Mueang Nonthaburi, Thailand
Mueang Nonthaburi, Thailand

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Guadamuz T.E.,University of Pittsburgh | Kunawararak P.,Thailand Ministry of Public Health | Pumpaisanchai J.,Thailand Ministry of Public Health | Wei C.,University of Pittsburgh
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2010

This paper reports demographic characteristics, HIV prevalence, and correlates among male sex workers (MSW) in Chiangmai, Thailand. A behavioral assessment survey was included as part of the Thailand Ministry of Public Health HIV sentinel surveillance conducted during June 2003. A sample of 181 MSW from 14 sex establishments around Chiangmai who self-identified as sex workers were interviewed. Non-Thai MSW made up half of the sample (48.6%), with the majority being of Shan ethnicity (64.7%). Thai MSW were significantly more likely to report having had receptive anal intercourse (38.0% vs. 11.8%, p<.001) and to have higher HIV prevalence than non-Thai MSW (11.8% vs. 3.4%, p<.001). In multivariate analysis, having one or more than one steady male partner in the past month (Odds Ratio: 5.56, 95% Confidence Intervals: 1.13-27.27 and 8.29, 2.01-34.20, respectively), and being older than 21 years (2.26, 1.04-4.90) were significantly and independently associated with prevalent HIV infection. While Thai MSW had higher HIV prevalence and engage in riskier activities, culturally appropriate education and outreach activities are still needed for the large number of ethnic minority MSW, particularly Shan MSW. © 2010 Taylor & Francis.


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.


Shinde V.,Centers for Disease Control and Prevention | Hanshaoworakul W.,Thailand Ministry of Public Health | Simmerman J.M.,Centers for Disease Control and Prevention | Narueponjirakul U.,Thailand Ministry of Public Health | And 5 more authors.
PLoS ONE | Year: 2011

Background:The National Avian Influenza Surveillance (NAIS) system detected human H5N1 cases in Thailand from 2004-2006. Using NAIS data, we identified risk factors for death among H5N1 cases and described differences between H5N1 and human (seasonal) influenza cases.Methods and Findings:NAIS identified 11,641 suspect H5N1 cases (e.g. persons with fever and respiratory symptoms or pneumonia, and exposure to sick or dead poultry). All suspect H5N1 cases were tested with polymerase chain reaction (PCR) assays for influenza A(H5N1) and human influenza viruses. NAIS detected 25 H5N1 and 2074 human influenza cases; 17 (68%) and 22 (1%) were fatal, respectively. We collected detailed information from medical records on all H5N1 cases, all fatal human influenza cases, and a sampled subset of 230 hospitalized non-fatal human influenza cases drawn from provinces with ≥1 H5N1 case or human influenza fatality.Fatal versus non-fatal H5N1 cases were more likely to present with low white blood cell (p = 0.05), lymphocyte (p<0.02), and platelet counts (p<0.01); have elevated liver enzymes (p = 0.05); and progress to circulatory (p<0.001) and respiratory failure (p<0.001). There were no differences in age, medical conditions, or antiviral treatment between fatal and non-fatal H5N1 cases. Compared to a sample of human influenza cases, all H5N1 cases had direct exposure to sick or dead birds (60% vs. 100%, p<0.05). Fatal H5N1 and fatal human influenza cases were similar clinically except that fatal H5N1 cases more commonly: had fever (p<0.001), vomiting (p<0.01), low white blood cell counts (p<0.01), received oseltamivir (71% vs. 23%, p<.001), but less often had ≥1 chronic medical conditions (p<0.001).Conclusions:In the absence of diagnostic testing during an influenza A(H5N1) epizootic, a few epidemiologic, clinical, and laboratory findings might provide clues to help target H5N1 control efforts. Severe human influenza and H5N1 cases were clinically similar, and both would benefit from early antiviral treatment.


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.


Dawood F.S.,Centers for Disease Control and Prevention | Fry A.M.,Centers for Disease Control and Prevention | Muangchana C.,Thailand Ministry of Public Health | Sanasuttipun W.,Centers for Disease Control and Prevention | And 4 more authors.
Vaccine | Year: 2011

The burden of influenza in children is increasingly appreciated; some middle-income countries are considering support for influenza vaccine programs. To support decision-making, methods to estimate the potential impact of proposed programs are needed. Using Thailand as a case-study, we present a model that uses surveillance data, published vaccine effectiveness estimates, and vaccination coverage assumptions to estimate the impact of influenza vaccination on pediatric influenza pneumonia hospitalizations. Approximately 56,000 influenza pneumonia hospitalizations occur annually among children aged <18 years in Thailand; 23,700 (41%) may be vaccine-preventable. Vaccination of 85% of Thai children aged 7 months-4 years might prevent 30% of all pediatric influenza pneumonia hospitalizations in Thailand. © 2011.


Martin M.,Health-U | Martin M.,Centers for Disease Control and Prevention | Vanichseni S.,Bangkok Tenofovir Study Group | Suntharasamai P.,Bangkok Tenofovir Study Group | And 14 more authors.
AIDS | Year: 2015

Objective: To describe participant adherence to daily oral tenofovir in an HIV preexposure prophylaxis (PrEP) trial, examine factors associated with adherence, and assess the impact of adherence on the risk of HIV infection. Design: The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial conducted among people who inject drugs, 2005-2012. Methods: Participants chose daily visits or monthly visits. Study nurses observed participants swallow study drug and both initialed a diary. We assessed adherence using the diary. We examined adherence by age group and sex and used logistic regression to evaluate demographics and risk behaviors as predictors of adherence and Cox regression to assess the impact of adherence on the risk of HIV infection. Results: A total of 2413 people enrolled and contributed 9665 person-years of follow-up (mean 4.0 years, maximum 6.9 years). The risk of HIV infection decreased as adherence improved, from 48.9% overall to 83.5% for those with at least 97.5% adherence. In multivariable analysis, men were less adherent than women (P = 0.006) and participants 20-29 years old (P < 0.001) and 30-39 years old (P = 0.01) were less adherent than older participants. Other factors associated with poor adherence included incarceration (P = 0.02) and injecting methamphetamine (P = 0.04). Conclusion: In this HIV PrEP trial among people who inject drugs, improved adherence to daily tenofovir was associated with a lower risk of HIV infection. This is consistent with trials among MSM and HIV-discordant heterosexual couples and suggests that HIV PrEP can provide a high level of protection from HIV infection. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | Centers for Disease Control and Prevention, Thailand Ministry of Public Health, U.S. Center for Disease Control and Prevention and Premiere Urgence Aide Medicale Internationale
Type: Journal Article | Journal: Vaccine | Year: 2015

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.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.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.Our results suggest that mass vaccination in refugee camps with a two-dose OCV is readily achievable and AEFI are few.


PubMed | Centers for Disease Control and Prevention, Thailand Ministry of Public Health, TUC and Emory University
Type: | Journal: AIDS research and human retroviruses | Year: 2016

HIV-1 incidence and prevalence remain high among men who have sex with men (MSM), and transgender women (TGW), in Thailand. To examine the link between epidemiologic factors and HIV-1 subtype transmission among Thai MSM, we compared covariates of infection with HIV CRF01-AE and other HIV strains among participants in the Bangkok MSM Cohort Study (BMCS).The BMCS was an observational cohort study of Thai MSM and TGW with up to 60 months of follow-up at 4-monthly intervals. Participants underwent HIV/STI testing, and provided behavioral data at each visit. Infecting viral strain was characterized by gene sequencing and/or multi-region hybridization assay. We correlated behavioral/clinical variables with infecting strain using Cox proportional hazards.Among a total of 1372 HIV seronegative enrolled participants with 4192 person-years of follow-up, we identified 215 seroconverters between April 2006 and December 2014, with 177 infected with CRF01_AE and 38 with non-CRF01_AE subtype. Age 18-21 years (AHR 2.2, 95% CI: 1.4-3.5), age 22-29 (1.6, 1.1-2.3), living alone (AHR 1.5, 1.1-2.1), drug use (AHR 2.2, 1.4-3.5), intermittent condom use (1.7, 1.3-2.3), any receptive anal intercourse (AHR 1.7, 1.2-2.4), group sex (1.5, 1.1-2.2), anti-HSV-1 (1.5, 1.1-2.1) and T. pallidum antibody positivity (2.5, 1.4-4.4) were associated with CRF01_AE infection. Age 18-21 years (5.1, 1.6-16.5), age 22-29 (3.6, 1.3-10.4), drug use (3.1, 1.3-7.5), group sex (2.4, 1.1-5.0), and hepatitis B virus surface antigen (3.6, 1.3-10.2) were associated with non-CRF01_AE infection.We observed several significant biological and behavioral correlates of infection with CRF01_AE and other HIV strains among Thai MSM. Divergence in correlates by strain may indicate differences HIV transmission epidemiology between CRF01_AE and other strains. These differences could reflect founder effects, transmission within networks distinguished by specific risk factors, and possibly biological differences between HIV strains.


PubMed | Bangkok Metropolitan Administration, Centers for Disease Control and Prevention, Thailand Ministry of Public Health, U.S. Center for Disease Control and Prevention and Taksin Hospital
Type: | Journal: The lancet. HIV | Year: 2016

Results of the randomised, double-blind, placebo-controlled Bangkok Tenofovir Study (BTS) showed that taking tenofovir daily as pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 49% in people who inject drugs. In an extension to the trial, participants were offered 1 year of open-label tenofovir. We aimed to examine the demographic characteristics, drug use, and risk behaviours associated with participants uptake of and adherence to PrEP.In this observational, open-label extension of the BTS (NCT00119106), non-pregnant, non-breastfeeding, HIV-negative BTS participants, all of whom were current or previous injecting drug users at the time of enrolment in the BTS, were offered daily oral tenofovir (300 mg) for 1 year at 17 Bangkok Metropolitan Administration drug-treatment clinics. Participant demographics, drug use, and risk behaviours were assessed at baseline and every 3 months using an audio computer-assisted self-interview. HIV testing was done monthly and serum creatinine was assessed every 3 months. We used logistic regression to examine factors associated with the decision to take daily tenofovir as PrEP, the decision to return for at least one PrEP follow-up visit, and greater than 90% adherence to PrEP.Between Aug 1, 2013, and Aug 31, 2014, 1348 (58%) of the 2306 surviving BTS participants returned to the clinics, 33 of whom were excluded because they had HIV (n=27) or grade 2-4 creatinine results (n=6). 798 (61%) of the 1315 eligible participants chose to start open-label PrEP and were followed up for a median of 335 days (IQR 0-364). 339 (42%) participants completed 12 months of follow-up; 220 (28%) did not return for any follow-up visits. Participants who were 30 years or older (odds ratio [OR] 18, 95% CI 14-22; p<00001), injected heroin (OR 15, 11-21; p=0007), or had been in prison (OR 17, 13-21; p<00001) during the randomised trial were more likely to choose PrEP than were those without these characteristics. Participants who reported injecting heroin or being in prison during the 3 months before open-label enrolment were more likely to return for at least one open-label follow-up visit than those who did not report injecting heroin (OR 30, 95 % CI 13-73; p=001) or being in prison (OR 23, 14-37; p=00007). Participants who injected midazolam or were in prison during open-label follow-up were more likely to be greater than 90% adherent than were those who did not inject midazolam (OR 22, 95% CI 12-43; p=002) or were not in prison (OR 47, 31-72; p<00001). One participant tested positive for HIV, yielding an HIV incidence of 21 (95% CI 005-117) per 1000 person-years. No serious adverse events related to tenofovir use were reported.More than 60% of returning, eligible BTS participants started PrEP, which indicates that a substantial proportion of PWID who are knowledgeable about PrEP might be interested in taking it. Participants who had injected heroin or been in prison were more likely to choose to take PrEP, suggesting that participants based their decision to take PrEP, at least in part, on their perceived risk of incident HIV infection.US Centers for Disease Control and Prevention and the Bangkok Metropolitan Administration.


PubMed | Bangkok Tenofovir Study Group, Bangkok Metropolitan Administration, Thailand Ministry of Public Health, Thailand MOPH U.S. CDC Collaboration and Centers for Disease Control and Prevention
Type: Clinical Trial | Journal: PloS one | Year: 2015

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.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.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, HIV-infected 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).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.ClinicalTrials.gov NCT00119106.

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