THAC0403 Same-Day ART Initiation in HIV/STI Testing Center
THAC0403 Same-Day ART Initiation in HIV/STI Testing Center in Bangkok, Thailand: Initial Results From Implementation Research Pich Seekaew, MPH Program Officer PREVENTION The Thai Red Cross AIDS Research Centre (USAID Linkages Program), Thailand This work was made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR). The contents are the responsibility of the LINKAGES project and do not necessarily reflect the views of USAID, PEPFAR, or the United States Government. LINKAGES, a five-year cooperative agreement (AID-OAA-A-1400045), is led by FHI 360 in partnership with IntraHealth International, Pact, and the University of North Carolina at Chapel Hill. Presented at the 22nd International AIDS Conference Amsterdam, the Netherlands Authors Pich Seekaew1, Nipat Teeratakulpisarn1, Pongsakorn Surapuchong1, Somsong Teeratakulpisarn1,
Sorawit Amatavete1, Pintip Jomja1, Chotika Prabjunteuk1, Chonthicha Hanaree1, Watcha Chaison1, Prapaipan Plodgratoke1, Klayduean Singhaseni1, Danai Lingjongrat2, Surang Janyam3, Panus Na Nakorn1, Sutinee Charoenying4, Stephen Mills4, Ravipa Vannakit5, Praphan Phanuphak1, Nittaya Phanuphak1 Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 2Rainbow Sky Association of Thailand, Bangkok, Thailand, 3The Service Workers In Group Foundation, Bangkok, Thailand, 4FHI 360 and USAID LINKAGES Project, Bangkok, Thailand, 5Office of Public Health, U.S. Agency for International Development Regional Development Mission Asia, Bangkok, Thailand 1 Outline Background Program Design and Implementation Outcome Measures Challenges Whats Next? Background
Subpar performance on the 2nd and 3rd targets of UNAIDS 90-90-90 Bangkok: 57% and 79% for 2nd and 3rd 90, respectively Median CD4 at diagnosis is approximately 160 cells/mm 3. Long waiting time for baseline lab results 2 to 4 weeks Multiple preparatory visits prior to ART initiation Physician factors: Refuse to start treatment among those with high CD4 count Personal judgement on client readiness Complicated process of changing assigned hospital under health benefit scheme Objectives Describe Same-Day ART using Initiation Hub Model Assess feasibility of Same-Day ART
Examine if Same-Day ART service improves: ART uptake after HIV diagnosis Viral load suppression Primary Outcomes Same-Day ART (July 2017 April 2018) Acceptability Clinical characteristic Time period of ART initiation Linkage to care Viral load suppression Comparison with historical data (February 2015 to April 2017) Clients from Thai Red Cross Anonymous Clinic Thai Red Cross Anonymous Clinic Large HIV and STI testing
center Provides research-based HIV and STI services Stand-alone VCT with 150-200 HIV tests (~8% positive) per day Same-Day ART Eligibility Criteria Willing to start ART (non-coercive) ART Nave Able to come back for follow-up visit(s) Results from symptomatic screening/chest X-ray/Gene Xpert MTB/RIF not indicative of tuberculosis Results from symptomatic screening/cryptococcal antigen test not indicative of cryptococcal meningitis Symptomatic screening not indicative of serious opportunistic infections that would likely require hospital admissions
Same-Day ART Algorithm ART drug regimen: FTC/TDF + EFV Baseline tests: Creatinine Urinalysis CD4 count HBsAg Anti-HCV Syphilis serology ALT Chest X-Ray Cryptococcal Ag (CD<100 cells/mm3) ART Initiation Hub Model at the TRC Anonymous Clinic
Baseline Characteristics and Acceptability HIGH LEVELS OF ART ACCEPTABILITY ACCEPTABILITY STRATIFIED BY POPULATIONS (TRC Anonymous Clinic, Jul 2017 April 2018, Unpublished) Clinical Characteristic: CD4 Level (TRC Anonymous Clinic, Jul 2017 April 2018, Unpublished) ART Initiation Time Periods (TRC Anonymous Clinic, Jul 2017 April 2018, Unpublished)
ART Uptake After HIV Diagnosis 0.50 0.75 1.00 Cumulative Proportion of ART Initiation 0.25 Same-Day ART Standard Care PLHIV initiating Same-Day ART were 3.9 times more likely to start ART when compared to
standard of care arm (HR: 3.9; 95%CI: 3.7-4.2; p<0.001). 0.00 P-value <0.001 0 Number at risk Same-Day ART 1429 Standard Care 5373 60 152 2239 120 180
240 Time to ART initiation (days) 121 1787 115 1639 111 1557 300 360 111 1523
109 1502 (TRC Anonymous Clinic, Jul 2017 April 2018, Unpublished) Retention-in-Care After ART Initiation 89.64% were successfully referred to long-term ART site* Median (days) IQR: 56 (38-70) Among those who were not referred, 4 stopped ART (2 by
physician due to ART-related side effect) *Assessed among those who reached 75 days after ART initiation (TRC Anonymous Clinic, Jul 2017 April 2018, Unpublished) Viral Load Suppression 1.00 Cumulative Proportion of VL Suppression 0.25 0.50 0.75
Same-Day ART Standard Care 0.00 P-value <0.001 0 Number at risk Same-Day ART 181 Standard Care 2513 60 178 2507 120
180 240 Time to VL suppression (days) 147 2300 71 1566 11 901 300 11 674 93.9% of clients who received VL testing were virally
suppressed Median (days) IQR: 162.5 (130-188) PLHIV initiating Same-Day ART were 2.2 times more likely to be virally suppressed when compared to standard of care arm (HR: 2.2; 95%CI: 1.9-2.6; p<0.001). (TRC Anonymous Clinic, Jul 2017 April 2018, Unpublished) Challenges Labor intensive Essential baseline laboratories may not be available in some settings (e.g. Gene Xpert MTB/RIF, same-day CD4 result, Cryotococcal antigen test, etc.) Concerns from healthcare professionals Client readiness
Clinical safety Long-term data depends on referred ART sites Whats Next? Scaling up to other provinces in Thailand Need health systems that support an increase in number of PLHIV on ART (e.g. Key Population-led Differentiated Service Delivery) More data on: Long-term health implications of Same-Day ART Qualitative assessment (quality of life, patients readiness, providers readiness, etc.) Cost-effectiveness Acknowledgements Persons Living with HIV Thai Red Cross AIDS Research Centre
Money slot. Tuck-in tab. Glued Tabs. What Information should I put onto the net? Logo. Bar Code. Recycling. Charity Name. Appropriate images. Appropriate colour scheme. Connection tabs. ... Product Design Pre-Release Exam Preparation materials Last modified by:
These statutes lawful if: Do not conflict with Williams Act, and Do not unduly burden interstate commerce in violation of the Commerce Clause of the U.S. Constitution. Multinational Corporations Corporations that operate in many countries through: Branch offices Subsidiary corporations...
American Romantics: 1820-1865 A journey away from the corruption of civilization and the limits of rational thought and toward the integrity of nature and the freedom of the imagination. Romanticism A movement in literature that celebrated the individual. The name...
Bullying. Get older peers to serve as monitors and intervene. Develop school-wide rules and sanctions against bullying and post them is school. Form friendship groups for adolescents who are regularly bullied by peers. Incorporate the message of the antibullying program...
VI. A. Influenza Properties Member of the Orthomyxovirus family Enveloped RNA virus Two envelope proteins Hemagglutinin and Neuraminidase Segmented RNA 8 segments; packaged into helical nucleocapsids Antigenic variation & genetic exchange lead to the appearance of new strains; requires use...
What is the message of the political cartoon? I do… Immigration since World War II. Florida migration due to tourism, retirees, and immigration - from Cuba & other Caribbean nations. Impact large Hispanic population, 17% of population is over age...
Ready to download the document? Go ahead and hit continue!