Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. PrEP is currently available in Thailand for free through demonstration projects, while some healthcare settings provide fee-based services. This study aims to look at retention in the two largest PrEP programs in Thailand; PrEP-15, a fee-based service available at the Thai Red Cross Anonymous Clinic (TRCAC) and Princess PrEP, a free service at the TRCAC and at 9 community clinics in 6 provinces with high HIV burden.
Self-reported demographic and risk behavior data was collected from January 2016-July 2019. Retention was determined if the client came back for a scheduled visit and measured at months 1, 3, 6, 9, and 12 after PrEP initiation. Multivariable linear regression was used to observe factors associated with loss to follow up at one month and one year after enrollment.
A total of 5,687 clients were provided with PrEP, 66.6% through Princess PrEP. 80% were men who have sex with men, 9.5% transgender women, 21.2% had education lower than bachelor’s degree, 72.3% reported inconsistent condom use, and 6.8% used amphetamine.Retention rates in PrEP-15 were 45.1%, 37.3%, 31.5%, 28.3%, and 25.2%, and in Princess PrEP were 65.4%, 56%, 48.2%, 44.5%, and 39.9% at month 1, 3 ,6, 9, and 12, respectively. In the multivariable analysis, factors associated with loss to follow up after month 1 were having an education lower than bachelor’s degree (adjusted odds ratio -aOR:1.56; 95% confidence interval -CI 1.32-1.84, p<0.001), clients aged less than 20 years (aOR:1.76; 95%CI 1.2-2.59, p<0.05), inconsistent condom use (aOR:1.31; 95%CI 1.1-1.55, p<0.05), reporting sex work (aOR:1.66; 95% CI 1.37-2.02, p<0.001), and clients who paid for PrEP (aOR:2.48; 95%CI 2.06-3.0, p<0.001). Factors associated with loss to follow at month 12 were clients aged less than 20 years (aOR:2.02; 95%CI 1.1-3.67, p<0.05), and clients who paid for PrEP (aOR:1.47; 95%CI 1.18-1.84, p<0.05).
Retention rates in free PrEP program where higher than in fee-based PrEP. PrEP should be available under universal health coverage to retain clients in care. Interventions tailored to support adolescents and clients with education less than bachelor's degree should be concise and promote PrEP as a health empowering tool should also be proritized to address this finding.