PROGRAM REPORT FORM
General: A report describing progress made in implementing the activity should be prepared at the mid- point of the activity on this form. The report should contain the information as requested in Parts I through IV in this form.
PART I. COVER SHEET This cover sheet is self-explanatory as it contains much of the same information found in the Proposal form and must be signed by the responsible officer.
Implementing Area 14 Provinces for MSM-TG, (Province): 4 Provinces for MSW, 1 Province for FSW, 7 Provinces for MW, and 12 Provinces for PWID Program Title: Stop TB and AIDS through RTTR (STAR)
Grant Number: THA-C-RTF Disease: TB/HIV principle-recipient: Raks Thai Foundation Grant Funds: Grant Signed Amount Up to the amount of US$22,278,214 (Twenty-Two Million Two Hundred Seventy-Eight Thousand Two Hundred and Fourteen US Dollar) or its equivalent in other currencies.
Report Period From: 1 April 2017 Report Period To: 31 December 2017 Date Report 5 April 2018 Submitted: Signature of Responsible officer / person for the program: Signature: …………………………………………… Name: Mr. Promboon Panitchpakdi Title: Executive Director Address: 185 Soi Pradipat 6, Pradipat Rd., Samsennai, Phayathai, Bangkok 10400, Thailand Tel.: +66 (0) 2265 6888 Ext. 30 Fax: +66) (0) 2271 4467 E-mail: [email protected]
Signature of Chief Financial officer / Person Signature: ………………………………………… Name: Ms. Supaluk Chumkrom Title: Director of Finance and Administration Address: 185 Soi Pradipat 6, Pradipat Rd., Samsennai, Phayathai, Bangkok 10400, Thailand Tel.: +66 (0) 2265 6888 Ext. 20 Fax: +66) (0) 2271 4467 E-mail: [email protected]
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PART II. PROGRAM SUMMARY: [The summary should not exceed two pages in length and should be treated as a self-contained document that can stand alone, without having to refer to any other document. It should include briefly program background, objectives, and planned-activities, accomplishments as of this reporting date, and summary table of target coverage in this report date.]
A. Program Background The HIV epidemic in Thailand has peaked and has been rapidly declining since 1992. AIDS related deaths have declined sharply since 2006, as a result of the scale up of ART. IBBS results and AEM trends in new infections have indicated that HIV prevalence is maintained at a low rate (2%) among venue-based female sex workers with decreasing numbers of new infection; still high (7-12%) among MSM/MSW with increasing numbers of infections; and stable but high (25%) among PWID with stable number of new infections. By the end of 2013, an estimated 451,258 people live with HIV in Thailand and 245,306 people have received ART. High prevalence is shown among PWID (over 20%) and MSM (8-25%) during the last five years. 90% of new adult HIV infections were transmitted through unsafe sex and 10% resulted from unsafe injecting drug use practice.
For TB, there has been a further decline in associated mortality, prevalence and incidence over the last five years. A prevalence survey was conducted in 2012-2013, but the final results are still not available. An external program review in 2013 identified several issues including: 1) low case notification among at- risk groups; 2) inefficient reporting and surveillance systems; 3) inadequate treatment outcomes; 4) lack of suitable care for migrants in need.
Under the Stop TB and AIDS through RTTR (STAR) program, there are two Principal Recipients (PRs) with a dual track financing scheme- the Department of Disease Control (DDC) as the government PR and the Raks Thai Foundation (RTF) as the civil society PR. PR DDC is primarily responsible for managing program implemented by government agencies and Sub Recipient World Vision Foundation Thailand (SR WVFT). Hence, PR DDC is accountable for the health system and for all activities on TB as well as activities for the migrant populations in Bangkok and Kanchanaburi. PR RTF focused on activities provided by civil society and direct implementation with Key Affected Populations (KAP) under the HIV component and on intensified case finding (ICF) for migrants.
A.1 Program Goal and Objectives Program Goal The program goal is to end AIDS in Thailand by 2030 (reducing annual new infections to below 1,000 cases (from the current 8,134 estimated new infections annually)) and to reduce the prevalence of TB from 159 per 100,000 to 120 per 100,000 between 2015 and 2019.
Program Objectives 1. To prevent the transmission of HIV and TB by sustaining intensive behaviour change activities, appropriate use of prophylaxis and the strategic use of anti-retroviral drugs. 2. Actively find HIV and TB cases in the community and health care settings by recruiting ‘at risk’ and ‘vulnerable populations’ into HIV testing and TB screening. 3. To ensure early and accurate diagnosis of both diseases by improving diagnostic capability, and reducing turn-around time (by using rapid HIV testing and molecular diagnostic techniques for TB) 4. To provide early treatment and ensure retention in care for all those diagnosed with HIV and/or TB. 5. To foster collaborative activities across HIV and TB programs at national and sub-national levels, and ensure sustainability by strengthening linkages between community and health systems. 6. To normalize HIV/TB and reduce stigma and discrimination.
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A.2 Program Implementation Area The STAR program is based on the national RRTTR (Reach- Recruit-Test- Treat- Retain) approach, aimed at optimizing network approaches and delivery models for increasing the uptake of services. STAR focused on the 38 highest HIV and TB disease burden provinces in Thailand. PR RTF provided strong community-based prevention and outreach, especially for HIV and TB prevention in 25 provinces. The PR RTF actively supported community system strengthening as an attempt to maintain sustainability of service provide to KAPs. Additionally, the PR RTF supported building mechanisms that reduce stigma and discrimination at all levels from KAPs to health service providers and policy makers. Under PR RTF the services were provided to five target groups of Key Affected Populations (KAPs) as: 1. Men who have Sex with Men (MSM) and Transgender (TG), 2. Male Sex Worker (MSW), 3. Female Sex Worker (FSW), 4. People Who Injected Drugs (PWID), and 5. Migrant Workers (MW)
Table A.2.1: STAR Program Implementation Area No. Province Region SR MSM/TG MSW FSW PWID MW-HIV MW-TB 1 Bangkok (BK) C RSAT SWING SWING OZONE WVFT under PR DDC RTF 2 Nonthaburi (NB) C RSAT 3 Pathum Thani (PA) C RSAT WVFT under PR DDC 4 Samut Prakarn (SP) C RSAT RTF RTF 5 Chonburi (CB) E RSAT SWING FAR 6 Trat (TT) E RTF 7 Rayong (RY) E FAR Kanchanaburi (KB) C PTR under PR DDC 8 Samut Sakhon (SA) C RTF 9 Nakhon Ratchasima (NA) NE B-FRIEND 10 Khon Kaen (KK) NE M-Reach 11 Udon Thani (UD) NE M-Friend 12 Ubon Ratchathani (UB) NE RSAT 13 Tak (TK) N OZONE WVFT under PR DDC 14 Chiang Rai (CR) N OZONE 15 Chiang Mai (CM) N M-PLUS M-PLUS TDN MAP CAREMAT CAREMAT OZONE 15 Chiang Mai (CM) N MPLUS MPLUS extended to Lampoon CAREMAT CAREMAT 16 Nakhon Si Thammarat S M-MOON (NS) 17 Phuket (PK) S RAPG RAPG WVFT under PR DDC Ranong (RN) S WVFT under PR DDC 18 Surat Thani (SR) S RTF 19 Trang (TR) S TDN 20 Narathiwat (NW) S OZONE 21 Pattani (PT) S OZONE 22 Phatthalung (PL) S TDN 23 Yala (YL) S OZONE 24 Satun (ST) S TDN 25 Songkhla (SK) S RSAT OZONE STM Total Provinces 14 4 1 12 13 7 provinces under PR RTF 6 provinces under PR DDC Remarks: N=North, NE = Northeast, C = Central, E = East, S = South
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The implementing agencies shown in Table 1 include the following organizations: Sub-recipients 1) Rainbow Sky Association of Thailand (RSAT) 2) Boyfriend Korat Group (BFK/B-FRIEND) through Nakhon Ratchasima Provincial Health Office (NA PHO) 3) M-Reach Group (MR/M-REACH) 4) M- Friend Group (MFU/M-FRIEND) 5) MPLUS Foundation (MPLUS/M-PLUS) 6) CAREMAT 7) M-Moon Network (MMN/M-MOON), terminated on 20 December 2017 8) Rung Andaman Phuket Group (RAPG), terminated on 31 October 2017 9) Service Workers in Group Foundation (SWING) 10) O-Zone Foundation (OZONE) 11) Thai Drug Users’ Network (TDN) 12) Foundation for AIDS Rights (FAR) 13) MAP Foundation for the Health and Knowledge of Ethnic Labour (MAP) 14) Stella Maris Seafarers Center Songkhla (STM)
Technical Assistant (TA) 1) Thai National AIDS Foundation (TNAF)
A.3 Key activities of Principle recipient and Sub-recipients
In this report, PR RTF separates program results into the following three reporting periods: Six months from 1 April 2016 to 30 September 2016, Twelve months from 1 October 2016 to 30 September 2017, Three months from 1 October 2017 to 31 December 2017
STAR program achieved the key activities listed as follows:
1) Outreach activities and VCCT uptake for KAPs: HIV outreach activities and testing for Key Affected Populations (KAPs) in the 25 provinces and TB performance in 7 provinces under PR RTF are shown in the table below. PR RTF’s performance is demonstrated in table A.3.1aFor reach and test of KPs in the six-month period of 1 April 2017 to 30 September 2017, PR RTF shares around 40% of total test target under the STAR program. These are the number of tested persons who received VCCT at a mobile clinic or HIV Testing Centre (HTC). The number also includes persons referred from CSO to VCCT services and completed the process at local hospital/ health service centre.
Table A.3.1a: PR RTF reach and test performance in 25 provinces during six-months of 1 April 2017 to 30 September 2017 HIV KAPs Number of persons Reached & Number of persons Tested Recruited
Target Result %Achievement Target Result %Achievement PR RTF as of 40% of PR-DDC
MSM/TG 55,912 34,411 61.54% 15,656 7,714 49.27%
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MSW 6,349 7,933 124.95% 2,160 2,149 99.49% FSW 3,183 3,318 104.24% 1,082 560 51.76%
PWID 6,826 2,678 39.23% 2,184 913 41.80%
Migrant (MW) 12,241 13,150 107.43% 2,351 2,724 115.87%
TB Target Result %Achievement
Number of 364 129 35.43% Migrant registered in TB all form Number of 218 98 44.95% Migrant successfully treated
Table A.3.1b shows the performance of KP’s reach and test for the fiscal year 2017 from 1 October 2016 to 30 September 2017.
Table A.3.1b: PR RTF reach and test performance in 25 provinces during twelve-months of 1 October 2016 to 30 September 2017 HIV KAPs Number of persons Reached & Recruited Number of persons Tested Target Result %Achievement Target Result %Achievement PR RTF as of 40% of PR-DDC MSM/TG 92,553 72,824 78.68% 25,916 15,528 59.92% MSW 14,105 16,302 115.58% 4,795 3,569 74.43% FSW 7,073 8,516 120.40% 2,405 1,049 43.62% PWID 13,646 8,590 62.95% 4,366 2,166 49.61% Migrant (MW) 22,729 27,236 119.83% 4,367 5,591 128.03% TB Target Result %Achievement Number of 725 232 32.00% Migrant registered in TB all form Number of 434 158 36.41% Migrant successfully treated
Table A.3.1c highlights the performance of KP’s reach and test for three-month of 1 October 2017 to 31 December 2017. In this reporting period, the performance is from 23 provinces since the PR RTF had terminated two SR contracts of SR-MMOON who works for MSM-TG in Nakhon Si Thammarat and SR-RAPG who works for MSM-TG and MSW in Phuket.
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Table A.3.1c: PR RTF reach and test performance in 23 provinces during three-months of 1 October 2017 to 31 December 2017 HIV KAPs Number of persons Reached & Recruited Number of persons Tested
Target Result %Achievement Target Result %Achievement PR RTF as of 40% of PR-DDC
MSM/TG 2,619 8,496 324.40% 731 2,056 281.26%
MSW 3,527 5,246 148.74% 1,200 1,188 99.00%
FSW 1,768 2,195 124.15% 601 297 49.42%
PWID 2,728 3,349 122.76% 875 414 47.31%
Migrant (MW) 6,994 7,068 101.06% 1,345 1,294 96.21%
TB Target Result %Achievement
Number of 217 17 7.83% Migrant registered in TB all form Number of 131 36 27.48% Migrant successfully treated
2) Commodity distribution for KAPs: 2.1 Condom and lubricant distribution to target population are shown in the below three tables according to the reporting periods. Table A.3.2a for the six-month period of 1 April 2017 to 30 September 2017. Table A.3.2b for the twelve-month period of 1 October 2016 to 30 September 2017, and Table A.3.2c for the three-month period of 1 October 2017 to 31 December 2017.
Notes: Condom distribution for MSM and MSW was lower than the target. SRs who received funding from USAID also distributed condoms supported by USAID grant to MSM-TG and MSW in Greater Bangkok, Songkhla, Chonburi, Ubon Ratchatani, Samut Prakarn, Nontaburi, Pratum Thani, and Chiang Mai.
Table A.3.2a: Number of condoms and lubricants provided to KPs during six-months of 1 April 2017 to 30 September 2017 KAPs Condom (piece) Lubricants (piece) Target Distribution Size 49 Size 52 Size 54 Size 56 Target Sachet Tube75 (all size) 5ml ml
MSM/TG 15,431,302 1,779,365 358,555 714,770 497,195 208,845 259,618 84,270 33,753 MSW 3,808,298 584,950 20,000 156,700 254,500 153,750 63,473 22,000 11,731
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FSW 1,909,710 222,000 0 58,000 106,000 58,000 31,829 0 5,880 PWID 354,796 134,098 52,216 81,882 0 0 0 0 0 MW 734,328 281,533 127,344 154,189 0 0 0 0 0 Grand Total 22,238,434 3,001,946 558,115 1,165,541 857,695 420,595 354,920 106,270 51,364
Table A.3.2b: Number of condoms and lubricants provided to KPs during twelve-months of 1 October 2016 to 30 September 2017 KAPs Condom (piece) Lubricants (piece) Target Distribution Size 49 Size 52 Size 54 Size 56 Target Sachet Tube75 (all size) 5ml ml
MSM/TG 25,545,379 3,478,795 642,200 1,471,445 933,355 431,795 429,437 412,340 66,245 MSW 8,462,880 1,014,510 70,000 310,700 381,060 252,750 141,054 22,000 20,396 FSW 4,243,800 492,000 44,000 114,000 233,500 100,500 70,730 0 9,500 PWID 709,592 245,799 94,362 151,437 0 0 0 0 0 MW 1,363,752 600,789 283,941 316,848 0 0 0 0 0 Grand Total 40,325,403 5,831,893 1,134,503 2,364,430 1,547,915 785,045 641,221 434,340 96,141
Table A.3.2c: Number of condoms and lubricants provided to KPs during three- months of 1 October 2017 to 31 December 2017 KAPs Condom (piece) Lubricants (piece) Target Distribution Size 49 Size 52 Size 54 Size 56 Target Sachet Tube75 (all size) 5ml ml
MSM/TG 723,343 584,252 117,478 238,570 136,374 91,839 12,169 42,290 12,092 MSW 2,115,722 281,500 0 126,000 89,500 66,000 35,263 38,000 5,680 FSW 1,060,950 154,000 0 74,000 54,000 26,000 17,683 60,000 0 PWID 141,918 73,966 29,584 44,382 0 0 0 0 0 MW 419,616 160,436 64,602 95,834 0 0 0 0 0 Grand Total 4,461,549 1,254,154 211,664 578,786 279,874 183,839 65,115 140,290 17,772
2.2 Needles and syringes distribution to PWID are shown in the following 3 tables, according to the reporting periods: Table A.3.3a for the six-month period of 1 April 2017 to 30 September 2017, Table A.3.3b for the twelve-month period of 1 October 2016 to 30 September 2017, and Table A.3.3c for the three-month period of 1 October 2017 to 31 December 2017
Note: 1 pack of N&S contains 5 sets of syringes and clean needles
Table A.3.3a: Number of needle and syringes provided to PWID during six-months of 1 April 2017- 30 September 2017 KAPs Target needle needle no. 25” needle no. 25” needle no. 27” needle no. 27” and syringe syringe 1ml syringe 3 ml syringe 1 ml syringe 1 ml fix (pack) (pack) detachable (pack) (pack) PWID 11,771 5,082 25,965 6,253 Total (pack) 49,071 Total (piece) 600,424 245,355
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From the result of six months from April - September 2017, needles and syringes (N&S) distribution to PWID in the reporting period was 91.62 piece/ person.
Table A.3.3b: Number of needle and syringes provided to PWID during twelve-months of 1 October 2016- 30 September 2017 KAPs Target needle needle no. 25” needle no. 25” needle no. 27” needle no. 27” and syringe syringe 1ml syringe 3 ml syringe 1 ml syringe 1 ml fix (pack) (pack) detachable (pack) (pack) PWID 24,241 10,748 51,515 19,149 Total (pack) 105,653 Total (piece) 1,200,848 528,265
From the result of 2016 fiscal year, needles and syringes (N&S) distribution to PWID in the reporting period was 61.49 piece/ person /year.
Table A.3.3c: Number of needle and syringes provided to PWID during three-months of 1 October 2017- 31 December 2017 KAPs Target needle needle no. 25” needle no. 25” needle no. 27” needle no. 27” and syringe syringe 1ml syringe 3 ml syringe 1 ml syringe 1 ml fix (pack) (pack) detachable (pack) (pack) PWID 6,293 3,776 13,978 5,938 Total (pack) 29,985 Total (piece) 240,170 149,925
From the result of three months from October - December 2017, needles and syringes (N&S) distribution to PWID in the reporting period was 44.76 piece/ person.
Rapid test kits for VCCT, which were the 1st RDT procured by PR DDC, expired on 15 December 2017. PR RTF suggested that all SRs should borrow from local hospitals or other projects for the testing of KAPs on World AIDS Day (1 December 2017).
3) Record and Reporting system Real Time Cohort Monitoring (RTCM) is a program data record system that was developed and used since February 2017. The Bureau of AIDS, TB and STI (BATs) has developed a new version of RTCM, called RTCM plus (RTCM+). Program data of all KAPs can be recording to the RTCM+. The RTCM+ will be functional by April 2018. During the reporting period, all implementing sites used RIHIS Reach, RIHIS Test and the old version of RTCM. However, the RTCM+ does not yet support the complete cascade of RRTTR. BATs needs to promptly act to link RTCM+ with the National AIDS Program (NAP). PR RTF developed an online platform to reach out to MSM and TG. It is an application named “Loveapp”. It could be downloaded by bothiOS and android users. The users need to search for Raks Thai Foundation as the developer. PR RTF is currently changed the searching word to Loveapp. The application provides knowledge on HIV and AIDS, information of health facilities, as well as a list of questions for MSM and TG’s self-assessment on their risk behaviors. In 2018, all MSM and TG implementation sites will be recommended to use this application. PR RTF initially developed website to disseminate knowledge of HIV/AIDs and TB. The website is www.atfocus.info This website is planned to disseminate program information as well as present program data. The program data will be generated from a single digital platform which will be designed in 2018.
4) Capacity building activities: PR RTF organized several trainings on organization development for PR and SR staff on four topics including1) Effective writing, 2) Powerful presentation, 3) Sales strategy, and 4) Proposal
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development. PR RTF also conducted additional training on risk and fraud mitigation including group workshops and individual SR self-assessments on fraud and risk. The result of the training is reporting of SRs risk mitigation plan which will be monitored in 2018. Routine monitoring of SRs managerial skills, including financial and programmatic, has been provided to all SRs by the Technical Assistance (TA) team of PR RTF who are based at provinces and regions. PR RTF central office performed TA functions for SRs based in the central region and provided coaching for regional TAs. Commissioned external consultants, PR RTF developed RRTTR curriculum for CSOs. Three curriculum were developed and tailored to MSM and TG, PWID, and Migrant. The PR planned to exercise the RRTTR training for all SRs in 2018.
4.1 Coordination and collaboration activities: Meetings between two PRs were organized on a monthly basis to discuss and update challenges of the program. PR RTF and PR DDC took turn to host the meeting. PR RTF organized seven Joint Steering Management Committee (JSMC) meetings: i) JSMC meeting with SRs MSM, MSW, FSW on 13-14 July 2017, 19-20 October 2017, and 18-19 December 2017, ii) JSMC meetings with SRs MW on 18-19 July 2017 and on 7-8 November 2017, and iii) JSMC meeting with SRs PWID 20-21 July 2017 and on 9-10 November 2017. Six PR and SR staff attended the 25th International Harm Reduction Conference in Montréal, Canada during 14 -17 May 2017. The participants came back and updated their learnings on harm reduction programs for PR and SR. PR RTF continues to disseminate information, communication and viral materials, as well as publications of the program to SRs and general public on www.facebook/STARproject As of 31 December 2017, PR-RTF concluded activities in 12 provinces for MSM-TG and handover the area to PEPFAR supporting grant. SR-FAR also commenced close-out of implementation for migrants in two provinces, Chonburi and Rayong, as the organizational strategy has tailored to focus only S&D and policy advocacy. Using the CAT tool from the Global Fund, PR RTF conducted SR capacity assessments to prepare for the 2018-2020 grant implementation. For Governance & Program and M&E assessment, PR staff carried out the work, however, for procurement and financial assessment, an external assessor team was hired. The assessment result was scored by PR RTF and external assessor. PR plans to hire an external consultant to finalized the CAT report in April 2018.
4.2 Operational research: The study on Assessment to Enabling Environment and Harm Reduction Advocacy Policy in Thailand was contracted and conducted by an external consultant. The purpose of the research aims to provide recommendations to improve both Environmental System and Harm Reduction Advocacy Policy in Thailand. The recommendations were based on international practices and applied to the Thailand context. The recommendations will be considered for PWID program re- design and development process to accelerate ongoing efforts toward reaching the goals and plan for a long-term sustainable program, especially on Harm Reduction policy. The report is being reviewed and will be finalized by June 2018.
A study on Gender Equality, Gender Sensitivity and Gender-Based Violence was commissioned by PR RTF. An external consultant identified key gender equality, gender sensitivity and GBV issues that are cross cutting or population specific under the STAR program. The recommendations are expected to address effective program integration of these issues. An appropriated assessment tool will be developed as a result of the study, so the program can further integrate gender equality or avoid the GBV in the program service to KAPs.
4.3 Policy and Advocacy activities:
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After the Harm Reduction (HR) strategy was announced on 17 February 2017 for its implementation in 37 provinces, PR and SR collaborated with ONCB to strengthen mechanisms for HR monitoring. A committee was set up for the HR monitoring, at the national and provincial level. The committee at the national level is well informed and ready for its function. However, the provincial committee has a challenge to foster an active mechanism for HR monitoring. CSOs are requested to play a crucial role to support the HR communication and ensure its effective implementation. PR RTF contacted Thai International Certified Assessment Co., Ltd (TICA) to study and develop standards for Civil Society Organizations (CSO’s Accreditation Standard). TICA conducted site visits to ten CSOs, registered and non-registered from community networks to foundation. The draft Standard and mechanism for accreditation has been proposed. The draft CSO standard included six principles: i) organizational management, ii) strategic plan, iii) resource management, iv) project management, v) measurement analysis and evaluation of organization performance, and vi) correction and development. PR RTF plans to conduct CSO consultations to review the Standard while TICA will trial of the Standard with SR organizations and CSOs who are not supported by the Global Fund grant. For partnership engagement, PR RTF will meet with stakeholders eg. NHSO, BATs, TRCARC, private sectors, academics, etc to review the accreditation mechanism. PR RTF supported accessibility to healthcare services for Migrants through the Migrant Fund Initiative, piloting in Tak Province by Dreamlopments, LTD. The aim was to support alternative migrant health insurance scheme to 700 undocumented/unregistered migrants. The migrants would be enrolled with one of the health insurance packages offered by M-Fund. Current packages are: Plan A – 60 Thai Baht/person/month, covering IPD, coverage limit at 60,000 Thai Baht/year; Plan B – 100 Thai Baht/person/month, covering IPD and OPD, coverage limit at 100,000 Thai Baht/year; and Plan B plus option on chronic diseases – +50 Thai Baht/person/month, covering IPD and OPD, and additional for chronic diseases (ex. Diabetes, hypertension, asthma, thyroid, cancer, HIV, TB, etc.), insurance limit at 100,000 Thai Baht/year. M-Fund established a contract with three facilities: i) Maesod hospital as a government hospital, ii) Maesod Ram hospital as a private hospital, and iii) Mae Tao Clinic as a community based health service operated by a non-profit organization. The M-Fund enrolled migrants with low cost of insurance and allowed payment on monthly basis. An electronic registration and payment system will be upgraded in the future. By the end of the study, M-Fund is expected to enrol 15,000 migrants. A feasibility study of the M-Fund model will be done in Samut Sakhon or Samut Prakarn province. Since the M-Fund demonstrated an administration of migrant health insurance payment on monthly basis. The result of M-Fund model will be collected and disseminated for policy advocacy on national MHI scheme. PR RTF contracted with Dreamlopments LTD for preparation of a clinical research study, C-Free, co-supported by Raks Thai funded by Global Fund, and FHI 360 and TRCARC funded by USAID under the PEPFAR program. The preparation was for purchasing and managing of study medicines and key diagnostics of a clinical research to test and treat HIV and viral hepatitis for PWID in Thailand. There are six C-Free study sites in four provinces, Bangkok (3 sites), Samut Prakarn (1 site), Songkhla (1 site), and Narathiwas (1 site). The study plans to commence in 2018. PR RTF and SR attended meetings with ONCB to assist designing of harm reduction program implementation according the harm reduction announcement on 17 February 2017. In 2018, all PWID sites will monitor actual implementation of harm reduction. The Medical Technology Council sent a letter dated 17 May 2017 to object to finger prick testing for HIV and STI by nurses at Health Promotion Hospital in 29 provinces. The letter recommended that medical technicians should be the person who provides HIV testing by finger prick test. This will be a challenge for communities or lay providers to test HIV for KAPs with finger prick test kit.
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Some 1.4 million migrant workers from Cambodia, Laos and Myanmar applied online on the last day of registration. Of the total, 1.2 million have already been registered and the remaining 180,000 people on the last day. Successfully registered workers can work in Thailand until 31 March 2020.
Harm Reduction Policy 2017: Thailand has introduced a harm reduction program to combat the country's national drug problem in 36 provinces. The country has now implemented harm reduction strategies to tackle drug problems. A harm reduction programme lets a user continue to use a drug, but at a much lighter level. The program is also a by-product of the removal of methamphetamines (ya ba) from the narcotic lists, a programme initiated by former justice minister Paiboon Koomchaya.
Methadone treatment is a proven method for reducing drug use and related crime and can be effective for treating opioid and heroin addiction. Methadone has been used by health personnel to treat heroin and opioid addiction in Thailand since 2012. It is listed as a category 2 drug on the narcotics list. The number of drug addicts who voluntarily undergo harm-reduction-based methadone treatment has gradually increased over time. According to, assistant to the director-general of National Health Security Office (NHSO), the period from 2013 to 2015, a total of 7,423 people who were addicted to opium took part in the program. This had grown to 9,573 in 2016.
PART III. PROGRAM STATUS: [The program status should describe precisely, and not exceed fifteen pages in length. The support documents referring to the program status should be attached in additional information]
C. Overall Performance of 15 months in Year 3 (1 October 2016- 31 December 2017) PR RTF reports program performance in two separating periods of 1 October 2016 to 30 September 2017 and 1 October 2017 to 31 December 2017.
From 1 October 2016 to 30 September 2017, the program performed outstandingly over the target in three indicators of MSW, FSW and MW reached with HIV prevention program. The percentage of result over target reported at 115.58%, 120.40%, and 119.83% consecutively. Overachieving results of these indicators described as following: i) For MSW, the program could exceed the reach target because SRs conducting BCC workshop in bar. At the workshop, SR introduced knowledge and information of HIV prevention including HIV, VCCT, STIs, TB, PrEP, and PEP. Condom and lubricant were made available for MSWs. SR MPLUS targeted non-venue based MSW who work around the public park in Chiang Mai. The online application was also used as a channel to reach non venue-based MSWs. The SRs conducted face-to-face individual talk for the online-reached MSWs. HIV Testing Center (HTC) operated by SRs could offer additional service of syphilis testing to MSWs. ii) For FSW, the outstanding performance of resulting from the high season for tourism in Thailand. SR SWING engaged with employers and organized outreach session in bar before FSWs started working. The SR reached out to new FSW area in Surawong. iii) For MW, SRs reached performance were access the target resulting from combination HIV-TB service provided to migrants in community and at workplace. SR STM started engaging employers of FSWs at the border of Songkhla.
Two indicators of MSM-TG and PWID reach performed lower than the target only 78,68% and 62.95% consecutively. For MSM/TG, low performance resulted from an implementation of SR RSAT in the following provinces: Samut Prakarn, Chonburi, Patum Thani and Bangkok. The low performance of SR RSAT was due to an inadequate capacity of program management and newly recruited outreach staff.
PWID reached had performed lower the target over the years. Implementation sites in Bangkok, Yala, and Pattalung provinces performed low result in this reporting period. Vacancy of staff remained a challenge even though the SRs recruited the new staff, the retention rate of was low. Many staff who
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performed well get an offer to work as contracted staff at facilities. Recruitment of young staff was still a challenged. While in other provinces, the performance could reach the target. The SRs provide package of harm reduction, HIV prevention knowledge, HCV, TB. Needle, syringe and condom was distributed to the PWID by peer educators and outreach worker. Number of N&S distribution was lower than the target. The N&S was distributed from peer to peer. Only in one area of Chiang Rai that N&S could be distributed through volunteer as a secondary N&S distribution.
Another reporting period of 1 October 2017 to 31 December 2017, all reach indicators were over 100% Result of MSM-TG reach was 120% over target in all implementation sites. Reaching MSM-TG online was increasing. Though PR stop implementation in two provinces, Phuket and Nakhon Si Thammarat, Result of MSW reach was 120% over target due to the high season of tourism. Online reach and online event was supplement the result of reach. Even though the program implementation was stop in Phuket, Result of FSW reach was 120% over target due to the high season of tourism. SR continue extended its implementation to new FSW area of Surawong, Performance of PWID reach was 120% achieved over the target in most of the implementation areas. SR and PR extended the implementation in the new areas. However, reaching PWID in Bangkok has still been challenged for the implementation over the program period, Migrants reach was 101% over target as the implementation provided HIV and TB services to Migrants community and work site.
The detail module and intervention update for the period of 15 months from 1 October 2016 - 31 December 2017
Module 1: Prevention programs for MSMs and TGs In this reporting period, SR MSM-TG host a workshop on the marital equality and rights of Lesbian, Gay, Bisexual, Trans and Inter-Sex on 23 August 2017.
On 1 July 2017, VCCT campaign was disseminated to MSM-TG, the SRs organized events such as beauty contest and singing contest with mandatory HIV testing for candidates and their friends.
PR RTF terminated contracted of two SRs, SR RAPG and SR MMN due to their mismanagement with evident of counterfeit receipts. Two cases reported to police and pursue with legal actions.
Intervention 1.1 Behaviour change for MSMs and TGs: Community outreach 1.1.1 Recruit and train outreach workers and peer educators for MSM and TG In this reporting period, 612 peer educators were trained on the knowledge of HIV, STI, PrEP and PEP, gender sensitivity, human rights, life-skills, communication to recruit new MSM/TG, and negotiation skill.
1.1.2 Develop and deliver tailored behaviour change communications for MSM and TGs Handy flip chart was developed as IEC/BCC packages for outreach workers to conduct session with MSM and TG. The IEC/BCC packages comprehended knowledge and information on HIV/AIDS, PrEP, TB, STI, Harm Reduction, and HCV. The package will be delivered to implementing sites in April 2018.
1.1.3 Outreach activities for MSM/TG, including condom distribution and services provide at Drop-in Centres (DiCs) MSM and TG were reach trough outreach sessions, individual and group sessions. From the result reach, there was 82% MSM and 18% TG. In the big cities like Bangkok, Chiang Mai, and Phuket, the SR organizes small events at night to reach the MSM and TG. The outreach sessions were provided for MSM/TGs at their meeting venue such as beauty shop, beach, park, stadium, university/vocational school, market, department store, entertainment venue, restaurant, cabaret, sauna, pub, bar, public transportation station, gasoline station, pier, temple, tourist attraction sites, campaign events, festival
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and traditional event, beauty contest, concert, and DiCs. SRs set a small gift containing condoms and lubricants and gave it free to MSM and TGs at the end of the outreach sessions. Condom and lubricants were distributed to MSM and TG at DiCs, campaign, mobile clinic, facilities based testing, and condom box at entertainment venues.
The online application was continue using to reach new MSM/TG. In fiscal year of 2017, there were around 2,635 MSM/TG reached through online application and some received a following session of individual talk to recruit for testing. Applications mostly used by MSM/TG are Facebook and Facebook live, BlueD, Line, Hornet, Beetalk, Grindr, Growlr, Wechat, and Mailbox. There were some online services that require member such as Bare club, do clip do, Gay Chiang Mai, Asian boy zone and Gay market. However, to earn trust from MSM/TGs who met through online, SR’s staff needed to have advance communication skills.
PR RTF introduced and trialed online application, loveapp, to SRs in November 2017. The loveapp was already launched and could be downloaded from app store. An upgraded version has been developed.
Intervention 1.2: HIV testing and counselling for MSMs and TGs 1.2 Increase MSMs/TGs demand and uptake for HTC service through SDR at DiCs, mobile clinic, PDI and referral client for HTC HIV testing service was offered to MSM-TGs at mobile clinic or referral to government health facility based by outreach workers and peer educators. Testing service provided in community by DiCs/HTCs. There were six HTCs operated by SRs, two in Bangkok, two in Chiang Mai, one in Songkhla, and Chonburi. The HTCs were technically monitored by TRCARC. These HTCs provided services of HIV testing, syphilis testing, and CD4 check. In Songkhla, there was additional service of level of hormone testing for TG.
Mobile clinics were organized in the community and at BCC events on special days such as Songkran Festival (13-15 April), Labour Day (1 May), VCCT Day (1 July), and World Aids Day (1 December), Together with the special events, SR supported organized contests, beauty and singing, and campaign activities. For example, SR MPLUS organized pool party for MSM-TG. Mobile clinics were organized in collaboration with local health service providers or by the medical technician and nurse from HTC.
During the reporting period, the SRs reported at least 314 HIV positive cases. The positive cases reported from HTC of SR RSAT in Bangkok and Songkhla, SR CAREMAT and SR MPLUS in Chiang Mai.
1.3 Strengthening network of MSM/TG SRs contacted MSM-TG volunteer to organized events and activities such as training on condom use, campaign for free VCCT, make up class, training for TB introduction, etc. These activities allowed the SRs to foster relationship with the key volunteers in the community and strengthened a network of MSM-TG in the community.
SRs introduced the program to owners of club, bar, and sauna for MSM-TG either by organized the meeting with the owners or pay a visit to individual owner. The owners were requested to provide space for condom and lubricants distribution to MSM-TG.
Module 2: Prevention programs for Sex Workers (MSW) and their clients PR RTF terminated contract with SR RAPG in September 2017 due to their mismanagement.
Intervention 2.1 Behaviour change for MSWs and their clients: Community outreach 2.1.1 Recruit and train outreach workers and peer educators for MSW 169 Peer educator and volunteer were trained on HIV/AIDs, TB, STI, and PrEP. Communication and negotiation skill trainings were provided to peer educator and volunteer. After volunteer training, SRs would select the one with high potential to be peer educator in bar. Online application, loveapp, to reach
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MSW was introduced and trained to outreach workers. Though loveapp was not tailored to MSW, it offered a chance for SRs to reach new MSW-MSM.
2.1.2 Outreach activities for MSWs, including condom distribution and services provide at Drop-in Centres (DiCs) Outreach activities for MSWs were provided individually through session and campaign in community or at entertainment places. The hotspots to reach MSWs venue and non-venue were at entertainment venue, such as pub, bar, sauna, massage parlour, coyote bar and non-venue such as public park, beach, and men’s room at the gas station. Night events were organized to reach MSWs prior their working hour. There were an increasing number of on-Thai MSWs, from Cambodia and Myanmar. The non-Thai MSWs have faced the same problem as migrants if they tested positive. It was more difficult to provide MHI to MSW as no one would be their employers. From result of MSW reached, there was 48% non-venue MSW and TGSW. Disaggregation between TGSW and MSW was 11% TGSW and 89% MSW. Out of MSW and TGSW, there was 14% non-Thai.
Social media, Camfrog and online reach to 388 MSWs in Bangkok and Chiang Mai by SR SWING and SR MPLUS. Information of HIV, STI, PrEP, and health related information as well as detail of health service provider was given to discreet MSWs. SR staff needed to communicate well and urge MSW to meet them face-to-face to further recruit the MSWs for HIV test. SR SWING maintained the number of Camfrog hosts.
SRs provided MSWs information on PrEP as an option for HIV prevention. If MSWs were interested to take PrEP, they could start at HTC of SR SWING and SR CAREMAT. In Phuket, MSWs could start PrEP at Thai Red Cross clinic.
Intervention 2.2: HIV testing and counselling for MSWs and their clients 2.2.1 Increase MSW demand and uptake for HTC service through SDR at DiCs, mobile clinic, and referral client for HTC Mobile clinics were organized to venue and non-venue based MSWs in all provinces except Phuket. MSWs were encourage to HIV testing at HTCs. SRs provided additional test on syphilis. In this reporting period, SR SWING and SR MPLUS reported 449 MSW tested with positive result.
2.2.2 Emergency support for MSW on HIV and related Health SR SWING supported 26 PLHIV MSW to change their health insurance and social security service to the hospital that are friendly to non-Thai and MSWs.
Module 3: Prevention programs for Sex Workers (FSW) and their clients
Intervention 3.1 Behaviour change for FSWs and their clients: Community outreach 3.1.1 Recruit and train outreach workers and peer educators for FSW 66 Peer educators were trained for HIV, VCCT, STI, and TB in this reporting period. Negotiation and life skill trainings were included for peer training. Many FSWs thought that they were sin being sex worker. At the end of training, most peer educators would request to stop and make good at temple.
3.1.2 Outreach activities for FSWs, including condom distribution and services provide at Drop-in Centres (DiCs) In the reporting period, outreach activities were provided through individual and group of FSWs at community session, and FSW entertainment venue. SR SWING continue communicated in group-line for FSW employers to provide them information on HIV, VCCT, STI, Prep, and PEP. Campaigns were organized on labour day and World AIDs Day. Campaign on labour day focused on “Sex work is work”
Small sessions on HIV information provided at the mobile clinic to non-venue based FSWs. FSWs who were reached at the mobile clinic could decide to continue VCCT right after the session. HIV and syphilis
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testing at HTC was promoted among FSWs. From result of FSW reach, there was 20% non-venue based FSW.
Intervention 3.2: HIV testing and counselling for FSW and their clients 3.2.1 Increase FSW demand and uptake for HTC service through SDR at DiCs, mobile clinic, and referral client for HTC FSWs are referred to receive testing of VCCT, syphilis and internal vagina check at DiC/HTC operated by SR SWING.
Module 4: Prevention programs for People who inject drugs (PWID) and their partners An announcement of Harm Reduction strategy on 17 February 2017, the national committee on harm reduction was formed. Provinces under harm reduction had set provincial committee to support mechanism of harm reduction implementation except 14 provinces: Chiang Mai, Payao, Nontaburi, Patum Thani, Ayudthaya, Kanchanaburi, Prajinburi, Loei, Pattalung, Narathiwas, Pattani, Satun, Yasothon, and Bangkok. However, the provincial committee lacked understanding of clear implementation according to the announcement. PR and SR met with Office of Narcotic Control Board to plan for monitoring harm reduction in the province.
PWID drug used had changed according to their financial status and availability of drug. There were increasing used of met-amphetamine (ya ba) among young MSM and young DU. Example of drug used by PWID shown in the following table:
Provinces Type of Drug used Tak Opium both inhale and injection, opium mix with met-amphetamine, and opium mix with methadone. Bangkok Dormicum, heroine, met-amphetamine, ice, K, proto q Dormicum mix with heroin, met-amphetamine, ice, or methadone, Xanac mix with methadone and dormicum, amitriptyline mix with methadone. Chiang Mai Met-amphetamine injection, methadone injection, opium, and heroine Songkhla Met-amphetamine injection, heroin, mix heroin with amphetamine or ice, and Kratom. Yala Heroin, met-amphetamine. Narathiwas Heroin, met-amphetamine, ice, marihuana, kratom, methadone. Sweet syrup mix with sleeping pill (drink) Trang Heroin, met-amphetamine injection, Kratom, and met-amphetamine. Satun Heroin, Kratom, met-amphetamine, marihuana, tramadol, alprazolam. Cap mix with Coke for drink Pattalung Heroin, amphetamine, ice, dry marihuana, Kratom. Coke mix with coughing medicine and Kratom Mitapab, Heroin, dormicum, met-amphetamine, dormicum mix with heroin, methadone. Samutprakarn Bangkok Heroin, methadone mix with dormicum, ice, met-amphetamine.
In the three utmost southern provinces, pattern of drug used was influent from PWID in Malaysia as it is very convenient for them to cross- border to work and come back to visit the family. MMT used by PWIDs were on and off depend on drug need which leads PWIDs to relapse or overdose. Used mixing drug, PWIDs were unable to estimate the right proportion of drug, resulting in their overdosed. Naloxone were made available at all DiCs. Some areas the SRs gave Naloxone to Health Promotion Hospital as well as to the group of PWID who received Naloxone training.
Intervention 4.1 Behaviour change for PWID and their partners: Community outreach 4.1.1 Recruit and train outreach workers and peer educators for PWID In this reporting period, 145 outreach workers and peer educators were trained to reach and provide HIV information, harm reduction, and HCV to PWID. Knowledge on harm reduction such as HIV, TB, Hep B/C,
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MMT, safe N&S, and overdose was trained. Specific topics such as relapse, working with female PWID and health rights on different insurance scheme were trained to field staff. PR implementation site had revised implementation management between two sites, Bangkok and Samut Prakarn, focusing on reaching out to coverage PWID in the areas and N&S distribution.
4.1.2 Develop and deliver tailored behaviour change communications for PWIDs Handy flip chart was developed as IEC/BCC packages for outreach workers to conduct session with MSM and TG. The IEC/BCC packages comprehended knowledge and information on HIV/AIDS, PrEP, TB, STI, Harm Reduction, and HCV. The package will be delivered to implementing sites in April 2018.
4.1.3 Outreach activities for PWIDs, including condom distribution and services provide at Drop-in Centres (DiCs) Outreach activities provided for PWID through peer education with an individual talk and community session in the community or at DiC. SRs hired nurse to provide health check-up for PWID at DiC every month. From the number of PWID reachd, 9% was non-Thai PWID. Out of the PWID reached, there was 92% Male and 8% Female PWID. Young PWID (age under 25 years) resulted only 12% of PWID reached. SR and PR extended PWID reach to new areas in Chiang Rai. In Bangkok, reaching to new PWID was still challenged either that SRs could not hire new peer educator or the peer educator could not find the new PWID network. Young outreach workers were recruited and trained. PR and SR explored possibilities to reach imprison PWIDs and youth in retention.
Working with PWID, PR and SR could not focus only their health, but their lives. Information provided at outreach session included effect of drug to PWID health, STIs, safe injection, HCV, HIV, health coverage scheme. Normally outreach activities in community were informal sessions, preferable not too long. Once one PWID reached, the program had to retain and took care of his/her health condition. Harm Reduction and N&S provided to the PWIDs allowed PR and SR to maintain relationships with the PWIDs and their network. In Pattani and Trang, SRs introduced member card to PWIDs so the SR could offer retention of the PWID through RRTTR.
PWID network strengthening was done through activities organized by SRs to encourage PWID participated at DIC. The activities were related to building PWID skill, increasing their income or reducing their daily expenses. Activities could be small plantation of vegetable and orchid, detergent producing, small pork farm, and dessert class. These activities would make PWID busy and pay attention to others apart from injecting drug.
Intervention 4.2: HIV counselling testing and for PWIDs 4.2.1 Increase PWIDs demand and uptake for HTC service through SDR at DiCs, mobile clinic, and referral client for HTC Mobile clinics were organized in collaboration with local governmental health service providers to PWIDs community in Chiang Rai, Pattalung, Yala, Naratiwas, and Chiang Mai. Mobile clinic has never organized in Bangkok and Samut Prakarn since it was convenient to refer PWID to health facilities. Trang model of mobile clinic was introduced to other sites. The program will fully implement this model in 2018.
Methadone service to PWID was available at district hospital. Though there was guideline for Methadone provided to PWID, its implementation was different as it was depended on hospital and doctor/nurse. In Chiang Rai and Tak where SR Ozone collaborated with nurse and pharmacist at the hospital to provide Methadone at DiC. Almost 100 PWIDs received methadone at Ozone DiCs in Chaing Rai. In Yala, SR Ozone collaborated with the local hospital to provide mobile methadone in community. In Satun, SR TDN contacted with local hospital to extended MMT in community. In Samut Prakarn, some PWIDs stop received methadone because the doctor decreased its dosage.
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Intervention 4.3: Needle and syringe program for PWID 4.3.1 Emergency support for HIV and related Health for PWID Availability of Naloxone in community had proved to save many PWID life. Outreach worker and peer educator training on Naloxone used was essential. Bureau of AIDs TB and STIs is interested in developing guideline of naloxone used by community. It’s most likely that the guideline would be developed in 2018.
4.3.2 Needle and syringe package for PWID In the reporting period of 2016 fiscal year, 528,265 pieces of N&S were distributed to PWID resulting in the N&S usage rate at 61.49 per PWID per year. In Chiang Rai, SR Ozone provide needle and syringe package to PWID volunteer to distribute to other PWIDs who injecting drug with this volunteer. In Songkhla, SR Ozone collaborated with two district health promotion hospitals for N&S distribution.
In July 2017, resulting from the stock out of N&S from PR DDC late procurement, PR RTF procure 360,250 pieces of N&S as emergency to prevent long stock out at site. After saving of the grant was identified, Global Fund approved PR RTF to procure 3,544,000 N&S for 2018-2020.
Module 6: Prevention programs for other vulnerable population (Migrants) Documented migrants had to completed certificate of identity (CI) process. Cost of CI per one migrant was 2,360 Baht (approx. US$79). With the CI, migrants could renew visa for 2 years. For those migrants who had CI but no visa, they would be fine for 500 Baht per day.
Implementation of Migrant Health Insurance (MHI) was remained problematic, many hospitals refused to sell the MHI. PLHIV Migrants patients could not renew their insurance and had to partially pay for the ART. In hospitals where MHI was sold, they could set the selling price such as Samut Sakhon hospital sold MHI at 2,100 baht for migrant between 7-55 years and 2,700 Baht for migrant over 55 years.
Cost of medical service at hospital in October 2017 was increased for example CD4 increase from 500 Baht to 900 Baht, hospital charge increased from 50 Baht to 100 Baht, etc.
Intervention 6.1 Behaviour change for Migrants (MWs): Community outreach 6.1.1 Recruit and train outreach workers and peer educators for MWs 93 Outreach workers and peer educators were trained to provide RRTTR service for HIV and TB. Training topic included discordant couple counselling. The were 529 Dot watcher trained to provide DOTs for TB patient in community. The training conducted to 203 migrant health volunteer in community on reducing stigma to migrant who injecting drug, self-stigma, HIV and TB information, registration or CI as well as health insurance scheme. 6.1.2 Develop and deliver tailored behaviour change communications for MWs Handy flip chart was developed as IEC/BCC packages for outreach workers to conduct session with MSM and TG. The IEC/BCC packages comprehended knowledge and information on HIV/AIDS, PrEP, TB, STI, Harm Reduction, and HCV. The package will be delivered to implementing sites in April 2018.
6.1.3 Outreach activities for MWs, including condom distribution and services provide at Drop-in Centres (DiCs) Outreach sessions for Migrants were provided to group of migrants in community and at their workplace. SR and PR renew mapping information especially for TB and migrant sex workers. SRs could reach many of migrants as they conduct outreach session on the day that migrants stop working or over the weekend.
From the migrants reached in this report period, there was 50% male and 50% female. Majority of migrants reached are from three nationalities, however there is few MW from other nationalities, around 76% was migrant from Myanmar and 23% from Cambodia. SR could reach most of migrants age over 25 years (around 72%) while the reach 20% of migrants age 20-24 year and 8% of migrant age under 19.
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SRs reached MWs who work at five occupations, there was around 10% fishermen, 19% seafood processing, 45% factory worker, 24% construction worker, and 2% sex worker.
Condom was provided to migrants at the outreach session, DiC, campaign activities, condom box, and volunteer. Some employers agree to set a space for condom box inside their premises.
Intervention 6.2: HIV testing and counselling for Migrants 6.2.1 Increase MWs demand and uptake for HTC service through SDR at DiCs, mobile clinic, and referral client for HTC and 6.2.2 STI diagnose and treatment for MWs Mobile clinic to migrant communities or workplaces organized in collaborated with local governmental hospital in all SR sites. The mobiles were organized for both HIV and TB depending on the location. If the location is a TB target area, more focus was on TB. 3,823 migrants received VCCT testing at the mobile clinics in this period.
Migrants refer to get VCCT, STI, and TB service at governmental health. In Samut Sakhon, Rayong and Chiang Mai, HTC services at DiCs provided testing for 838 migrants. Hence the program concluded that mobile clinic is the most cost effective way to provide testing to migrants. However, SRs needed to refer all positive cases to re-confirm at the hospital.
Same day result test kit, the 1st test, expired on 15 December 2017, the SR borrow the test kit form local hospital.
Module 8: Treatment, care and support-Migrants
Intervention 8.1 Antiretroviral Therapy (ART) for Migrants 8.1.1 ART case management, self-help group support for MW patients, and Care Support network for MWs In this period, SRs and PR refer 51 PLHIV migrants to start ART. Some cases could procure health insurance but co-payment for medicine was needed. In Samut Sakhon, Aid Health Foundation has program for free ART for all migrants who reside in Samut Sakhon and Bangkok. There were four migrant patients were referred back to their home countries. Three out of four cases had TB and requested for cross border referral to their home countries.
Migrant patients’ self-help groups supported 92 PLHIV migrants and 24 TB patient migrant.
Intervention 8.2: Treatment monitoring for Migrants 8.2.1 Care and support network for MWs Home visits were organized by all SRs and PR to PLHIV Migrants and TB migrant patients. SR and PR staff provided psycho-counselling support and self-care for MW patients. The information on routine ARV and TB medicine taking, drug resistant and living with others in the house or in community was mentioned.
Intervention 8.3: Treatment adherence for Migrants 8.3.1 ARV and drug adherence for MWs In this report period, PR and SRs supported 8 migrant patients in Samut Sakhon and Samut Prakarn to address drug side effect of ART as well as drug adherence.
Module 10: TB care and Prevention (Migrants)
Intervention 10.1 Case detention and diagnosis for Migrants 10.1.1 TB-HIV case detection and ACF session in community for MWs TB Community outreach for migrants was provided together with HIV information. Field staff provided ACF session in MW communities, workplaces, and also conducted TB screening for suspect cases of TB
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such as household contact. In the report period, SRs and PR conducted TB screening of migrants in communities and workplaces. There were around 426 migrants were screened with ACF and have TB symptom and around 414 referred to sputum testing. All sites organized TB-HIV mobile clinic with additional service for migrant’s health check.
Gene-Xpert is not mostly in service for migrants since the machine capacity was at 12 specimens per day. Lack of trained staff at the hospital to operate the Xpert. Most of sputum collected from migrants would have regular lab test and took around two weeks to get the result.
Intervention 10.2: TB Treatment monitoring for Migrants 10.2.1 TB Patient treatment and support for MWs Once MWs who were TB suspect receive confirmed lab test as M+, M- or EP from the local hospital, field staff would provide support for the MW TB patient, M+, treatment for six to eight months. Staff performed treatment monitoring according to the month of treatment as i) intensive treatment of the first two months, the monitoring would be done every week, ii) follow up treatment of the next four months, monitoring would be done every month. Hence for one TB patient, the treatment monitoring would be required at least 12 times of staff visits. After six months, if the patient was not cured or completed, the treatment monitoring would still require for the patients. Dots in community was either provided by Dots watcher or field staff.
Intervention 10.3: Community TB care delivery for Migrants 10.3.1 Outreach worker training and Daily DOTs support for MWs Outreach worker training for Daily DOTs is conducted in all sites. In the reporting period 529 Dot watchers were trained to provide DOTs for TB patient in community. Dots supervisor monitors the work of DOTs watcher when visit to TB patient at home by checking patient daily record and urine check.
Module 11: TB/HIV
Intervention 11.1 Counselling training for TB/HIV SR FAR and SR STM referred 13 PLHIV migrant patient for TB testing in the reporting period.
Module 14: Community system strengthening
Intervention 14.1 Advocacy for social accountability and Intervention 14.2 Social mobilization, building community linkages
CSO Transition Activities The key SR under this component is the Thai National AIDS Foundation (TNAF), although several other sub-recipients and other civil society organizations were also involved under the transition component.
Private Resources Development: SR TNAF as a fund manager for CSO Resource Mobilization (CRM) from private sector. Currently CRM has 30 CSO organizations in its partnership. CRM has been perceived as additional funding mechanism to fill funding gaps in the country. Policy and regulations related to the use of the funds would be set up and monitored by a multi-sector committee (civil society, private sector, government and academia). SR-TNAF developed a website www.AidsAlmostZero.org that would be the public communications channel. Dr. Anand Panyarachun, a former Prime Minister of Thailand, agreed to be a lead advisor to the CRM. SR- TNAF worked with an external consultant to conduct three studies of Provincial Resource Model. The studies focused on funding from local private sector and Local Administration Office (LAO) channels in Chiang Mai, Songkhla and Khon Kaen. There three reports from the study which was disseminated to all partners.
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Though the CRM has proved its value, there is limited funding to support the CRM in 2018. The funding for local resource mobilization in 2018-2020 has been requested for Thai Fund under PR-DDC. SR-TNAF was recommended to contact PR-DDC for the CRM continuation.
Monitoring of NHSO Funding SR TNAF worked with PR RTF to monitor funding mechanism of government funding to NGO including NHSO funding amount of 200 million Baht (around USD$ 6.66 Million) and NGO support funding from BATs at 50 million Baht (US$ 1.67 Million). Challenges and recommendations were collected and drafted for advocacy. TNAF developed a list of NGO/CSO who engaged in HIV/AIDS work in Thailand. This list will later be shared with NHSO or domestic donor who intended to support HIV/AIDs work in Thailand.
Intervention 14.3: Institution capacity building, planning and leadership development 14.3.1 Improve the capacity of Sub-Recipients, Sub-sub recipients, community based organizations and local health facilities on program quality monitoring as well as utilizing data for program improvement PR RTF started organized series of capacity building for SRs skills as i) Powerful presentation/TED talk, ii) Sales strategy/ Fund raising, and iii) Proposal development. For financial management, Fraud and risk training was organized to 15 SRs with full report for risk mitigation.
PR RTF contacted Thai International Certified Assessment Co., Ltd (TICA) to study and develop standards for Civil Society Organizations (CSO’s Accreditation Standard). TICA conducted site visits to ten CSOs, registered and non-registered from community networks to foundation. The draft Standard and mechanism for accreditation has been proposed. The draft CSO standard included six principles: i) organizational management, ii) strategic plan, iii) resource management, iv) project management, v) measurement analysis and evaluation of organization performance, and vi) correction and development. PR RTF plans to conduct CSO consultations to review the Standard while TICA will trial of the Standard with SR organizations and CSOs who are not supported by the Global Fund grant. For partnership engagement, PR RTF will meet with stakeholders eg. NHSO, BATs, TRCARC, private sectors, academics, etc to review the accreditation mechanism.
Module 15: Removing legal barriers to access
Intervention 15.1 Legal and policy environment assessment and law reform 15.1.1 Develop mechanism for protecting and promoting rights SR FAR provided legal support to KAPs who were abused their rights. According to SR FAR, legal support was addressed i) labour rights especially for migrants, ii) HIV/AIDs rights, iii) PWID rights, and iv) general rights or human rights. There were around 176 cases called for service.
SR FAR conducted self-stigma training to 30 participants from CSO and KAPs. The training will be extended to governmental health service provider. After training, the participants would be able to monitor their self-stigma. SR FAR planned to developed Self-stigma Reduction Program (SRP) in STAR 2018-2020. The SRP will support health workers to retain PLHIV patients.
SR FAR organized sensitized workshop with 40 police and law enforcement. The workshop aimed to follow up CSO strategic plan for harm reduction.
Intervention 15.2: Legal aid services and legal literacy 15.2.1 Paralegal training Paralegal training conducted to 84 SRs staff who work with MSM-TG, MSW, FSW, PWID, and MW. The staff who participated the training were expected to be an active member of local network on KAPs right protection. In six provinces of Chiang Mai, Tak, Songkhla, Rayong, Chonburi, and Bangkok, SR FAR
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