This program will evaluate the use of an enhanced and focused strategy to improve retention rate, adherence to antiretroviral therapy (ART), and viral load suppression among men who have sex with men (MSM) and transgender women (TG) in the 'Test and Treat' program in Thailand. Peer supporters will be empowered to be able to communicate the importance and consequences of HIV testing, adherence to ART, and HIV drug resistance. Use of social networking tools such as LINE, WhatsApp, Blackberry Messengers, text messaging, Facebook, and electronic mail will be studied in a randomized fashion, compared to telephone call, to evaluate its additional benefit on retention rate, adherence to clinic visits, and adherence to ART. Among participants who test HIV-positive in the program, simplified, low-cost and/or generic, first-line ART regimens will be offered to enhance adherence, along with the provision of adherence counseling at every clinic visit. Drug resistance testing will be performed in blood at the time of HIV positivity, HIV RNA in blood will be measured every 6 months, and choices of ART will be modified accordingly. HIV RNA measurement and resistance pattern in the ano-genital compartments will also be studied to deepen the understanding of HIV compartmentalization and transmission.
The program will be implemented in 3 provinces: Bangkok (central), Ubonratchathani (northeastern), and Lampang (northern)
This program is the first demonstration program in the region to use the 'Test and Treat' strategy among MSM and TG. Several steps which impact general health system are needed in order to get people into HIV testing and follow those who tested HIV-positive through to having undetectable HIV RNA in the body for own's health benefit and for community's prevention benefit.