NHSO organizes a workshop to update knowledge to increase the potential of personnel responsible for HIV work of the NHSO in the area. The President of the AIDS Society of Thailand suggested after this that more proactive HIV screening should be added.
The National Health Security Office (NHSO) organized a workshop to exchange knowledge of HIV personnel to drive the strategy to end AIDS problems. Between March 28-29, 2023 in Pattaya City, Bang Lamung District, Chonburi Province, with representatives from the AIDS Society of Thailand. Institute for HIV Research and Innovation (IHRI) UNAIDS Bang Lamung Hospital Section 3 Civil Society Service Unit on HIV Representatives of NGOs dealing with AIDS in Pattaya as well as persons responsible for AIDS work from the NHSO in different areas attended the meeting to exchange knowledge on the latest situation and knowledge about AIDS. Ready to brainstorm to develop strategic plans and mutual agreements to drive future operations.
Dr. Rattapon Triamwichanon NHSO experts said that updating knowledge about HIV must be done all the time which came to organize training in Pattaya this time Because it is an area with quality civil society. Have a consistent track record of helping sex workers at risk of HIV infection As well as being able to develop themselves in research and create knowledge. Therefore, the NHSO team and the public sector team will come together to update knowledge from the AIDS Association of Thailand, UNAIDs and IHRI, as well as visit work in the area. TRUE at the Pattaya Service Worker Friends Foundation (SWING) in collaboration with the Rainbow Sky Foundation of Thailand and Sister Chonburi Proactive work study area, distribution of condoms to risk groups So that people in charge of HIV work from the NHSO can bring back to drive mechanisms in their area.
“This meeting will gain new knowledge. has assessed the strengths, weaknesses and points that the NHSO should take action on Especially the cooperation between the 3 health funds that still have gaps between the boundaries in changing rights. which must find a way to make all 3 systems connected and after this workshop The NHSO will also hold ongoing meetings on adding new benefits such as HIV Self-testing, ”said Dr. Rattapon.
Dr. Peerawong Weerarak from the AIDS Society of Thailand said that in terms of current treatment, it is considered to have developed very far. In the past, when Thailand was experiencing new outbreaks There were many deaths. There are more than 100,000 new cases of infection each year. But nowadays, new infections are reduced to about 5,000-6,000 people a year. Medicines used in treatment can help extend life expectancy as long as normal people and patients are still treated for free. The treated patients had quality of life comparable to those who were not infected. able to work Have a family, have children
Dr. Peerawong went on to say that There is now talk of the distribution of HIV self-tests, however, it is usually possible to detect antibodies that reflect infection. It takes about 3 weeks after infection to be detected. The examination in the first 1-2 weeks may have a false negative result. Therefore, self-test kits are suitable for people who have regular sexual intercourse. or people who regularly check for infection But for people who have recently had unsafe sex and come for a quick test. May have a false negative result, so if the test results are negative, it will have to be tested again to confirm.
“Blood test When checking whether it’s positive or negative We will give equal importance. If the result is positive, it goes into the treatment process. But if it’s a negative result, it must be given the same attention. Because it shows that he is at risk to come to check Preventive measures such as post-exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP) must be put in place for them, along with other prophylaxis. so that that person will continue to have negative test results, ”said Dr. Peerawong.
Dr. Chureerat Bowonwattanuwong, President of the AIDS Society of Thailand, said that from his experience working in AIDS since the beginning of the outbreak in Thailand. Images of patients in the early days were negative memories, such as being sexually promiscuous. Sick, physically deteriorated and died in trouble. make the society disgusted Although the current treatment has developed far. But this stigma still exists in society for over 40 years.
In addition, there are gaps that are problematic: 1. Late Presentation The fear of HIV is that those infected in the first 5-10 years do not show symptoms but can spread to other people. But from the patients who met, there were more than 50% of those who had a CD4 count below 200, because they did not show symptoms before, so they did not come to check. Therefore, we must find this group of people as soon as possible in order to bring them into the treatment process. so as not to infect others The standalone examination in the hospital is therefore insufficient. More proactive search needs to be done. Including finding a way to solve the stigma from society as well
2. Limitation of ART Regimens This period is when old antiretroviral drugs are being disrupted because they are switching to new TLD formulations. But personally, I think that it should not flag or force the patient to immediately switch to this drug formula. because there will be chaos No new drugs are coming in. The old medicine is gone. Should wait for the market of this new formulation to stabilize before discontinuing the old formulation.
3. Loss to follow-up: It is important that patients take antiretroviral drugs for the rest of their lives in order to suppress the virus to an undetectable level. But there are many factors that cause the patient to miss taking the drug continuously, such as changing the health rights from one fund to another fund, COVID, flooding, going to jail. I ate until I got bored so I stopped taking the drug. Or no one to remind, etc. Therefore, the NHSO must be asked to set up a system to detect and follow up in the case of stopping taking the drug.
4. Lack of policy implement NHSO has many good policies, such as PEP, which has been announced as a benefit since January 2022, but the month before he encountered a case of a woman having risky sex and wanting to take the drug. PEP recommends going to a government hospital near home. Went to the emergency room, was told there was a risk of exposure and asked for PEP, but it turned out that I told the emergency room nurse, but all were denied. Until having to pretend to be sick to see a doctor This is a simple policy example. I think everyone in the hospital must know. But in reality it’s not.
5. Less Healthcare Workers There are no official positions in hospitals for AIDS workers. There is no career growth path. People who are working are doing it because they really love their work.
while Dr. Jakraphat Bunruang, medical researcher The Institute for HIV Research and Innovation (IHRI) said that although the NHSO has a very good service package. But access to HIV services Rather, there are obstacles or barriers such as stigma from society and oneself. make people living with HIV Some groups do not dare to receive the service, which IHRI has developed an innovative service model. for patients to access more services
One of the successful innovations is Community Based Same Day ART. One of Thailand’s unique characteristics is that most AIDS-related services take place in community-based organizations or community health centers. which is provided by civil society organizations, while Same Day ART is a new policy to start antiretroviral drugs within 24 hours after knowing the result of infection, which IHRI believes that this service should be able to provide this service in the community, thus becoming a community-based Same Day ART in 2021-2022 in the form of research Recruiting 399 volunteers to join the project. At the end of the research in September 2022, it was found that there were 95% of those who could start taking the drug within 24 hours after knowing the positive blood test result. to many areas, which if the NHSO in various areas wants to expand this service able to walk in and talk to civil society organizations working on AIDS in that area
In addition, there is also the matter of HIV Self-testing, which is not widespread in Thailand. The reason is because there is very little talk about the Thai patient care guideline, but in 2022, the World Health Organization issued Differentiated and simplified pre-exposure prophylaxis for HIV prevention states HIV Self-test is another option for people taking PrEP or for those who want to test themselves. Which just this sentence can open the door for many services.
“IHRI’s Blink Clinic has begun offering PrEP Telehealth services using HIV Self-test. The clinic will send a test kit to your home. when the test results are obtained If the result is negative The clinic will deliver the PrEP pill the same day. Just like in the case of people who regularly take drugs, they can submit their test results and wait for the drugs, ”said Dr. Chakraphat.
Dr. Jakraphat further said that Results from the PrEP Telehealth service show that there is an increasing proportion of people who have never been tested for HIV in their lives. Reflecting that the service is reaching more secretive populations at risk of infection But the problem is that the rate of not returning the test results to the clinic is still high. because this group of people does not want to reveal themselves also afraid of stigma from society It is therefore an important question for the NHSO to design a disbursement system that will not allow HIV self-test recipients to reveal their identity. themselves, etc., as well as having to update the National Guidelines of Thailand to be able to use HIV Self-test as well, and finally, allowing the government to help support the operation of community health centers. both in terms of support and issuing regulations to facilitate the provision of HIV services in the future
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