Thailand's commitment to support community-led HIV services
Authors: Cheewanan Lertpiriyasuwat, Suchada Jiamsiri, Plearnpit Prommali
Journal: The Lancet HIV (2024)

Sima Barmania's recent feature story, Successes and challenges in Thailand's HIV response,1Barmania S Successes and challenges in Thailand's HIV response.Lancet HIV. 2023; 10: e699-e700Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar questioned the Thailand Ministry of Public Health's commitment to support community-led HIV services. The report stated that "the new guidelines by the Ministry of Public Health revoke authorisation of [pre-exposure prophylaxis] PrEP by lay people" and that two new requirements—which were "only government doctors can prescribe PrEP" and "key-population-led clinics cannot stock PrEP medicine"—pose a real threat to community-led clinics.1Barmania S Successes and challenges in Thailand's HIV response.Lancet HIV. 2023; 10: e699-e700Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar In 2019, the Ministry of Public Health issued three ministerial regulations that permitted certified community health workers to provide HIV services under the supervision of health professionals.2Ministerial regulations on community health worker providing HIV/STIs servicesNonthaburi: Division of AIDS and STIs.https://ddc.moph.go.th/das/pagecontent.php?page=1511&dept=dasDate: 2019Date accessed: November 22, 2023Google Scholar These regulations allowed community health workers to screen for HIV and to give prescribed antiretrovirals to those who need them, which non-medical personnel had never been permitted to do before. These changes reflect the Ministry of Public Health's commitment to enable and engage civil society in the provision of HIV services. In 2023, the Ministry of Public Health issued a guideline on PrEP service delivery for civil society organisations (community-led organisations). The guideline aimed to integrate civil society organisations through service pairing with government health facilities. However, the guideline did not limit private doctors to prescribe PrEP at private clinics. With this pairing model, civil society organisations can work under professional supervision through telehealth services, offer counselling, screening, and stock prescribed PrEP at civil society organisations before delivery to PrEP recipients.3Guideline on PrEP service delivery at community-led facilityNonthaburi: Division of AIDS and STIs.https://ddc.moph.go.th/uploads/ckeditor2//files/Guideline.pdfDate: March 24, 2023Date accessed: November 22, 2023Google Scholar However, there are limitations for community-led clinics that are registered as medical technology clinics. These clinics must comply with the Medical Facilities Act, B.E. 2541 (1998) and the Medical Technology Profession Act, B.E. 2547 (2004), which only permit these clinics to do laboratory investigations, analysis, research, and report on the examination of medical specimens.4Medical Facilities Act, B.E. 2541.https://www.ocs.go.th/council-of-state/#/public/doc/VTJGc2RHVmtYMTlkMG5Bdk0vandTbTEzWEYrb25qYlp1VjJMNFdleitmQT0%3DDate: 1998Date accessed: November 22, 2023Google Scholar, 5Medical Technology Profession Act, B.E. 2547.https://www.ocs.go.th/council-of-state/#/public/doc/VTJGc2RHVmtYMTlkMG5Bdk0vandTbzhXQWVjU2g1cFhISHZLL3NWK0xYMD0%3DDate: 2004Date accessed: November 22, 2023Google Scholar We declare no competing interests. Successes and challenges in Thailand's HIV responseLong at the forefront of innovations in HIV/AIDS care in Asia, Thailand's community engagement has been key in their HIV response. But, Sima Barmania reports, all is not plain sailing. Full-Text PDF Response to Thailand's commitment to support community-led HIV servicesCheewanan Lertpiriyasuwat and colleagues1 argue that Thailand's Ministry of Public Health made a commitment to enable and engage civil society in HIV services as providers by the issuance in 2019 of three ministerial regulations, which permitted certified community health workers to provide HIV services under the supervision of health professionals. This action is truly commendable as it had been a long process to achieve formalised partnerships between civil society and government with the mutual goal of ending AIDS in Thailand. Full-Text PDF