Key population-led HIV services for MSM and transgender women in Thailand Nittaya Phanuphak, MD, PhD  Thai Red Cross AIDS Research Centre, Bangkok, Thailand 

Key population-led HIV services for MSM and transgender women in Thailand CD4 COUNT AT DIAGNOSIS N = 260 <350 118 (45%) 350-500 70 (27%) >500 72 (28%) Median (IQR) 375 (275-507) CD4 COUNT AT DIAGNOSIS N = 260 <350 118 (45%) 350-500 70 (27%) >500 72 (28%) Median (IQR) 375 (275-507) 16% 99% 83% MSM and TGW contribute to around 50% of new HIV infections each year in Thailand. Key population-led HIV service for MSM and TG is an innovative model where members of key populations who are well-trained, qualified, and receive continuous quality control take on roles of HIV testing, counseling, linkage to ART and PrEP provision in their own community health centers. The key population-led service model has proved feasible and highly effective in ‘reaching and bridging high-risk MSM and TG’ into HIV services as shown by high HIV prevalence of 16%. Compared to MSM and TG who accessed a conventional facility-based HIV testing center, key population-led service model reached more of those who had lower levels of education and income. In addition, the model also has achieved ‘early HIV diagnosis’ as shown by more than half of newly diagnosed cases who had CD4 count above 350 and ‘high rates of ART acceptance and ART initiation’ as shown by 83% of HIV-positive MSM and TG who successfully started ART within a median time of only 15 days after HIV diagnosis. 82% had VL below 50 copies/mL and 92% had VL below 1,000 copies/mL at 6 months after ART initiation. 83% successfully started ART Median days to start ART 15 days (IQR 9-22) 82% had VL <50 copies/mL 92% had VL <1,000 copies/mL 6 months after ART

What make key population-led HIV services for MSM and transgender women in Thailand successful? Dusit Meekrua prepares to conduct a finger-prick test at the SWING drop-in center. “Every time I provide counseling service, I feel like I’m helping someone in my own family,” she says. Open-minded attitudes and great collaborations among CBOs, public health authorities, researchers and funder are key to the success. Members of key populations who are now trained lay providers are fully empowered and are providing services to their communities with pride. Service packages were designed and tailored by key populations, those for MSM are different than those for transgenders and different from those for male sex workers. We are fortunate to have ‘champions’ in the country who do not only dare to point out the problems, but also teach us to accept those problems and take quick actions. Many problems are still there but there is no need to take them too serious. Just do what you can do little by little with courage, joy and pride. Atachai Phunkron puts on his lab coat and gets ready to serve his clients as a trained HIV counselor at the SWING drop-in center in Bangkok. FrontLines, March/April 2016, Dressed to Test: Empowered Communities Take HIV Services to the Streets

Bringing key population-led HIV services for MSM and transgender women to scale Accreditation, legalization and financing mechanisms for KP-led services Optimization through exploring ‘differentiated care models’ and innovating in ‘online technology’ Unknown HIV & HIV-negative MSM and TG HIV & syphilis testing HIV-negative MSM and TG HIV-positive MSM and TG HIV-positive MSM and TG on ART POC CD4 testing q 6-12 mo and samples for HIV VL sent outside HIV-negative MSM and TG on PrEP HIV testing q 3 mo Syphilis testing q 6 mo q 6 mo not on PrEP HIV-positive MSM and TG remain virally suppressed HIV-negative MSM and TG stay negative Online-to-Offline platform and eCascade: Online demand generation and online HIV service provision + Real-time tracking of HIV cascades to improve performances Thailand is ready to gradually increase domestic funding to support the scale up of key population-led HIV services. Now that global recognitions on the importance of task sharing and key population engagement to end the AIDS epidemic is stronger than ever, it is the right time to work quickly further to accredit, legalize and finance key population-led HIV services. Accreditation, legalization and financing mechanisms are key steps to bring key population-led HIV service model to scale. At the same time, we know we can still improve the program through optimization. Optimization can be done by exploring ‘differentiated care models’ such as reducing frequency of clinic visits, doing ART distribution by lay providers, integrating point-of-care testing to improve value for money and by innovating in ‘online technology’ to bridge harder-to-reach populations to testing and treatment and to monitor real-time cascade to further improve services. Thailand is grateful to international donors who have wise and clear vision to allow the continuation of international fund for the country to further explore the optimization of service models not only for MSM and transgenders but also to expand the model to other key populations. Differentiated care models: Less frequent visits and ART distribution by community + Point-of-Care VL, TB, STI and HCV testing

Thank you very much.