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Mueang Nonthaburi, Thailand

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.


Fongkaew W.,Chiang Mai University | Cupp P.K.,Pacific Institute for Research and Evaluation | Miller B.A.,Pacific Institute for Research and Evaluation | Atwood K.A.,Pacific Institute for Research and Evaluation | And 5 more authors.
Nursing and Health Sciences | Year: 2012

This qualitative study explores the perceptions of parents and adolescents toward sexual risk-taking behaviors. In-depth interviews were conducted with 30 parents and 30 adolescents (aged 13-14years) in Bangkok, and were analyzed by using coding and thematic analysis. The results showed that although parents generally believed that Thai teens begin to have sex at an early age and engage in sexual risk-taking behaviors, they trusted that their teens would follow parental guidance and rules and not engage in sexual activity at this age. Most of the Thai teens reported that their parents were not really aware of their sexual behaviors because of their tendency to keep their sexual stories secret for fear of being scolded, blamed, and punished. The teens also reported that they wanted their parents to listen, give them warmth and more freedom, and be more in touch with their activities. Parents expressed their need for knowledge and skills so that they could help guide their adolescent children to avoid sexual risk-taking behaviors. A family intervention specifically aimed at empowering Thai urban parents is needed. © 2012 Wiley Publishing Asia Pty Ltd.


Phares C.R.,Centers for Disease Control and Prevention | Date K.,Centers for Disease Control and Prevention | Travers P.,Premiere Urgence Aide Medicale Internationale | Deglise C.,Premiere Urgence Aide Medicale Internationale | And 3 more authors.
Vaccine | Year: 2016

Background: During 2005-2012, surveillance in Maela refugee camp, Thailand, identified four cholera outbreaks, with rates up to 10.7 cases per 1000 refugees. In 2013, the Thailand Ministry of Public Health sponsored a two-dose oral cholera vaccine (OCV) campaign for the approximately 46,000 refugees living in Maela. Methods: We enumerated the target population (refugees living in Maela who are ≥1 year old and not pregnant) in a census three months before the campaign and issued barcoded OCV cards to each individual. We conducted the campaign using a fixed-post strategy during two eight-day rounds plus one two-day round for persons who had missed their second dose and recorded vaccine status for each individual. To identify factors associated with no vaccination (versus at least one dose) and those associated with adverse events following immunization (AEFI), we used separate marginal log-binomial regression models with robust variance estimates to account for household clustering. Results: A total of 63,057 OCV doses were administered to a target population of 43,485 refugees. An estimated 35,399 (81%) refugees received at least one dose and 27,658 (64%) received two doses. A total of 993 additional doses (1.5%) were wasted including 297 that were spat out. Only 0.05% of refugees, mostly children, could not be vaccinated due to repeated spitting. Characteristics associated with no vaccination (versus at least one dose) included age ≥15 years (versus 1-14 years), Karen ethnicity (versus any other ethnicity) and, only among adults 15-64 years old, male sex. Passive surveillance identified 84 refugees who experienced 108 AEFI including three serious but coincidental events. The most frequent AEFI were nausea (49%), dizziness (38%), and fever (30%). Overall, AEFI were more prevalent among young children and older adults. Conclusions: Our results suggest that mass vaccination in refugee camps with a two-dose OCV is readily achievable and AEFI are few. © 2015 .


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.


Martin M.,Centers for Disease Control and Prevention | Vanichseni S.,Bangkok Tenofovir Study Group | Suntharasamai P.,Bangkok Tenofovir Study Group | Sangkum U.,Bangkok Tenofovir Study Group | And 9 more authors.
PLoS ONE | Year: 2011

Background: The Bangkok Tenofovir Study was launched in 2005 to determine if pre-exposure prophylaxis with tenofovir will reduce the risk of HIV infection among injecting drug users (IDUs). We describe recruitment, screening, enrollment, and baseline characteristics of study participants and contrast risk behavior of Tenofovir Study participants with participants in the 1999-2003 AIDSVAX B/E Vaccine Trial. Methods: The Bangkok Tenofovir Study is an ongoing, phase-3, randomized, double-blind, placebo-controlled, HIV pre-exposure prophylaxis trial of daily oral tenofovir. The Tenofovir Study and the Vaccine Trial were conducted among IDUs at 17 drug-treatment clinics in Bangkok. Tenofovir Study sample size was based on HIV incidence in the Vaccine Trial. Standardized questionnaires were used to collect demographic, risk behavior, and incarceration data. The Tenofovir Study is registered with ClinicalTrials.gov, number-NCT00119106. Results: From June 2005 through July 2010, 4094 IDUs were screened and 2413 enrolled in the Bangkok Tenofovir Study. The median age of enrolled participants was 31 years (range, 20-59), 80% were male, and 63% reported they injected drugs during the 3 months before enrollment. Among those who injected, 53% injected methamphetamine, 37% midazolam, and 35% heroin. Tenofovir Study participants were less likely to inject drugs, inject daily, or share needles (all, p<0.001) than Vaccine Trial participants. Discussion: The Bangkok Tenofovir Study has been successfully launched and is fully enrolled. Study participants are significantly less likely to report injecting drugs and sharing needles than participants in the 1999-2003 AIDSVAX B/E Vaccine Trial suggesting HIV incidence will be lower than expected. In response, the Bangkok Tenofovir Study enrollment was increased from 1600 to 2400 and the study design was changed from a defined 1-year follow-up period to an endpoint-driven design. Trial results demonstrating whether or not daily oral tenofovir reduces the risk of HIV infection among IDUs are expected in 2012.

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