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Bangkok, Thailand

Pitisuttithum P.,Mahidol University | Choopanya K.,Bangkok Tenofovir Study Group | Rerk-Ngnam S.,Ministry of Public Health
Vaccine | Year: 2010

Thailand has been committed to HIV-Vaccine Research and Development since the launch of its National Plan, in 1993. Series of phase I/II trials, and two phase III clinical trials, have been conducted. The first efficacy trial was conducted with a high-risk group, injecting drug users (IDUs), and the second involved communities in the Eastern-seaboard provinces of Thailand. Both involved similar challenges in terms of infrastructure strengthening, capacity building, implementing the trials into the existing health system, staffing, and commitments. However, there were different issues in recruitment process, follow up, social impact events and community involvement since the target participants were different. © 2009 Elsevier Ltd. All rights reserved.


Colby D.,Red Cross | Srithanaviboonchai K.,Chiang Mai University | Vanichseni S.,Bangkok Tenofovir Study Group | Ongwandee S.,Bureau of AIDS | And 6 more authors.
Journal of the International AIDS Society | Year: 2015

Introduction: Pre-exposure prophylaxis (PrEP) is recommended by the World Health Organization as an effective method of HIV prevention for individuals at risk for infection. In this paper, we describe the unique role that Thailand has played in the global effort to combat the HIV epidemic, including its role in proving the efficacy of PrEP, and discuss the opportunities and challenges of implementing PrEP in a middle-income country. Discussion: Thailand was one of the first countries in the world to successfully reverse a generalized HIV epidemic. Despite this early success, HIV prevalence has remained high among people who inject drugs and has surged among men who have sex with men (MSM) and transgender women (TGW). Two pivotal trials that showed that the use of oral antiretroviral medication as PrEP can reduce HIV transmission were conducted partially or entirely at Thai sites. Demonstration projects of PrEP, as well as clinical trials of alternative PrEP regimens, began or will begin in 2014-2015 in Thailand and will provide additional data and experience on how to best implement PrEP for high-risk individuals in the community. Financing of drug costs, the need for routine laboratory monitoring and lack of awareness about PrEP among at-risk groups all present challenges to the wider implementation of PrEP for HIV prevention in Thailand. Conclusions: Although significant challenges to wider use remain, PrEP holds promise as a safe and highly effective method to be used as part of a combined HIV prevention strategy for MSM and TGW in Thailand. © 2015 Colby D et al.


Suntharasamai P.,Bangkok Tenofovir Study Group | Martin M.,Thailand MOPH U.S. CDC Collaboration | Martin M.,Centers for Disease Control and Prevention | Choopanya K.,Bangkok Tenofovir Study Group | And 15 more authors.
PLoS ONE | Year: 2015

Background: Rapid easy-to-use HIV tests offer opportunities to increase HIV testing among populations at risk of infection. We used the OraQuick Rapid HIV-1/2 antibody test (OraQuick) in the Bangkok Tenofovir Study, an HIV pre-exposure prophylaxis trial among people who inject drugs. Methods: The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial. We tested participants' oral fluid for HIV using OraQuick monthly and blood using a nucleic-acid amplification test (NAAT) every 3 months. We used Kaplan-Meier methods to estimate the duration from a positive HIV NAAT until the mid-point between the last non-reactive and first reactive oral fluid test and proportional hazards to examine factors associated with the time until the test was reactive. Results: We screened 3678 people for HIV using OraQuick. Among 447 with reactive results, 436 (97.5%) were confirmed HIV-infected, 10 (2.2%) HIV-uninfected, and one (0.2%) had indeterminate results. Two participants with non-reactive OraQuick results were, in fact, HIVinfected at screening yielding 99.5% sensitivity, 99.7% specificity, a 97.8% positive predictive value, and a 99.9% negative predictive value. Participants receiving tenofovir took longer to develop a reactive OraQuick (191.8 days) than participants receiving placebo (16.8 days) (p = 0.02) and participants infected with HIV CRF01-AE developed a reactive OraQuick earlier than participants infected with other subtypes (p = 0.04). Discussion: The oral fluid HIV test performed well at screening, suggesting it can be used when rapid results and non-invasive tools are preferred. However, participants receiving tenofovir took longer to develop a reactive oral fluid test result than those receiving placebo. Thus, among people using pre-exposure prophylaxis, a blood-based HIV test may be an appropriate choice.


Vanichseni S.,Bangkok Tenofovir Study Group | Martin M.,Centers for Disease Control and Prevention | Suntharasamai P.,Bangkok Tenofovir Study Group | Sangkum U.,Bangkok Tenofovir Study Group | And 10 more authors.
American Journal of Public Health | Year: 2015

Objectives. We examined the causes of hospitalization and death of people who inject drugs participating in the Bangkok Tenofovir Study, an HIV preexposure prophylaxis trial. Methods. The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial conducted during 2005 to 2012 among 2413 people who inject drugs. We reviewed medical records to define the causes of hospitalization and death, examined participant characteristics and risk behaviors to determine predictors of death, and compared the participant mortality rate with the rate of the general population of Bangkok, Thailand. Results. Participants were followed an average of 4 years; 107 died: 22 (20.6%) from overdose, 13 (12.2%) from traffic accidents, and 12 (11.2%) from sepsis. In multivariable analysis, older age (40-59 years; P = .001), injecting drugs (P = .03), and injecting midazolam (P < .001) were associated with death. The standardized mortality ratio was 2.9. Conclusions. People who injected drugs were nearly 3 times as likely to die as were those in the general population of Bangkok and injecting midazolam was independently associated with death. Drug overdose and traffic accidents were the most common causes of death, and their prevention should be public health priorities. © 2015, American Public Health Association Inc. All rights reserved.


Choopanya K.,Bangkok Tenofovir Study Group | Martin M.,Health-U | Martin M.,Centers for Disease Control and Prevention | Suntharasamai P.,Bangkok Tenofovir Study Group | And 16 more authors.
The Lancet | Year: 2013

Background Antiretroviral pre-exposure prophylaxis reduces sexual transmission of HIV. We assessed whether daily oral use of tenofovir disoproxil fumarate (tenofovir), an antiretroviral, can reduce HIV transmission in injecting drug users. Methods In this randomised, double-blind, placebo-controlled trial, we enrolled volunteers from 17 drug-treatment clinics in Bangkok, Thailand. Participants were eligible if they were aged 20-60 years, were HIV-negative, and reported injecting drugs during the previous year. We randomly assigned participants (1:1; blocks of four) to either tenofovir or placebo using a computer-generated randomisation sequence. Participants chose either daily directly observed treatment or monthly visits and could switch at monthly visits. Participants received monthly HIV testing and individualised risk-reduction and adherence counselling, blood safety assessments every 3 months, and were off ered condoms and methadone treatment. The primary effi cacy endpoint was HIV infection, analysed by modifi ed intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT00119106. Findings Between June 9, 2005, and July 22, 2010, we enrolled 2413 participants, assigning 1204 to tenofovir and 1209 to placebo. Two participants had HIV at enrolment and 50 became infected during follow-up: 17 in the tenofovir group (an incidence of 0.35 per 100 person-years) and 33 in the placebo group (0.68 per 100 person-years), indicating a 48.9% reduction in HIV incidence (95% CI 9.6-72.2; p=0.01). The occurrence of serious adverse events was much the same between the two groups (p=0.35). Nausea was more common in participants in the tenofovir group than in the placebo group (p=0.002). Interpretation In this study, daily oral tenofovir reduced the risk of HIV infection in people who inject drugs. Preexposure prophylaxis with tenofovir can now be considered for use as part of an HIV prevention package for people who inject drugs. Copyright © 2013 Elsevier B.V.

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