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Introduction Same‐day antiretroviral therapy (SDART) initiation has been implemented at the Thai Red Cross Anonymous Clinic (TRCAC) in Bangkok, Thailand, since 2017. HIV‐positive, antiretroviral therapy (ART)‐naïve clients who are willing and clinically eligible start ART on the day of HIV diagnosis. In response to the first wave of the coronavirus disease 2019 (COVID‐19) outbreak in March 2020, telehealth follow‐up was established to comply with COVID‐19 preventive measures and allow service continuation. Here, we evaluate its implementation. Methods Pre‐COVID‐19 (until February 2020) clients who initiated SDART received a 2‐week ART supply and returned to the clinic for evaluation before being referred to long‐term ART maintenance facilities. If no adverse events (AEs) occurred, another 8‐week ART supply was provided while referral was arranged. During the first wave of COVID‐19 (March–May 2020), clients received a 4‐week ART supply and the option of conducting follow‐up consultation and physical examination via video call. Clients with severe AEs were required to return to TRCAC; those without received another 6‐week ART supply by courier to bridge transition to long‐term facilities. This adaptation continued post‐first wave (May–August 2020). Routine service data were analysed using data from March to August 2019 for the pre‐COVID‐19 period. Interviews and thematic analysis were conducted to understand experiences of clients and providers, and gain feedback for service improvement. Results Of 922, 183 and 321 eligible clients from the three periods, SDART reach [89.9%, 96.2% and 92.2% (p = 0.018)] and ART initiation rates [88.1%, 90.9% and 94.9% (p

Background Viral hepatitis is highly prevalent among people living with HIV (PLHIV) and can lead to chronic liver complications. Thailand started universal hepatitis B vaccination at birth in 1992. We explored prevalence rates of hepatitis B and C and associated factors among PLHIV from same-day antiretroviral therapy (SDART) service at the Thai Red Cross Anonymous Clinic, Bangkok, Thailand. Methods We collected baseline characteristics from PLHIV enrolled in the SDART service between July 2017 and November 2019. Multivariate logistic regression was carried out to determine factors associated with positive hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV). Results We included a total of 4,011 newly diagnosed PLHIV who had HBsAg or anti-HCV results at baseline. Included were 2,941 men who have sex with men (MSM; 73.3%), 851 general population (21.2%), 215 transgender women (TGW; 5.4%), and 4 transgender men (0.1%). Median age was 27 years. Overall seroprevalence of HBsAg and anti-HCV were 6.0% and 4.1%, respectively. Subgroup prevalence rates were 6.2% and 4.7% among MSM, 4.6% and 2.4% among general population, and 9.3% and 3.7% among TGW. Factors associated with HBsAg positivity were being MSM (adjusted odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.13 to 2.40), being TGW (aOR 2.87, 95% CI 1.60 to 5.17), birth year before 1992 (aOR 2.32, 95% CI 1.69 to 3.16), CD4 count 3 (aOR 1.38, 95% CI 1.03, 1.86), and alanine aminotransferase ≥ 62.5 U/L (aOR 2.39, 95% CI 1.66 to 3.43). Factors associated with anti-HCV positivity were being MSM (aOR 2.11, 95% CI 1.26 to 3.55), age > 30 years (aOR 1.54, 95% CI 1.10 to 2.17), alanine aminotransferase ≥ 62.5 U/L (aOR 7.74, 95% CI 5.48 to 10.9), creatinine clearance

Introduction Differentiated service delivery (DSD) for antiretroviral therapy (ART) maintenance embodies the client‐centred approach to tailor services to support people living with HIV in adhering to treatment and achieving viral suppression. We aimed to assess the preferences for HIV care and attitudes towards DSD for ART maintenance among ART clients and providers at healthcare facilities in Thailand. Methods A cross‐sectional study using self‐administered questionnaires was conducted in September‐November 2018 at five healthcare facilities in four high HIV burden provinces in Thailand. Eligible participants who were ART clients aged ≥18 years and ART providers were recruited by consecutive sampling. Descriptive statistics were used to summarize demographic characteristics, preferences for HIV services and expectations and concerns towards DSD for ART maintenance. Results Five hundred clients and 52 providers completed the questionnaires. Their median ages (interquartile range; IQR) were 38.6 (29.8 to 45.5) and 37.3 (27.3 to 45.1); 48.5% and 78.9% were females, 16.8% and 1.9% were men who have sex with men, and 2.4% and 7.7% were transgender women, respectively. Most clients and providers agreed that ART maintenance tasks, including ART refill, viral load testing, HIV/sexually transmitted infection monitoring, and psychosocial support should be provided at ART clinics (85.2% to 90.8% vs. 76.9% to 84.6%), by physicians (77.0% to 94.6% vs. 71.2% to 100.0%), every three months (26.7% to 40.8% vs. 17.3% to 55.8%) or six months (33.0% to 56.7% vs. 28.9% to 80.8%). Clients agreed that DSD would encourage their autonomy (84.9%) and empower responsibility for their health (87.7%). Some clients and providers disagreed that DSD would lead to poor ART retention (54.0% vs. 40.4%), increased loss to follow‐up (52.5% vs. 42.3%), and delayed detection of treatment failure (48.3% vs. 44.2%), whereas 31.4% to 50.0% of providers were unsure about these expectations and concerns. Conclusions Physician‐led, facility‐based clinical consultation visit spacing in combination with multi‐month ART refill was identified as one promising DSD model in Thailand. However, low preference for decentralization and task shifting may prove challenging to implement other models, especially since many providers were unsure about DSD benefits. This calls for local implementation studies to prove feasibility and governmental and social support to legitimize and normalize DSD in order to gain acceptance among clients and providers.