Napneung is a 3-year project which aims at evaluating new methods to increase the uptake of testing and counseling services for HIV, hepatitis B and C and syphilis in the public health system. The project includes several research components.
NAPNEUNG นับหนึ่ง WORKSHOP IN MAE FAH LUANG UNIVERSITY
On 17 December 2018, in Mae Fah Luang University, a research group established in Chiang Mai met with NGOs and HIV supporting groups to discuss the results of Napneung, a research program led by investigators from Chiang Mai University and the French Research Institute for Sustainable Development (IRD).
The President of Mae Fah Luang University, Dr. Vanchai Sirichana, the French ambassador to Thailand, Jacques Lapouge and the UNAIDS representative in Thailand, Taoufik Bakkali, joined the meeting.
Napneung was a three-year research program to study how to increase uptake of HIV regular testing by people at risk of HIV infection, supported by the French 5% Initiative, which works closely with the Global Fund.
According to UNAIDS, there were 15,000 deaths related to AIDS in 2017 in Thailand and more than 6,000 new infections.
The elimination of mother to child transmission of HIV in Thailand has been recognized by WHO in 2016. However, sexual transmission and transmission through contaminated needles and syringes persist, especially in the younger generation that seems less aware of the risk of HIV transmission while international exchanges with foreign students and workers are increasing.
Several studies have demonstrated that people with HIV treated with antiretroviral treatment are no longer infectious. In other words, if all people with HIV are on antiretroviral treatment, no transmissions can occur.
However, many people who have been recently infected have no symptoms for several years and are not tested before they experience symptoms. It is therefore essential to reach out to people at risk of HIV infection and facilitate their access to testing.
To improve access to testing, the Napneung Project has offered since December 2015 free testing and counseling for HIV, syphilis, hepatitis B and C infections in 4 facilities in Chiang Mai and in Chiang Rai.
The project team reached out to people through vouchers for free testing distributed in the towns, in entertainment places, in universities and schools. In addition, advertisement was made on social media (Facebook: นับหนึ่ง) and on the internet. People are invited to set up an appointment at their convenience through a hotline (061-681-3399) or directly online (https://www.napneung.net).
To date, about 5,600 persons have received testing and counseling in the project. More than 1,000 people at risk of infection came again for retest. About 100 people (1.7%) learned that they were infected with HIV and were referred to a treatment program. Another 60 people who already knew that they were infected with HIV came for confirmation or to test for the other 3 infections. Almost 100 other people learned that they were infected with syphilis and subsequently received antibiotic treatment.
Gonzague Jourdain, an expert from IRD working at Chiang Mai University, said “It is more and more difficult to find people who do not know they are infected with HIV but this is crucial if we want to get to Zero Transmissions in Thailand”
Overall, 10% of the clients were referred for treatment of one of the 4 infections or for antiretroviral prevention of HIV, “pre-exposure prophylaxis” or PrEP. This new method consists in taking a treatment to prevent infection. This method is now recommended for those who are at high risk of infection, those who report having multiple partners and are not using condoms consistently.
The program also assessed a new method of counseling, “computer-assisted counseling” on a tablet. This was found equivalent to traditional counseling in terms of knowledge gained and the proportion of people at risk of HIV infection coming back for retest within 7 months. However, the added value of this method is to reduce the time of counseling and therefore the costs.
The project also evaluated methods to remind persons at risk of HIV infection to get a new test. The most efficient method was to decide the date of the next appointment with the client immediately during the session even if this was several months later and to send an SMS a few days before the appointment. Indeed, people infected with HIV should be diagnosed as soon as possible after infection, so they can start treatment and be no longer infectious.
Using laboratory techniques, it was determined that a significant part of those clients who learned that they were infected with HIV had been infected for less than 6 months. If they are treated, many transmissions to others can be prevented. An economic analysis was conducted to assess the cost-effectiveness of these new methods that can detect infections earlier. This analysis shows that, although it is somewhat more expensive to organize such testing, reaching out to persons at risk is still very cost effective.
The French Ambassador to Thailand announced that the Chiang Mai University-IRD research team was selected by the 5% Initiative to start a new project to work with the Thailand Public Health System to implement these findings in the real world. The new project will be supported by a grant of 1.25 million Euros (= 46 million Baht).
This offers hope for ending the HIV epidemic in Thailand.
Contact: Mrs. Pra-ornsuda Sukrakanchana, PHPT (08 9633 7252)