Implementing the “Test and Treat” Approach in Thailand

Proposed by the World Health Organization in 2009 as a possible means of controlling the global HIV epidemic, the “test and treat” approach recommends voluntary annual or more frequent testing for HIV and immediate antiretroviral therapy for anyone found to be HIV-positive. With support from Merck, TREAT Asia is organizing educational activities in advance of a “test and treat” pilot study with men who have sex with men (MSM) and transgender women (TG) being conducted by the Thai Red Cross AIDS Research Centre in three provinces in Thailand: Bangkok, Ubon Ratchathani, and Lampang.

Modeling experiments have shown that the “test and treat” strategy has the potential to lower HIV incidence by reducing community viral load—a population-based measure of HIV virus levels in HIV-positive individuals in a local community. The strategy was given further validation by the landmark clinical trial known as HPTN 052, which showed that people with HIV who start treatment before their immune systems are moderately damaged are 96 percent less likely to transmit the virus to an uninfected partner.

As part of a community preparedness and consultation component leading up to the project, TREAT Asia held a forum in Bangkok in May 2012 to gauge MSM/TG community leaders’ interest in “test and treat” and discuss the potential benefits and limitations of the strategy.

Subsequent workshops at all three sites in June provided key partners with technical information and created an opportunity for exchanging ideas, addressing possible issues, and facilitating the engagement of community members in the study. Service provider attitudes toward MSM and TG were identified as a principal barrier to the uptake of HIV counseling and testing services among these communities. “Some providers have negative attitudes toward MSM and TG, and therefore they do not want to provide care to this group,” said Natchanon Srijan, coordinator of the Ubon Ratchathani Provincial Health Office. “As a result, some MSM and TG avoid returning to the clinics and pass this negative information on to their peers.”

To address this, two trainings on MSM and TG sensitivity and HIV counseling and testing are being conducted in October in Ubon Ratchathani and Lampang. The aim of the sessions is to build sensitivity and awareness of the sexual health needs of MSM and TG among nurses, pharmacists, medical technologists, and other staff who will be involved in the pilot study.

Results from the study will help to determine the acceptability of immediate treatment after diagnosis among MSM and TG, and may be used to inform future policy on the strategic use of “test and treat” in Thailand.