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Thitipatarakorn S, Teeratakulpisarn N, Nonenoy S, Klinsukontakul A, Suriwong S, Makphol J, Hongchookiat P, Chaya‐ananchot T, Chinlaertworasiri N, Mingkwanrungruang P, Sacdalan C, Poltavee K, Pankam T, Kerr SJ, Ramautarsing R, Colby D, Phanuphak N. Prevalence and incidence of anal high-grade squamous intraepithelial lesions in a cohort of cisgender men and transgender women who have sex with men diagnosed and treated during acute HIV acquisition in Bangkok, Thailand. J Int AIDS Soc 2024; 27:e26242. [PMID: 38695517 PMCID: PMC11064653 DOI: 10.1002/jia2.26242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored. METHODS Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits. RESULTS A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03-18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57-29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27-14.14), syphilis infection (aHR 4.67, 95% CI 1.10-19.90) and CD4 count <350 cells/mm3 (aHR 3.09, 95% CI 1.28-7.48). CONCLUSIONS With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.
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Affiliation(s)
| | | | | | | | | | - Jirat Makphol
- Institute of HIV Research and InnovationBangkokThailand
| | | | | | | | | | - Carlo Sacdalan
- SEARCH Research FoundationBangkokThailand
- Research AffairsFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | | | - Stephen J. Kerr
- HIV‐NATThai Red Cross AIDS Research CenterBangkokThailand
- Biostatistics Excellence CenterFaculty of MedicineChulalongkorn UniversityBangkokThailand
- The Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Donn Colby
- Institute of HIV Research and InnovationBangkokThailand
| | - Nittaya Phanuphak
- Institute of HIV Research and InnovationBangkokThailand
- Center of Excellence in Transgender HealthChulalongkorn UniversityBangkokThailand
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Thammajaruk N, Ramautarsing RA, Hiransuthikul A, Suriwong S, Tasomboon W, Thapwong P, Phunkron A, Saiwaew S, Sangpasert T, Pankam T, Avery M, Mills S, Phanuphak P, Phanuphak N. Pooled Pharyngeal, Rectal, and Urine Specimens for the Point-of-Care Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by Lay Providers in Key Population-Led Health Services in Thailand. Pathogens 2023; 12:1268. [PMID: 37887784 PMCID: PMC10609829 DOI: 10.3390/pathogens12101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Routine testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in people with heightened risk is lacking in Thailand. This study aimed to assess the performance of the Cepheid Xpert CT/NG assay, conducted by key population (KP) lay providers, for CT and NG detection on single-site and pooled specimens from the pharynx, rectum, and urine. Between August and October 2019, 188 men who have sex with men and 11 transgender women were enrolled. Participants collected urine specimens while trained KP lay providers obtained pharyngeal and rectal swabs. Compared to single-site testing with the Abbott RealTime CT/NG assay by medical technologists, the Xpert assay missed one pharyngeal NG infection out of 199 single-site specimens, giving a 93.3% sensitivity for pharyngeal NG and one missed pharyngeal NG infection out of fifty pooled specimens, giving an 88.9% sensitivity for pharyngeal NG. There was no discrepancy between the two assays for CT detection. The Cohen's Kappa coefficient of pooled specimen testing by the Xpert was 0.93 for NG and 1 for CT when compared to single-site testing by Abbott. Implementing pooled specimen testing by KP lay providers can be a cost-saving strategy to enhance the uptake of CT/NG services for populations facing increased risk.
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Affiliation(s)
| | | | - Akarin Hiransuthikul
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sujittra Suriwong
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Waranya Tasomboon
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Prasopsuk Thapwong
- The Service Workers In Group Foundation (SWING), Bangkok 10500, Thailand
| | - Atachai Phunkron
- The Service Workers In Group Foundation (SWING), Bangkok 10500, Thailand
| | - Somporn Saiwaew
- Rainbow Sky Association of Thailand (RSAT), Bangkok 10240, Thailand
| | | | - Tippawan Pankam
- Thai Red Cross Anonymous Clinic, Thai Red Cross AIDS Research Centre (TRCARC), Bangkok 10330, Thailand
| | - Matthew Avery
- USAID/EpiC Thailand project, FHI 360, Bangkok 10330, Thailand
| | - Stephen Mills
- USAID/EpiC Thailand project, FHI 360, Bangkok 10330, Thailand
| | - Praphan Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
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Lujintanon S, Amatavete S, Photisan N, Suriwong S, Noopetch P, Shanthachol T, Leenasirimakul P, Meechure J, Sangtong S, Sittikarn S, Phoopisutthisak P, Avery M, Mills S, Phanuphak N, Ramautarsing RA. Differentiated service delivery for HIV treatment models in Thailand: a cross-sectional assessment of real-world implementation and uptake. Trop Med Int Health 2023; 28:374-383. [PMID: 36938836 DOI: 10.1111/tmi.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVES First, to describe the antiretroviral therapy (ART) delivery models available in Thailand to understand differentiated service delivery (DSD) for further service system optimization and expansion of best practices; second, to determine the client characteristics associated with model uptake. METHODS Cross-sectional assessment using secondary data to describe ART models implemented as routine services at 4 public hospitals in 3 major provinces with a high HIV burden in Thailand. From April to October 2020, ART clients were screened consecutively according to the inclusion criteria: Thai, aged ≥18 years, and on ART for ≥6 months. HIV treatment models were categorized based on the service type, location, provider, and frequency. Logistic regression was used to identify the associated factors. RESULTS Seven individual ART delivery models were identified: 4 were facility-based and 3 were out-of-facility. No group models were identified. Of 3,366 records of ART clients reviewed, 3,213 (95.5%) met the study criteria and received ART through the following models: conventional (32.6%), nurse-led clinical consultation (10.0%), fast-track refill (29.0%), after-hours clinic (10.6%), pharmacist-led pickup center (3.6%), key population-led community-based organization (2.7%), and mailing (11.5%). Age, population, duration on ART, and VL were associated with the uptake of certain alternative service models when compared to the conventional model. CONCLUSIONS Among the variety of ART delivery approaches available in Thailand, facility-based models remain the most prevalent. Future work should investigate the role of client preference and choice in choosing service models and service utilization patterns over time, and assess the acceptability and effectiveness of these models.
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Affiliation(s)
- Sita Lujintanon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Institute of HIV Research and Innovation, Bangkok, Thailand
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Amatavete S, Lujintanon S, Teeratakulpisarn N, Thitipatarakorn S, Seekaew P, Hanaree C, Sripanjakun J, Prabjuntuek C, Suwannarat L, Phattanathawornkool T, Photisan N, Suriwong S, Avery M, Mills S, Phanuphak P, Phanuphak N, Ramautarsing RA. Evaluation of the integration of telehealth into the same-day antiretroviral therapy initiation service in Bangkok, Thailand in response to COVID-19: a mixed-method analysis of real-world data. J Int AIDS Soc 2021; 24 Suppl 6:e25816. [PMID: 34713623 PMCID: PMC8554221 DOI: 10.1002/jia2.25816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Same‐day antiretroviral therapy (SDART) initiation has been implemented at the Thai Red Cross Anonymous Clinic (TRCAC) in Bangkok, Thailand, since 2017. HIV‐positive, antiretroviral therapy (ART)‐naïve clients who are willing and clinically eligible start ART on the day of HIV diagnosis. In response to the first wave of the coronavirus disease 2019 (COVID‐19) outbreak in March 2020, telehealth follow‐up was established to comply with COVID‐19 preventive measures and allow service continuation. Here, we evaluate its implementation. Methods Pre‐COVID‐19 (until February 2020) clients who initiated SDART received a 2‐week ART supply and returned to the clinic for evaluation before being referred to long‐term ART maintenance facilities. If no adverse events (AEs) occurred, another 8‐week ART supply was provided while referral was arranged. During the first wave of COVID‐19 (March–May 2020), clients received a 4‐week ART supply and the option of conducting follow‐up consultation and physical examination via video call. Clients with severe AEs were required to return to TRCAC; those without received another 6‐week ART supply by courier to bridge transition to long‐term facilities. This adaptation continued post‐first wave (May–August 2020). Routine service data were analysed using data from March to August 2019 for the pre‐COVID‐19 period. Interviews and thematic analysis were conducted to understand experiences of clients and providers, and gain feedback for service improvement. Results Of 922, 183 and 321 eligible clients from the three periods, SDART reach [89.9%, 96.2% and 92.2% (p = 0.018)] and ART initiation rates [88.1%, 90.9% and 94.9% (p<0.001)] were high. ART uptake, time to ART initiation and rates of follow‐up completion improved over time. After the integration, 35.3% received the telehealth follow‐up. The rates of successful referral to a long‐term facility (91.8% vs. 95.3%, p = 0.535) and retention in care at months 3 (97.5% vs. 98.0%, p = 0.963) and 6 (94.1% vs. 98.4%, p = 0.148) were comparable for those receiving in‐person and telehealth follow‐up. Six clients and nine providers were interviewed; six themes on service experience and feedback were identified. Conclusions Telehealth follow‐up with ART delivery for SDART clients is a feasible option to differentiate ART initiation services at TRCAC, which led to its incorporation into routine service.
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Affiliation(s)
| | | | | | | | - Pich Seekaew
- Institute of HIV Research and Innovation, Bangkok, Thailand.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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