Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand

Nittaya Phanuphak; Thanthip Sungsing; Jureeporn Jantarapakde; Supabhorn Pengnonyang; Deondara Trachunthong; Pravit Mingkwanrungruang; Waraporn Sirisakyot; Pattareeya Phiayura; Pich Seekaew; Phubet Panpet; Phathranis Meekrua; Nanthika Praweprai; Fonthip Suwan; Supakarn Sangtong; Pornpichit Brutrat; Tashada Wongsri; Panus Rattakittvijun Na Nakorn; Stephen Mills; Matthew Avery; Ravipa Vannakit; Praphan Phanuphak

doi:10.1071/SH18065

RESEARCH ARTICLE (Open Access)

Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand

Nittaya Phanuphak ^A ^K , Thanthip Sungsing ^A , Jureeporn Jantarapakde ^A , Supabhorn Pengnonyang ^A , Deondara Trachunthong ^A , Pravit Mingkwanrungruang ^A , Waraporn Sirisakyot ^A , Pattareeya Phiayura ^A , Pich Seekaew ^A , Phubet Panpet ^B , Phathranis Meekrua ^C , Nanthika Praweprai ^D , Fonthip Suwan ^E , Supakarn Sangtong ^F , Pornpichit Brutrat ^G , Tashada Wongsri ^H , Panus Rattakittvijun Na Nakorn ^A , Stephen Mills ^I , Matthew Avery ^I , Ravipa Vannakit ^J and Praphan Phanuphak ^A

+ Author Affiliations

- Author Affiliations

^A PREVENTION, Thai Red Cross AIDS Research Centre, 104 Rajdumri Road, Pathumwan, Bangkok 10330, Thailand.

^B Rainbow Sky Association of Thailand, 1, 3 Ramkhamhaeng Road, Bangkapi, Bangkok 10240, Thailand.

^C Service Workers IN Group (SWING) Foundation, 3 Surawongse Road, Bangrak, Bangkok 10500, Thailand.

^D Sisters Foundation, 417/64-65 Central Pattaya Road, Banglamung, Chonburi 20150, Thailand.

^E Rainbow Sky Association of Thailand, 97 Nipatsongkroh 2 Road, Hat Yai, Songkhla 90110, Thailand.

^F MPlus Foundation, 142 Soi Chomchan, Muang, Chiang Mai 50200, Thailand.

^G SWING Foundation, 45/54 South Pattaya Road, Banglamung, Chonburi 20260, Thailand.

^H Caremat Foundation, 257/36 Suthep Road, Muang, Chiang Mai 50200, Thailand.

^I FHI 360 and LINKAGES Project, 19th Floor, Sindhorn Building, Wiresless Road, Pathumwan, Bangkok 10330, Thailand.

^J Office of Public Health, U.S. Agency for International Development Regional Development Mission for Asia, 25th Floor, Athenee Building, Wireless Road, Pathumwan, Bangkok 10330, Thailand.

^K Corresponding author. Email: nittaya.p@trcarc.org

Sexual Health 15(6) 542-555 https://doi.org/10.1071/SH18065
Submitted: 1 April 2018 Accepted: 19 June 2018 Published: 25 September 2018

Journal Compilation © CSIRO 2018 Open Access CC BY-NC-ND

Abstract

Background: No data are available on the feasibility of pre-exposure prophylaxis (PrEP) delivered by trained key population (KP) community health workers. Herein we report data from the KP-led Princess PrEP program serving men who have sex with men (MSM) and transgender women (TGW) in Thailand. Methods: From January 2016 to December 2017, trained MSM and TGW community health workers delivered same-day PrEP service in community health centres, allowing clients to receive one PrEP bottle to start on the day of HIV-negative testing. Visits were scheduled at Months 1 and 3, and every 3 months thereafter. Uptake, retention and adherence to PrEP services and changes in risk behaviours over time are reported. Results: Of 1467 MSM and 230 TGW who started PrEP, 44.1% had had condomless sex in the past 3 months. At Months 1, 3, 6, 9 and 12, retention was 74.2%, 64.0%, 56.2%, 46.7% and 43.9% respectively (lower in TGW than MSM at all visits; P < 0.001), with adherence to at least four PrEP pills per week self-reported by 97.4%, 96.8%, 96.5%, 97.5% and 99.5% of respondents respectively (no difference between MSM and TGW). Logistic regression analysis identified age >25 years, being MSM and having at least a Bachelors degree significantly increased retention. Condomless sex did not change over the 12-month period (from 47.2% to 45.2%; P = 0.20). New syphilis was diagnosed in 4.9% and 3.0% of PrEP clients at Months 6 and 12 (cf. 7.0% at baseline; P = 0.007). Among PrEP adherers and non-adherers, there were one and six HIV cases of seroconversion respectively, which resulted in corresponding HIV incidence rates (95% confidence interval) of 0.27 (0.04–1.90) and 1.36 (0.61–3.02) per 100 person-years. Conclusion: Our KP-led PrEP program successfully delivered PrEP to MSM and TGW. Innovative retention supports are needed, especially for TGW and those who are young or with lower education levels. To scale-up and sustain KP-led PrEP programs, strong endorsement from international and national guidelines is necessary.

Additional keywords: community health workers, key populations, key population-led health services, men who have sex with men, same-day pre-exposure prophylaxis, transgender women.

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