Peer-delivered HIV testing and counseling among people who inject drugs in Bangkok, Thailand

Peer-delivered HIV testing and counseling among people who inject

drugs in Bangkok, ThailandLianping Ti 1

Kanna Hayashi 1,2

Karyn Kaplan 3

Paisan Suwannawong 3

Evan Wood 1,4

Julio Montaner 1,4

Thomas Kerr 1,4

1British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada2Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, BC, Canada3Thai AIDS Treatment Action Group, Bangkok, Thailand4Department of Medicine, University of British Columbia, Vancouver, BC, Canada

HIV EPIDEMIC IN THAILAND

0

10

20

30

40

50

60Thailand HIV Prevalence by Risk Group (Median Values), 1989-2011

Injection Drug Users

Direct female commercial sex workers

Indirect female com-mercial sex workers

Male clients at STI clinics

Blood donors

Pregnant women at an-tenatal care clinics

Perc

ent (

%)

Source: MOPH Thailand

HIV TESTING• Reduce HIV-related

morbidity and mortality

• May minimize high-risk behaviour

• Provide linkages to HIV treatment and care services

Wood et al. (2006). Impact of HIV testing on uptake of HIV therapy among antiretroviral naïve HIV-infected injection drug users. Drug and Alcohol Review, 25, 451-454.

BARRIERS TO HIV TESTING IN THAILAND• Uptake of HIV testing <20% among IDU in Asia-Pacific

• 2003 “War on Drugs” campaign

• Fear of HIV-positive test result

• Stigma and discrimination

• Breaches of patient confidentiality

OBJECTIVES• Seek – Test – Treat - Retain

• Explore acceptability of novel methods of testing and counselling (VCT)

MITSAMPAN COMMUNITY RESEARCH PROJECT• A collaborative research effort involving:

• Peer researchers involved in all stages of the project• Former/active drug users trained as peer researchers

Interviewers Outreach workers

• Three completed cycles to date (2008, 2009, 2011)

MITSAMPAN HARM REDUCTION CENTER (MSHRC)

Photo by Rico Gustav

METHODS• Recruited IDU through peer outreach and word-of-mouth

• Completed interviewer-administered questionnaire

• Eligibility criteria: Injection drug use in the previous six months Reside in Bangkok or adjacent provinces Informed consent

• Data collected in 2011• Restricted sample to HIV-negative IDU or IDU of unknown

HIV serostatus

RESULTS

Yes44%

No56%

Willingness to receive peer-delivered pre-test

counsellingMSCRP 2011 Cohort

(n=350)

Yes38%

No62%

Willingness to receive peer-delivered rapid

HIV testingMSCRP 2011 Cohort

(n=350)

Yes36%

No64%

Willingness to receive peer-delivered post-

test counsellingMSCRP 2011 Cohort

(n=350)

RESULTSWillingness to receive peer-delivered pre-test counselling

Multivariate associations

AOR (95%CI)

Binge use* 2.39 (1.46 – 3.95)

Higher than secondary level education

1.98(1.25 – 3.16)

Male gender 0.52 (0.29 – 0.90)

Willingness to receive peer-delivered rapid HIV testing


AOR (95%CI)

Binge use* 2.23 (1.36 – 3.70)

Higher than secondary level education

2.06 (1.27 – 3.39)

Ever incarcerated

2.68(1.56 – 4.72)

Avoid HIV tests 0.24(0.10 – 0.52)

Ever been to MSHRC

1.63(1.02 – 2.62)

Willingness to receive peer-delivered post-test counselling


AOR (95%CI)

Binge use* 2.40 (1.48 – 3.93)

Ever incarcerated 1.94 (1.16 – 3.33)

Avoid HIV tests 0.23(0.09 – 0.52)

AOR: adjusted odds ratio, CI: confidence interval, MSHRC: Mitsampan Harm Reduction Center*Activities in the previous six months

DISCUSSION• Substantial proportion willing to get peer-delivered VCT

at a drug user-run drop-in centre

• Peer-delivered VCT could reach key groups who may be missed through traditional public health methods IDU who were previously incarcerated IDU engaged in high intensity drug use

• Need for HIV prevention education efforts for IDU Increase awareness of HIV risks and transmission Target IDU with lower education and those who avoid HIV tests

CONCLUSION• Current HIV testing approaches in Thailand are

limited• Need for ongoing HIV prevention education efforts• Potential of novel approaches to VCT for IDU

Photo by BC-CfE

ACKNOWLEDGEMENTS• MSCRP participants

• MSHRC, TTAG, & O-Zone House staff and volunteers

• Chulalongkorn University: Dr. Niyada Kitaying-Angsulee

• BC-CfE staff: Tricia Collingham, Deborah Graham, Caitlin Johnston, Calvin Lai, Peter Vann

• MSCRP staff: Prempreeda Pramoj Na Ayutthaya, Arphatsaporn Chaimongkon, Sattara Hattirat

Peer-delivered HIV testing and counseling among people who inject drugs in Bangkok, Thailand

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