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Introduction WHO has recommended rapid antiretroviral therapy (ART) initiation, including same‐day ART (SDART). However, data on the feasibility in real‐world settings are limited. We implemented a cohort study at a stand‐alone HIV testing centre to examine its applicability and effectiveness. Methods Data were collected from the Thai Red Cross Anonymous Clinic in Bangkok, Thailand, between July 2017 and July 2018 from clients who were ART‐naïve and could return for follow‐up visits. Baseline laboratory tests and chest X‐ray were performed according to national guidelines, and clinical eligibility was determined based on physical examination and chest X‐ray findings. Primary outcomes were retention in care and viral load suppression at 3, 6 and 12 months. Results During the study period, 2427 people tested HIV positive. Of these, 2107 (2207/2427, 86.8%) met logistical criteria, and 1904 (1904/2427, 78.5%) agreed to SDART. One thousand seven hundred and twenty‐nine (1729/2427, 71.2%) were placed on ART, with 1257 received same‐day initiation and 1576 initiated ART within 7 days; 1198 clients were successfully referred to free, sustained ART sites. Retention among eligible clients who accepted SDART service at months 3, 6 and 12 was 79.8%, 75.2% and 75.3%, respectively. Conclusions Same‐day ART initiation hub model at a stand‐alone HIV testing centre in an urban setting in Bangkok, Thailand, is highly feasible and has a potential for scaling up. Clinical Trial Number NCT04032028

Limited data are available on circumcision prevalence and acceptability among Thai men to prevent human immunodeficiency virus. Of 408 high-risk heterosexual men, 12.3% were circumcised. 14.2% and 24.9% expressed willingness to be circumcised before and after circumcision education, respectively. Neonatal circumcision acceptability was relatively high. One participant underwent circumcision at 3-month follow-up.

The long running debate about clinical trial sponsors’ responsibility for providing treatment to patients after a trial has ended does not seem likely to end soon. In September 2003 the World Medical Association postponed its decision about whether or not the Declaration of Helsinki should be revised to reflect concerns that the US government and the pharmaceutical industry have expressed about post-trial treatment. Paragraph 30 of the Declaration of Helsinki currently states: “At the conclusion of the study every patient entered into the study should be assured of access to the best proven prophylactic diagnostic and therapeutic methods identified by the study”. The proposed revision to paragraph 30 would introduce two main changes: that the physician should make every effort to see that patients receive treatment once it has been approved by appropriate authorities and that the physician is required to explicitly tell patients if they are unlikely to continue receiving treatment from sponsors after they leave the study. The ethical concerns over the undertaking of clinical trials in developing countries especially with respect to the standard of treatment that should be provided to trial participants have resulted in little research in countries where interventions are needed most. The initiation of preventative HIV vaccine trials has been delayed by debate about the provision of antiretrovirals to participants. (excerpt)