. The Udon Thani regional hospital is one of the largest provincial hospitals in Thailand. They provide referral services to community hospitals from 20 districts;
- Recommendations provided to CDC Thailand and Ministry of Health in effective quality improvement (QI);
- Developed Quality Improvement Manual with a focus on human-centered approaches in supportive supervision activities to be used in health facilities. The Manual was launched in Bangkok in September 2020 with a group of national stakeholders;
- An on-line (due to COVID) Regional Learning Summit organized by AIHA in close collaboration with CDC Thailand and DAS in Bangkok in September that showcased successes and best practices from the Asia region on the subject of Index testing protocol.