In Thailand, health service delivery models were designed to improve HIV service uptake among transgender women and gay men and other men who have sex with men, as well as addressing the challenges of low rates of linkage to care and high rates of loss to follow up. Clients were eligible for ART maintenance through key population-led health services if they were established on ART.
Three models of differentiated ART delivery were developed in collaboration with community-based organizations (CBOs). In the “one-stop shop CBO model”, clinicians go to Key Population-led CBOs to support ART initiation. Once established on ART, Community Health Workers (CHWs) provide support to clients for ART maintenance. In the “hospital to CBO model”, CBO staff accompany clients to their provincial ART network hospitals for initiation and then once established on ART, clients are referred to CHWs at their CBOs for ART maintenance. In the “combined hospital to CBO model”, treatment initiation and maintenance can occur at the hospitals, as well as at the CBO, depending upon clients’ preferences. The models are examples of out- of-facility individual models of ART delivery.
Impact: Between May 2015 and October 2016, 784 transgender women were tested for HIV, 83 (10.6%) were HIV-positive and 68 (81.9%) started ART. Viral suppression was achieved by 46 of 50 clients (92%) in care at month six. By March 2018, 19 of 50 patients on ART were established on ART, 16 were still in follow up and were offered ART maintenance by CHW at Key population-led clinics. Ten (62.5%) transgender women agreed to be seen by CHWs, while six (37.5%) preferred to receive ART maintenance elsewhere.
Eligibility
12 months on ART, virally suppressed, no adverse drug reactions or opportunistic infections, no co-morbidities that need regular medical follow-up and good understanding of lifelong adherence.
Building Blocks
ART refills
What
Doctors: ART rescripts, clinical consultation
KP-CHWs: ART refills, comprehensive health check, adherence check and counselling, and referral to doctor as needed
When
Monthly or every three months
During regular business hours for doctor led visits, additionally during evenings and/or weekends for KP-CHW led visits
Where
Alternately hospital and CBOs, or all visits at the CBO, depending on client preference and local circumstances
Who
Alternately doctors and KP-CHWs
Clinical consultation
What
Doctors: ART rescripts, clinical consultation
KP-CHWs: comprehensive health check, adherence check and counselling, and referral to a doctor as needed
When
Every three months
During regular business hours for doctor led visits, additionally during evenings and/or weekends for KP-CHW led visits
Where
Alternately hospital and CBOs, or all visits at the CBO, depending on client preference and local circumstances
Who
Alternately doctors and KP-CHWs
Psychosocial support
What
CSOs: psychosocial support, safe sex counselling and referral for additional counselling if needed
When
Every three months, or as needed
During regular business hours for doctor led visits, additionally during evenings and/or weekends for KP-CHW led visits
Where
Alternately hospital and CBOs, or all visits at the CBO, depending on client preference and local circumstances
Who
Care and support officers (CSOs)
Further reading
Read more about DSD for key populations here. Also available in French and Portuguese
