WEAB0104

Title

High acceptability and feasibility of same-day antiretroviral therapy services among HIV-positive adolescents in Bangkok, Thailand

Presenter

Pich Seekaew

Authors

P. Seekaew¹, W.N. Songtaweesin^2,3, T. Puthanakit^2,3, S. Amatavete¹, N. Teeratakulpisarn¹, P. Surapuchong¹, S. Teeratakulpisarn¹, T. Chinbunchorn¹, P. Jomja¹, C. Hanaree¹, P. Plodgratoke⁴, C. Saisaengjan⁵, K. Singhaseni¹, R. Meksena¹, S. Charoenying⁶, S. Mills⁶, R. Vannakit⁷, P. Phanuphak¹, N. Phanuphak¹

Institutions

¹Thai Red Cross AIDS Research Centre, PREVENTION, Bangkok, Thailand, ²Chulalongkorn University, Faculty of Medicine, Bangkok, Thailand, ³Chulalongkorn University, Center of Excellence in Pediatric Infectious Diseases and Vaccines, Bangkok, Thailand, ⁴Thai Red Cross AIDS Research Centre, Bangkok, Thailand, ⁵Thai Red Cross AIDS Research Centre, South East Asia Research Collaboration in HIV, Bangkok, Thailand, ⁶FHI 360 and LINKAGES, Bangkok, Thailand, ⁷USAID Regional Development Mission Asia, Office of Public Health, Bangkok, Thailand

Background: There has been an increase in global HIV incidence among adolescents; however, little is known about their care status after HIV diagnosis. Same-day antiretroviral therapy (SDART) services have shortened preparatory steps while maintaining close relationships with clients after ART initiation. This study aims to assess the acceptability and feasibility of SDART among adolescents.
Methods: Data were collected among HIV-positive clients aged 12-19 years at the Thai Red Cross Anonymous Clinic, the largest VCT clinic in Bangkok. Acceptability was self-reported. Baseline laboratory tests and chest X-rays were performed according to national guidelines. Physicians evaluated ART eligibility and initiated Tenofovir/Emtricitabine/Efavirenz, Nevirapine or Rilpivirine regimens on the day of diagnosis or as soon as clinically possible. Clients were screened for mental health problems as needed. ART was provided for 2 months and clients linked to long-term ART according to their health insurance scheme. Time from care engagement to ART initiation and retention in care were calculated.
Results: From July 2017-December 2018, 100 adolescents tested HIV-positive: 82% were men who have sex with men (MSM), 16% general population and 2% transgender women (TGW). 95% accepted SDART: 96.3% among MSM, 87.5% general population, and 100% of TGW. Median (IQR) CD4 was 311 (253-381) cells/mm³; 27.5% tested reactive for syphilis (rapid plasma reagin test). 79% had same-day ART initiation, another 17.8% within one week. Of 20 clients who had mental health screening, 4 had adjustment disorder, and 1 had major depressive disorder. Linkage to long-term ART sites was successful in 81.3%. Retention among those linked successfully at 3, 6, and 12 months was 91.4%, 86.8%, and 80% respectively. 78% (25/32) of clients were virally suppressed after 6-months of ART. Adolescents who were lost to follow-up had lower income (100% vs. 42.9% with monthly income ≤10,000 THB, p=0.042) than those retained.
Conclusions: The majority of newly diagnosed HIV-positive adolescents were MSM. Acceptability of SDART was high and almost 80% started ART on the day of diagnosis. However, to ensure engagement in long-term ART care, integrated mental health services and social support is needed for programs serving adolescents.

Go to Session