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THAILAND'S ACHIEVEMENTS IN HIV TREATMENT, PREVENTION, AND CURE RESEARCH
1Thai Red Cross AIDS Research Center, Bangkok, Thailand
To the external world, Thailand has achieved considerably on HIV treatment, prevention, and cure research but the reality could be different. For HIV treatment, even with Universal ART Coverage since 2006 and the Treat-All policy since 2014, the 'second 90' is still far below with a median CD4 count at ART initiation of <150 cells/ML in Thailand. To close this gap, 'Same-Day ART (SDART) Initiation Hub' was launched at the Thai Red Cross Anonymous Clinic (TRC-AC). In one year, 77% of 2,000 PLHIV started ART on the day of diagnosis and another 19% in a week. However, the Thai government and most ID doctors are still too afraid of SDART since even in the US it has not yet been implemented and WHO puts SDART only as a subset of Rapid ART. Only 54% of PLHIV in Thailand reached undetectable viral load. This, coupled with low 'consistent condom use' rate among key populations, dictates the urgent need of PrEP. Providers who serve MSM, transgender women, and sex workers have been trained and qualified to provide HIV testing and dispense PrEP, the so called 'key population-led health services or KPLHS', to around 50% of all Thai PrEP users. Four years after Thai Guidelines recommended PrEP, only 4% of 150,000 Thais at risk access PrEP. Government needs to de-medicalize PrEP and accept KPLHS roles in ending AIDS now. Over a decade, the world's largest cohort (RV254) of 600 acute HIV cases has been established at TRC-AC. Through available routine NAT screening, early and frequent HIV testing has formed among certain populations. Immediate ART, together with extensive virologic/immunologic studies, demonstrated very low HIV reservoir even though there is no good news so far for HIV remission/cure. Crucial data for global HIV cure research are generated from Thailand although it is still too far away to get government's attention. Achievements described is the outcome of continuing commitment of government, civil society, academics and royal family. Policy makers and politicians, who change frequently, are vital in the process since all successful pilot projects need to be scaled up. The country needs some influential 'watch dogs' to keep these strategies on track. Too much international appraisal can cause complacency among policy makers and politicians.