Implementation and assessment of a model to increase HIV testing among men who have sex with men and transgender women in Thailand, 2011–2016

ABSTRACT

HIV testing among men who have sex with men (MSM) and transgender (TG) women remains low in Thailand. The HIV prevention program (PREV) to increase HIV testing and link those who tested HIV-positive to care provided trainings to peer educators to conduct target mapping, identify high risk MSM and TG women through outreach education and offer them rapid HIV testing. Trained hospital staff provided HIV testing and counseling with same-day results at hospitals and mobile clinics and referred HIV-positive participants for care and treatment. We used a standardized HIV pre-test counseling form to collect participant characteristics and analyzed HIV test results using Poisson regression and Wilcoxon rank sum trend tests to determine trends over time. We calculated HIV incidence using data from participants who initially tested HIV-negative and tested at least one more time during the program. Confidence intervals for HIV incidence rates were calculated using the Exact Poisson method.

From September 2011 through August 2016, 5,629 participants had an HIV test; their median age was 24 years, 1,923 (34%) tested at mobile clinics, 5,609 (99.6%) received their test result, and 1,193 (21%) tested HIV positive. The number of people testing increased from 458 in 2012 to 1,832 in 2016 (p < 0.001). Participants testing at mobile clinics were younger (p < 0.001) and more likely to be testing for the first time (p < 0.001) than those tested at hospitals. Of 1,193 HIV-positive participants, 756 (63%) had CD4 testing. Among 925 participants who returned for HIV testing, HIV incidence was 6.2 per 100 person-years. Incidence was highest among people 20–24 years old (10.9 per 100 person-years).

HIV testing among MSM and TG women increased during the PREV program. HIV incidence remains alarmingly high especially among young participants. There is an urgent need to expand HIV prevention services to MSM and TG women in Thailand.

KEYWORDS:

• HIV
• men who have sex with men
• transgender women
• HIV testing
• HIV incidence
• Thailand

Acknowledgements

We wish to thank all our participants, health care providers from Sabaidee clinic, Patong Hospital, Bangrak STI hospital, Bangkok, Chatapadung clinic, Khon Kaen hospital, and Napa clinic, Udonthani hospital, and peers and staff of the community-based organizations M-REACH, M-Friend, Fa Andaman, RSAT and SWING for their dedication and consistent support. All authors reviewed and approved the manuscript for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

ORCID

Chomnad Manopaiboon http://orcid.org/0000-0002-7412-3826

Additional information

Funding

This project has been supported in part by the U.S. President Emergency Plan for AIDS Relief (PEPFAR ) through the Centers for Disease Control and Prevention (CDC ) under the terms of 5 U2G GH000616.