Page 1 Peer-delivered HIV testing and counseling among people who inject drugs in Bangkok, Thailand Lianping Ti 1 Kanna Hayashi 1,2 Karyn Kaplan 3 Paisan Suwannawong 3 Evan Wood 1,4 Julio Montaner 1,4 Thomas Kerr 1,4 1 British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada 2 Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, BC, Canada 3 Thai AIDS Treatment Action Group, Bangkok, Thailand 4 Department of Medicine, University of British Columbia, Vancouver, BC, Canada

Page 2 HIV EPIDEMIC IN THAILAND Source: MOPH Thailand

Page 3 HIV TESTING Reduce HIV-related morbidity and mortality May minimize high-risk behaviour Provide linkages to HIV treatment and care services Wood et al. (2006). Impact of HIV testing on uptake of HIV therapy among antiretroviral naïve HIV-infected injection drug users. Drug and Alcohol Review, 25,

Page 4 BARRIERS TO HIV TESTING IN THAILAND Uptake of HIV testing <20% among IDU in Asia-Pacific 2003 “War on Drugs” campaign Fear of HIV-positive test result Stigma and discrimination Breaches of patient confidentiality

Page 5 OBJECTIVES Seek – Test – Treat - Retain Explore acceptability of novel methods of testing and counselling (VCT)

Page 6 MITSAMPAN COMMUNITY RESEARCH PROJECT A collaborative research effort involving: Peer researchers involved in all stages of the project Former/active drug users trained as peer researchers  Interviewers  Outreach workers Three completed cycles to date (2008, 2009, 2011)

Page 7 MITSAMPAN HARM REDUCTION CENTER (MSHRC) Photo by Rico Gustav

Page 8 METHODS Recruited IDU through peer outreach and word-of-mouth Completed interviewer-administered questionnaire Eligibility criteria:  Injection drug use in the previous six months  Reside in Bangkok or adjacent provinces  Informed consent Data collected in 2011 Restricted sample to HIV-negative IDU or IDU of unknown HIV serostatus

Page 9 RESULTS

Page 10 RESULTS Willingness to receive peer- delivered pre-test counselling Multivariate associations AOR (95%CI) Binge use* 2.39 (1.46 – 3.95) Higher than secondary level education 1.98 (1.25 – 3.16) Male gender 0.52 (0.29 – 0.90) Willingness to receive peer- delivered rapid HIV testing Multivariate associations AOR (95%CI) Binge use* 2.23 (1.36 – 3.70) Higher than secondary level education 2.06 (1.27 – 3.39) Ever incarcerated 2.68 (1.56 – 4.72) Avoid HIV tests 0.24 (0.10 – 0.52) Ever been to MSHRC 1.63 (1.02 – 2.62) Willingness to receive peer- delivered post-test counselling Multivariate associations AOR (95%CI) Binge use* 2.40 (1.48 – 3.93) Ever incarcerated 1.94 (1.16 – 3.33) Avoid HIV tests 0.23 (0.09 – 0.52) AOR: adjusted odds ratio, CI: confidence interval, MSHRC: Mitsampan Harm Reduction Center *Activities in the previous six months

Page 11 RESULTS Willingness to receive peer- delivered pre-test counselling Multivariate associations AOR (95%CI) Binge use* 2.39 (1.46 – 3.95) Higher than secondary level education 1.98 (1.25 – 3.16) Male gender 0.52 (0.29 – 0.90) Willingness to receive peer- delivered rapid HIV testing Multivariate associations AOR (95%CI) Binge use* 2.23 (1.36 – 3.70) Higher than secondary level education 2.06 (1.27 – 3.39) Ever incarcerated 2.68 (1.56 – 4.72) Avoid HIV tests 0.24 (0.10 – 0.52) Ever been to MSHRC 1.63 (1.02 – 2.62) Willingness to receive peer- delivered post-test counselling Multivariate associations AOR (95%CI) Binge use* 2.40 (1.48 – 3.93) Ever incarcerated 1.94 (1.16 – 3.33) Avoid HIV tests 0.23 (0.09 – 0.52) AOR: adjusted odds ratio, CI: confidence interval, MSHRC: Mitsampan Harm Reduction Center *Activities in the previous six months

Page 12 DISCUSSION Substantial proportion willing to get peer-delivered VCT at a drug user-run drop-in centre Peer-delivered VCT could reach key groups who may be missed through traditional public health methods  IDU who were previously incarcerated  IDU engaged in high intensity drug use Need for HIV prevention education efforts for IDU  Increase awareness of HIV risks and transmission  Target IDU with lower education and those who avoid HIV tests

Page 13 CONCLUSION Current HIV testing approaches in Thailand are limited Need for ongoing HIV prevention education efforts Potential of novel approaches to VCT for IDU Photo by BC-CfE

Page 14 ACKNOWLEDGEMENTS MSCRP participants MSHRC, TTAG, & O-Zone House staff and volunteers Chulalongkorn University: Dr. Niyada Kitaying-Angsulee BC-CfE staff: Tricia Collingham, Deborah Graham, Caitlin Johnston, Calvin Lai, Peter Vann MSCRP staff: Prempreeda Pramoj Na Ayutthaya, Arphatsaporn Chaimongkon, Sattara Hattirat

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