Implementation and assessment of a prevention with positives intervention among people living with HIV at five hospitals in Thailand.
BACKGROUND
We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals.


METHODS
From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up.


RESULTS
A total of 830 PLHIV were interviewed and 756 (91.1%) completed four visits. The median age of these 756 participants was 37 years, 400 (52.9%) were women, and 475 (62.8%) had a steady partner. At baseline, 353 (74.3%) of the steady partners had been tested for HIV and 132 (37.4%) had tested negative. Among the 756 PLHIV, 427 (56.5%) reported having sex in the 3 months before enrollment and 413 (54.6%) in the 3 months before the fourth visit. The proportion reporting having vaginal or anal sex without a condom decreased from 20.8% at baseline to 5.1% at the fourth visit (p<0.001). Factors associated (p<0.05) with abstinence or 100% condom use at follow-up visits included: completing ≥ two visits, being diagnosed with HIV for longer than 3 months, and receiving HIV prevention messages from a doctor (versus a nurse or counselor).


CONCLUSIONS
Safe sex behaviors increased among PLHIV receiving PwP services, suggesting that expansion of hospital-based PwP services may reduce the number of new HIV infections in Thailand.
Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand.
Benjamas
B
Baipluthong
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Thanomsak
T
Anekthananon
Faculty of Medicine, Vajira Hospital, Navamindharadhiraj University, Bangkok, Thailand.
Warangkana
W
Munsakul
HIV Clinic, Taksin Hospital, Bangkok, Thailand.
Supunnee
S
Jirajariyavej
Obstetrics and Gynecology Unit, Rajavithi Hospital, Bangkok, Thailand.
Suvanna
S
Asavapiriyanont
HIV Clinic, Wiang Pa Pao Hospital, Chiang Rai, Thailand.
Ubonsri
U
Hancharoenkit
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Anuvat
A
Roongpisuthipong
Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand.
Sarika
S
Pattanasin
Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand.
Michael
M
Martin
Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand.
Lisa
L
Guntamala
Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand.
Rangsima
R
Lolekha
D000328:Adult; D000368:Aged; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D012746:Sexual Abstinence / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult