Vigorous prevention efforts enabled Thailand to avert some five million HIV infections during the 1990s. The number of new infections fell from a high of approximately 140,000 in 1991 to 21,000 in 2003. Now the Thai government has made a commitment to treating its approximately 700,000 HIV-positive citizens. Until recently, AIDS patients on antiretroviral (ARV) therapy had to juggle complex regimens involving dozens of pills a day. “Partly as a result,” according to Philip Guest, program associate and country representative for the Population Council in Thailand, “the focus of global AIDS efforts has been on prevention and support services. However, with treatment now simplified to as few as two pills daily and access to antiretroviral drugs expanding, widespread treatment is now possible. Treatment is also less expensive and much easier to manage.”  A participant in the ARV study learns how to use a watch with an alarm to remind her to take her medication twice a day.
Photo credit: Melissa May |
Nevertheless, ARVs still require rigorous adherence to a twice-a-day schedule: To be effective, the pills must be taken 12 hours apart with only an hour’s leeway. Even in the United States, where people are accustomed to taking prescription drugs, only about half of the patients with a prescription take the drug as directed. As Thailand continues to invest in treatment—some 15,000 Thais were in treatment by the end of 2003, up from about 2,500 a year earlier—patient compliance will be critically important. Horizons, the Council’s AIDS operations research program, supported by the United States Agency for International Development (USAID), and its local partners completed a large study in 2002 assessing access to care. The Thai government then asked Horizons to work with them to develop and evaluate alternative approaches to the provision of care. Subsequently, two new approaches were developed to compare with the standard of care currently offered to HIV-positive patients by the Ministry of Public Health. The second study arm provides ARV therapy counseling by hospital staff, using the practical guidelines developed by Horizons and its partners. The third arm includes the same counseling, but also involves HIV-positive volunteers who provide peer education, additional counseling, and support at the hospital and at clients’ homes. Fifteen hospitals have been assigned to each study arm, for a total of 45 study sites. Findings from this research will be used to help strengthen and scale up the ARV treatment program throughout Thailand, whose leaders hope to have 50,000 people in treatment by the end of 2004. (Return to issue contents)
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