Princess Prep

I’m delighted to hear PrincessPrEP that the donation of

Thai people for the Thai the ﬁrst key population-led model to deliver PrEP Red Cross“ Princess to key populations by key populations in Thailand Suddhararinatha HIV Prevention Fund has been used for setting up The Princess PrEP Project is a demonstration project initiated by the Thai Red the community-led“ PrEP Cross AIDS Research Centre (TRCARC) in collaboration with LINKAGES Thailand services to prevent HIV Project (managed by FHI 360), the Thailand Ministry of Public Health and the Thai among populations at Government Pharmaceutical Organization. The project receives funding support substantial risk. from the Thai Red Cross Princess Soamsawali HIV Prevention Fund and the United States Agency for International Development under the United States President’s Emergency Plan for AIDS Relief. HRH Princess Suddhanarinatha February 10, 2016

The Princess PrEP Project provides free PrEP services in six The three-year project, starting in January 2016, was set up high HIV prevalence provinces for members of key populations to celebrate the auspicious occasion of Her Royal Highness including men who have sex with men, transgender women, Princess Suddhanarinatha’s 60th birthday. Its aim is to generate female sex workers and people who inject drugs. Same- evidence to support the Thai government in issuing a concrete day HIV testing and PrEP services are provided by trained policy to de-medicalize PrEP by allowing trained CHWs who community health workers (CHWs), themselves members of are members of key populations to provide PrEP to individuals the key populations they serve, working for four community- who are at risk of HIV infection. This key population-led PrEP based organizations that collectively operate nine community services have contributed to almost half of all Thai PrEP users. health centers: Rainbow Sky Association of Thailand (RSAT) Thailand, subsequently, has included PrEP service into the in Bangkok, Chonburi, Ubon Ratchathani and Songkhla; country’s Universal Health Coverage in October 2019, becoming Service Workers in Group Foundation (SWING) in Bangkok the first country in Asia to scale up PrEP service at large. More and Chonburi; Caremat in Chiang Mai; and Mplus in Chiang Mai affordable PrEP is expected to increase its uptake in order to and Chiang Rai. TRCARC provides continuous capacity building meet the national target which is still far behind. to ensure that CHWs can provide HIV services in accordance with national standards.

2020 National PrEP target 12,000 11,330 143,948 Only 8% 11,000 receiving PrEP 117,984 MSM 10,000 9,209 TGW 14,021 PWID 9,000 2,734 Partners in 8,000 serodiscordant couples

PrEP users

T 7,000

r 6,000

u 5,000

e 48% v 4,000 ti of PrEP users

u 3,000 contributed by

u Princess PrEP C 2,000

1,000

0 Dec 2014 Jun 2015 Dec 2015 Jun 2016 Dec 2016 Jun 2017 Dec 2017 Jun 2018 Dec 2018 June 2019 October 2019

PrEP-30/PrEP-15 Princess PrEP National PrEP database INITIAL FINDINGS 17.6% In a serodiscordant relationship Since January 2016, a total of 11,330 individuals have accessed PrEP through the Princess PrEP 67.4% 46.2% Project, accounting for more than Have multiple Inconsistent partners condom use half of all reported Thai PrEP users in Thailand. The majority of these PrEP users had multiple partners of unknown HIV status, and half of users reported inconsistent condom use. Some PrEP users reported being in serodiscordant relationships, 10.5% 11.9% having been diagnosed with an STI or Previously Previously previous PEP use. To date, only 1 HIV diagnosed used PEP with STI seroconversion was identified despite self-reported full adherence to PrEP. 57.4% Partners with unknown HIV status

KP-LED PrEP SERVICE FLOW

HIV testing (Blood collection HIV+ for creatinine and HBsAg) Risk assessment Start ART and PrEP counseling immediately process HIV-

Routine appointment PrEP PrEP (HIV testing at least every 6 months) Willing to take More details Not willing to PrEP on PrEP take PrEP

eGFR <60 Referral to renal doctor, mL/min consider re-screening PrEP for PrEP, and HIV testing at least every 6 months Provide a monthly supply Discontinue PrEP PrEP of PrEP to start

eGFR >60 Month 1, month 3 mL/min and quarterly PrEP follow up

Continue PrEP