Background: Despite WHO''s recommendation on Universal ART, one-third of persons living with HIV in Thailand are without antiretroviral therapy (ART). Attrition from care due to delays in initiating treatment may contribute to this gap. There is strong evidence to suggest clinical and practical benefits of rapid ART initiation, including Same-Day ART. However, data on safety and feasibility in real-world settings is limited.
Methods: Data was collected among HIV-seropositive Thai clients at Thai Red Cross Anonymous Clinic in Bangkok, Thailand. Clients were categorized as newly diagnosed or reengaged. Assessment of acceptability, logistical eligibility (no previous ART and could return for follow-up visits), and first date of known HIV-seropositive status were self-reported. Baseline laboratory tests (creatinine/ALT/syphilis/HBsAg/anti-HCV/CD4/CrAg if CD4< 100) and chest x-ray were performed according to national guidelines. Physicians determined clinical eligibility of Same-Day ART based on signs/symptoms and only results of CD4 and chest x-ray to rule out tuberculosis, cryptococcal meningitis, and serious illnesses. Mean days from HIV diagnosis/reengagement to ART initiation were calculated. Referral rate to long-term ART continuation site, after 10 weeks of ART, was also determined.
Results: From July-December 2017, 86.8% of 1,062 HIV-seropositive clients were logistically eligible for Same-Day ART service and 90% (95% newly diagnosed; 85% reengaged) accepted the service. Median (IQR) CD4 was 295.5 (203-415) cells/mm3. 82% of those who accepted the service were clinically eligible and initiated ART. Among these, 79% received ART on the day of HIV diagnosis/reengagement. Mean (SD) days from HIV diagnosis/reengagement to ART initiation was 1.4 (5.2) days for newly diagnosed clients and was 1.1 (4.0) days for reengaged clients. Immune reconstitution inflammatory syndrome was not seen. Referral to long-term ART site was successful among 88.2%. Virologic suppression was achieved by 100% of 12 clients who reached month six after ART.
Conclusions: Same-Day ART initiation in an HIV/STI testing center in Thailand is highly feasible and safe, with high rates of client eligibility and acceptability. Preliminary data on referral to long-term ART site and short-term virologic suppression are encouraging. Same-Day ART should be immediately scaled-up, with rigorous and longitudinal evaluations to further inform HIV guidelines.