Karyn Kaplan Thai AIDS Treatment Action Group (TTAG)

 Thailand: Population: 62 million  Est. HCV prevalence reports range from.7% - 5% in voluntary blood donors (active/inactive unspecified)  IDU population: 160,000  Est. HCV prevalence 92.5%  IDU HIV/HCV co-infection 88-96%  JAIDS: “…almost universal prevalence of HCV in HIV-infected IDU…”  “…a diagnosis of HIV in IDU should indicate probable HIV/HCV co-infection”

 Antibody test ( THB*)  Screened if suspected IDU  If HIV+ every mos. basic liver enzyme testing performed  Many Bangkok IDU get their health care in context of clinical trials  Genotyping (2,500 – 7,000 THB)  Diagnostic tests can be ordered by physician and paid for under universal health care, rarely practised in reality and genotyping available only in few major city hospitals a. IDU have little access to health care b. Negative attitude toward providers toward IDU adherence capaciy further inhibits access to diagnostics and treatment, including ART c. Lack of access to treatment precludes urgency of diagnostics (prohibitive cost most frequently-stated problem) HCV Viral Load (2,500 THB) “So many (hepatitis) tests” – confirmatory, ultrasound (800 THB), monitoring side effects (100 THB) “HIV gets priority, ie, cd4 will be performed over hepatitis diagnostics with limited hospital budgets” *1 USD = 35 THB

 International guidelines  Leading hepatologists at major public hospital still only treating 3-5 cases/year  Both Roche and Schering-Plough tx available, ribavirin cheap or free; PEG-IFN 7,000/dose x 24 or 48 weeks or $10-15,000 USD/person  “How can we get away from Roche and get IFN from China?”  IFN v. PEG-IFN efficacy study completed, equally effective SVR

 Side effects include: astemia, anemia, leucopenia, nausea, anorexia, headache, insomnia, fever  Provision of anti-depressants or NSIADS  Dose reductions or discontinuation  HIV exclusion criteria; also, alcohol/drug use  Mixed willingness to treat OST clients

 WHO IS GOING TO PAY?  Patient education – integrate hepatitis issues into HIV care and drug treatment? What to ask your doctor. Earlier access to HIV tx  Provider education – training across disciplines (HIV, hepatology, drug treatment) and improved treatment guidelines; med school curriculum  Improve referral system  Improve health care system (health care worker shortage, rotation of doctors, lack of support for nurses)

 Prison health care capitation 100 THB/person  Universal health care – not cover HAV, HBV vax or screening  Lack of harm reduction services and less IDU in care  Organization of IDU/PLWHA/NGOs/providers/GPO/NHSO/MSF and need for global campaign