title: HIV pre-exposure prophylaxis and health and community systems in the Global South: Thailand case study.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Donn
authors.initials: D
authors.lastname: Colby
authors.affiliation: Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.|Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Kriengkrai
authors.initials: K
authors.lastname: Srithanaviboonchai
authors.affiliation: Bangkok Tenofovir Study Group, Bangkok, Thailand.
authors.forename: Suphak
authors.initials: S
authors.lastname: Vanichseni
authors.affiliation: Bureau of AIDS, TB and STI, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Sumet
authors.initials: S
authors.lastname: Ongwandee
authors.affiliation: SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.affiliation: Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.|U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Martin
authors.affiliation: Bangkok Tenofovir Study Group, Bangkok, Thailand.
authors.forename: Kachit
authors.initials: K
authors.lastname: Choopanya
authors.affiliation: Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.|Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Suwat
authors.initials: S
authors.lastname: Chariyalertsak
authors.affiliation: Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|Division of Preventive Medicine and Public Health, University of California - San Francisco San Francisco, CA, USA; fritsvg@trcarc.org.
authors.forename: Frits
authors.initials: F
authors.lastname: van Griensven
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis; D013785:Thailand; D063106:Transgender Persons
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; PrEP; Thailand; prevention; prophylaxis