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Background: PrEP is a necessary component of a national AIDS program in many settings, but particularly in countries with concentrated epidemics among key populations (KPs). There are to date only a few countries who have approved PrEP and even fewer who have attempted rapid scale-up for epidemic control.
Methods: PrEP is available through multiple providers in Thailand, including 13 government hospitals, 5 public- and private-sector clinics, and 7 community-based organizations working under a key population-led health services (KP-LHS) model. We examined data from sites to assess the contribution of KP-LHS as part of a national strategy to increase PrEP uptake.
Results: Between October 2016 and January 2018, the cumulative number of reported PrEP users in Thailand from all sources increased by more than 200%. PrEP uptake as a percentage of all clients tested HIV-negative was slightly higher at government facilities than through community-based providers (7% versus 5%) but the total number of KP clients receiving PrEP under the KPLHS model was six times higher (1,299 versus 183). PrEP uptake at a private-sector clinic targeting men who have sex with men was significantly higher (1,205 PrEP clients, 16%) but PrEP clients at that clinic were significantly more likely to be non-Thai clients compared with clients at community-based services (88% versus 8%). Over the 15-month period, none of the clients who accessed PrEP through hospital services seroconverted; four clients who accessed community-based PrEP later tested HIV-positive (0.2%), though it is impossible to ascertain whether these clients were actively using PrEP at the time of infection.
Conclusions: Our study on the scale-up of PrEP showed that the most significant increase of clients requesting PrEP were at KP-LHS sites as well as private clinics whose services are provided by KPs. These organizations appear to be the most critical for rapid scale-up, particularly where epidemic growth is concentrated among KPs. Government health facilities are still needed for sustainability and coverage. However, our data suggest that in the early stages of introduction, KP-LHS can quickly add new products such as PrEP and obtain high uptake through their trusted relationships with KPs.