The Princess Programme is part of key population-led health services (KPLHS) in Thailand.  This is a set of services that is identified, designed and delivered by trained members of key populations  and other lay health providers.  Services include PrEP counselling, HIV and STI testing and dispensation of free PrEP that is approved remotely on standing order by doctors. 
 
Impact: Data collected from January 2016-December 2017 showed that retention in the PrEP programme was 74.2%, 64.0%, 56.2%, 46.7% and 43.9% at months 1, 3, 6, 9 and 12 respectively.  Ninety-five percent of clients who were retained self-reported adherence to at least four PrEP pills per week.  The Princess Programme model of service delivery has increased HIV service uptake among gay men and other men who have sex with men and transgender people over the past five years; it is the main model being used to scale-up PrEP in Thailand.   

Target clients

Key population members, including gay men and other men who have sex with men and transgender people.

Building blocks of the Princess PrEP service – Pre COVID-19

PrEP screening

What

Same-day HIV & syphilis testing 
Cr & HBsAG testing (delayed result) 
PrEP counselling 

When

Same-day

Where

Key population-led clinics

Who

Key population lay providers dispense PrEP which has been remotely prescribed by doctors

PrEP initiation

What

Same-day HIV & syphilis testing 
Cr & HBsAG testing (delayed result) 
PrEP counselling 

When

Same-day

Where

Key population-led clinics

Who

Key population lay providers dispense PrEP which has been remotely prescribed by doctors

PrEP initial follow-up

What

HIV testing 
PrEP counselling 

When

Months 1 & 3

Where

Key population-led clinics

Who

Key population lay providers

PrEP continuation: Routine clinical follow-up

What

HIV testing 
Syphilis and Cr testing (every 6 months) 
PrEP counselling 

When

Every 3 months

Where

Key population-led clinics

Who

Key population lay providers

In response to COVID-19 health system disruptions, services in the programme were further differentiated, with many of the changes implemented likely to be retained going forward. These adaptations aimed to reduce time spent in clinics and included introduction and scale-up of telehealth services, home PrEP refill delivery and X-Press services. In addition, there was self-sampling for STI testing and an extension of PrEP refills from three to six months. The PrEP effective use concept was also introduced, whereby PrEP users are provided with information that enables them to tailor their PrEP use according to their risk status. The PrEP effective use concept was especially useful during the first few months of COVID-19, where PrEP stocks were low and there was substantial supply chain instability.

COVID-19 Building blocks of the Princess PrEP service

PrEP screening

What

Same-day HIV & syphilis testing 
Cr & HBsAG testing (delayed result) 
PrEP counselling 

When

Same-day

Where

Key population-led clinics

Who

Key population lay providers dispense PrEP which has been remotely prescribed by doctors

PrEP initiation

What

Same-day HIV & syphilis testing 
Cr & HBsAG testing (delayed result) 
PrEP counselling

When

Same-day

Where

Key population-led clinics

Who

Key population lay providers dispense PrEP which has been remotely prescribed by doctors

PrEP initial follow-up

What

HIV testing 
PrEP counselling 

When

Months 1 & 3

Where

Key population-led clinics

Who

Key population lay providers

PrEP continuation: Routine clinical follow-up 

What

Xpress, self-sampling / testing for HIV/STIs 
Syphilis and Cr testing (every 6 months) 
PrEP effective use counselling

When

3 or 6 monthly

Where

Key population-led clinics or via Telehealth

Who

Key population lay providers