The challenges of ending AIDS in Asia: outcomes of the Thai National AIDS Universal Coverage Programme, 2000–2014

Author List
Suchada Chaivooth
Sorakij Bhakeecheep
Kiat Ruxrungtham
Sirinya Teeraananchai
Stephen J Kerr
Achara Teeraratkul
Petchsri Sirinirund
Sumet Ongwandee
Anchalee Avihingsanon
Patchara Benjarattanaporn
Nittaya Phanuphak
Somnuek Sungkanuparph
Sophon Mekthon
Praphan Phanuphan

Abstract

Objectives: We sought to determine Thai National AIDS Program (NAP) outcomes and gaps, and success in reaching the WHO 90:90:90 goals. Methods: Retrospective study of treatment outcomes, mortality and loss to follow-up (LTFU), of all individuals aged >15 years who registered to the NAP from 2000 to 2014. We focused outcomes on data from 2008 when the NAP was linked to the death registry. Results: A total of 429,294 patients registered to the NAP up to November 2014, and 309,313 patients aged >15 years started ART. Median (IQR) age was 37 (31–43) years; 51% were male. From 2008 to 2014, long-term follow-up rates per 100 person-years were 3.2 in those who started ART vs 3.5 in those who did not (P<0.001) and mortality rates per 100 person-years were 3.5 in those who started ART vs 4.9 in those who did not (P<0.001). Mortality reduced from 16% in 2008 to 3% in 2014 for those who started ART. For patients starting treatment since 2000, 87% of those alive and with a recent viral load (VL) result had <50 copies/mL, and 6% had VL ≥1000 copies/mL. In a continuum-of-care analysis from 2008 to 2014, 68% were living and retained on ART, and 46% of diagnosed individuals were virally suppressed at <50 copies/mL. Conclusions: In the Thai NAP, death and LTFU are major factors disrupting the care-continuum, and many patients initiate ART with low CD4 cell counts. Rolling out systems for early detection and treatment for all, regardless of CD4 cell count, are essential and under way.

Article Category

Resistance

Article Type

Original research

Posted Date

01-10-2017

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