Background
In 2020, approximately 50% of newly diagnosed persons living with HIV (PLHIV) had a baseline CD4 <200 cells/µL in Thailand. As a result, the Ministry of Public Health implemented and expanded the national index partner testing (IPT) program to increase early HIV detection (baseline CD4 ≥200 cells/µL) and rapid antiretroviral (ART) treatment initiation. We analyzed trends in baseline CD4 and ART initiation and investigated factors associated with ART initiation among contacts of PLHIV in 2020-2023.
Methods
IPT services were offered to all PLHIV ≥ 1 years of age at 144 health facilities after providing informed consent for health services. Contacts of PLHIV, including sexual and drug injecting contact within the past year, biological children, or biological parents if child was PLHIV, were elicited and offered HIV testing and linkage to ART. We collected contact’s demographic and clinical data using an online monitoring system. Linkage to ART and analysis of factors associated with ART initiation among contacts of PLHIV was conducted for those testing HIV positive.
Results
Of 6,541 contacts elicited and tested, 1,683 (25.7%) tested HIV-positive. Of these, the median age was 34 years (IQR: 26-43), 1,135 (67.4%) were male, 1,290 (76.6%) were ≥25 years, 529 (31.4%) self-reported as high-risk population (HRP), 1,572 (93.4%) were sexual contacts, 682 (40.5%) were contacts of newly diagnosed PLHIV, 1,487 (88.4% ) initiated ART, and 771 (45.8%) had baseline CD4 information, with 27.8% (214/771) CD4 <200. Baseline median CD4 among contacts was slightly higher in 2023 (351 cells/µL, IQR: 218-479) than in 2020 (318 cells/µL, IQR:182-481) (p=0.23). ART initiation slightly increased from 87.4% (304/348) in 2020 to 88.5% (416/470) in 2023 (p<0.001). Contacts who self-reported as HRP vs. those who did not (Adjusted Odds Ratio [AOR] 2.59; 95% CI: 2.26-2.97), had sex with the index case vs. those who had a biologic relationship (AOR 2.8; 95% CI: 1.18-6.88), had sex and shared needles with the index case vs. those who had a biologic relationship (AOR 2.26; 95% CI: 0.93 – 5.63), and was a contact of index case diagnosed >12 months vs. contact of a newly diagnosed index case (AOR 1.69; 95% CI: 1.52-1.88) were associated with ART initiation.
Conclusions
The slight increase in ART uptake over time may indicate the effectiveness of the IPT services program. Programs may consider integrating HIV self-test or other services to improve case finding among contacts of index cases.