SEATTLE – The first HIV vaccine trials to yield signs of hope happened here. Thailand was also the first Asian country to eliminate mother-to-child transmission of HIV. Now, Thailand has achieved the first part of UNAIDS’ 90-90-90 targets: 98 percent of people infected with HIV know their status. Of that, 70 percent are receiving HIV treatment, and of them, 83 percent are virally suppressed. Thailand is on the right path to achieve HIV epidemic control, Praphan Phanuphak of the Thai Red Cross AIDS Research Center said as he delivered the N’Galy Mann Lecture, because the country has not shied away from taking risks in their HIV response and employing innovative methods to reach the most high-risk groups – lessons that could be applied in the U.S., he said.
Those innovations include having members of the most affected communities leading outreach activities, including men who have sex with men, transgender women and sex workers, Phanuphak, who diagnosed the first HIV cases in Thailand during the 1980s, said. These community health workers tested half of all men who have sex with men and transgender women who were tested for HIV nationwide, and also detected 35 percent of all newly HIV-diagnosed individuals in these groups, Phanuphak said.
Key population-lead services are an innovation that could be adopted as part of the Department of Health and Human Service’s newly announced plan to end the epidemic in the U.S., Phanuphak said.
With funding from USAID and the President’s Emergency Plan for AIDS Relief, trained transgender heath care workers also provide HIV testing and other services to their peers at clinics providing hormonal therapy and other health services tailored for transgender women, Phanuphak said.
Another key to success was not waiting for guidance from the World Health Organization to scale-up key interventions, Phanuphak said. Thailand began to offer triple therapy for prevention of mother-to-child transmission in 2004, six years before the WHO issued recommendations.
Placing patients on antiretroviral therapy the same day they’re diagnosed with HIV has also improved retention to care and outcomes, Phanuphak said. Phanuphak and his colleagues at the Thai Red Cross Anonymous Clinic have found that of patients offered same-day HIV treatment, nearly 90 percent remain in care 12 months after treatment initiation and almost 90 percent achieve undetectable levels of HIV viral load. The Clinic has found that patients offered treatment the same day they are diagnosed are four times more likely to start HIV treatment and are two times more likely to be virally suppressed, Phanuphak said.
“Be innovative and dare to try new things,” Phanuphak said of the U.S. epidemic. “Use key population-led services in HIV hot spots in the U.S. and offer same-day antiretroviral therapy everywhere in the U.S.,” he said.
The next frontier is scaling up access to therapy to prevent acquiring the virus, Phanuphak said. The Thai government will include pre-exposure prophylaxis as part of their universal health program by the end of the year, he said.