National access to antiretroviral program for PHA (NAPHA) in Thailand

Bureau of AIDS, TB and STIs, Department of Disease Control, Ministry of Public Health, Thailand.
The Southeast Asian journal of tropical medicine and public health (Impact Factor: 0.72). 08/2006; 37(4):704-15.
Source: PubMed


To describe the development, components, initial results and lessons learned from Thailand's National Access to Antiretroviral Program for People living with HIV/AIDS (NAPHA), a historical review was conducted and program monitoring was analyzed. The national antiretroviral therapy program at different levels of the public health system was implemented with all major program components; ARV protocol development, health care professional training, drug supply chain management, laboratory network formation, monitoring and evaluation, and multi-sector and PHA involvement since 2001, which was based on elements of research, pilot projects, training, national guideline development, experiences and policy making. A national monitoring system was developed to monitor the progress of the program. From February 2001 to December 2004, the monitoring reports received from implementing hospitals showed that 58,133 cases had received antiretroviral therapy (ART), and 85% (49,477) of them were continuing to take ARV drugs. In conclusion, the NAPHA was implemented nationwide with comprehensive systems. The reports indicate achievement of expansion of the ART program. Lessons learned from the program initiation and scaling up show local leadership, comprehensive training, adherence, and coordination are essential to program effectiveness and sustainability.

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Available from: Sanchai Chasombat, Apr 08, 2015
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    • "Combination antiretroviral therapy (ART) has significantly reduced mortality and morbidity since its introduction in Thailand [3-5]. Since 2001, the government has committed to providing ART free of charge to people living with HIV under the National Access to Antiretroviral Program for People Living with HIV/AIDS (NAPHA) [6]. The subsequent production and use of generic drugs led to more than an eight-fold expansion in treatment provision between 2001 and 2003 [7]. "
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    ABSTRACT: After rapid scaling up of antiretroviral therapy in HIV-1-infected patients, the data of primary HIV-1 drug resistance in Thailand is still limited. This study aims to determine the prevalence and associated factors of primary HIV-1 drug resistance in Thailand. A prospective observational study was conducted among antiretroviral-naïve HIV-1-infected Thai patients from 2007 to 2010. HIV-1 subtypes and mutations were assayed by sequencing a region of HIV-1 pol gene. Surveillance drug resistance mutations recommended by the World Health Organization for surveillance of transmitted HIV-1 drug resistance in 2009 were used in all analyses. Primary HIV-1 drug resistance was defined as the presence of one or more surveillance drug resistance mutations. Of 466 patients with a mean age of 38.8 years, 58.6% were males. Risks of HIV-1 infection included heterosexual (77.7%), homosexual (16.7%), and intravenous drug use (5.6%). Median (IQR) CD4 cell count and HIV-1 RNA were 176 (42-317) cells/mm(3) and 68,600 (19,515-220,330) copies/mL, respectively. HIV-1 subtypes were CRF01_AE (86.9%), B (8.6) and other recombinants (4.5%). The prevalence of primary HIV-1 drug resistance was 4.9%; most of these (73.9%) had surveillance drug resistance mutations to only one class of antiretroviral drugs. The prevalence of patients with NRTI, NNRTI, and PI surveillance drug resistance mutations was 1.9%, 2.8% and 1.7%, respectively. From logistic regression analysis, there was no factor significantly associated with primary HIV-1 drug resistance. There was a trend toward higher prevalence in females [odds ratio 2.18; 95% confidence interval 0.896-5.304; p = 0.086]. There is a significant emergence of primary HIV-1 drug resistance in Thailand after rapid scaling up of antiretroviral therapy. Although HIV-1 genotyping prior to antiretroviral therapy initiation is not routinely recommended in Thailand, our results raise concerns about the risk of early treatment failure in patients with primary HIV-1 drug resistance. Interventions to prevent the transmission of HIV-1 drug resistance and continuation of surveillance for primary HIV-1 drug resistance in Thailand are indicated.
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    • "The mathematic model describing the epidemic trends using the Asia Epidemic Model software projected that there will be 10,835 new HIV cases each year [1]. In Thailand, it was only after the establishment of the National Access to Antiretroviral Program for People living with HIV/AIDS (NAPHA) in 2002 that combination antiretroviral therapy (cART) became widely available free of charge throughout the country [2]. In a previous study from Thailand, treatment with GPO-VIR® (a locally-produced generic fixed-dose combination of stavudine, lamivudine, and nevirapine) resulted in 62.7% and 93.3% of 90 HIV treatment-naïve patients achieving undetectable HIV viral load at 24 and 48 weeks, respectively [3]. "
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    • "In October 2003, the government eventually declared its commitment to provide universal access to triple ARVs for HIV/AIDS treatment. This was due to a combination of sustained pressure from the movement of people living with HIV/AIDS (PLWHA) and civil society groups in Thailand, availability of low-cost triple therapy (GPO-VIR, produced locally by the GPO), and financial support from the Global Fund [35]. Although the government responded to this commitment by significantly increasing the national health budget, the budget increase was still not sufficient to meet the goal of universal access to ARVs in Thailand. "
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