UNAIDS aims to end AIDS by 2030 using "90-90-90" diagnosis-treatment-viral suppression targets. Thailand has achieved elimination of HIV mother-to-child transmission, but continues to see new infections among adolescent men who have sex with men (YMSM) and transgender women (YTGW). Reaching and engagement of key populations to HIV services remains a major challenge, with differentiated care needed to address this. Investigators propose a study on outreach for HIV at-risk adolescents using peer-led social network strategies (SNS), linkage to facility-based HIV self-testing, and same day HIV prevention or treatment. The study will focus on the 15-19 year age group who have the highest HIV incidence in Thailand (6.9-10 per 100 person years, PY), but will also include young adults aged 20- 24 years of age, due to their frequently intertwining sex networks and very similar HIV incidence of 4.9-7.2 per 100 PY. Eight hundred adolescent and young adult (AYA) MSM and TGW aged between 15-24 years will be recruited into a double HIV cascade care system. AYA aged between 15-24 years will be trained as recruiters to approach and refer their peers, 'network members' (NMs) to our adolescent clinic. NMs will be offered a choice of either blood-based or oral fluid-based HIV self-testing. HIV positive cases will be offered same-day antiretroviral therapy (SDART) and high-risk adolescents will be offered same day preexposure prophylaxis (PrEP). The project will be conducted at adolescent differentiated care services previously established by CIPHER grants in Thailand, located at King Chulalongkorn Memorial Hospital (KCMH), Bangkok. It will inform both Thailand and other Asia-Pacific region countries with similar epidemic patterns through an implementation research lens on strategies to engage YMSM and YTGW into HIV services, which investigators believe will make high-impact contributions to our collective ultimate goal of ending AIDS.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
202
SNS utilizes peers to reach and recruit their network members into HIV services, therefore having the advantage that recruiters with different behavioral risks and HIV statuses are likely to have access to a wide variety of HIV at risk populations
The Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
Bangkok, Thailand
The effectiveness of using social network strategies to increase HIV testing uptake in YMSM and YTGW.
Effectiveness will be measured by proportion of first-time testers among participants enrolled, defined as number of first-time testers divided by total number enrolled. SNS strategies are considered effective when proportions exceed 50 percent. Descriptive statistics of first-time tester characteristics, HIV risk factors, and their recruiter's characteristics will be described.
Time frame: 24 months
Pre-exposure prophylaxis (PrEP) uptake among HIV negative at-risk adolescents
PrEP uptake is defined as the number of participants agreeing to initiate PrEP divided by the total number of HIV negative participants enrolled and association of PrEP uptake with factors include recruiter's characteristics will be evaluated utilizing logistic regression to calculate odd ratios and 95 percent confident intervals.
Time frame: 24 months
Viral suppression at 6 months for those initiated on antiretroviral treatment among newly diagnosed HIV positive adolescents
Proportions of viral suppression seen at 6 months for those initiated on antiretroviral treatment among newly diagnosed HIV positive adolescents will be calculated. Descriptive statistics will used to describe this group of the sample. Comparison of characteristics between those viral suppressed and not virally suppressed will be performed.
Time frame: 24 months
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