Response to Thailand's commitment to support community-led HIV services
Authors: Nittaya Phanuphak, Surang Janyam, Pongpeera Patpeerapong, Satayu Sittikan, Kittinan Daramadhaj, Supabhorn Pengnonyang, Rena Janamnuaysook, Inthira Suya, Stephen Mills, Praphan Phanuphak
Journal: The Lancet HIV (2024)

Cheewanan Lertpiriyasuwat and colleagues1Lertpiriyasuwat C Jiamsiri S Prommali P Thailand's commitment to support community-led HIV services.Lancet HIV. 2024; (published online Feb 6.)http://doi.org/10.1016/S2352-3018(24)00012-2Summary Full Text Full Text PDF Scopus (1) Google Scholar 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.2Pengnonyang S Ramautarsing RA Janyam S et al.Certification of lay providers to deliver key population-led HIV services in Thailand's National Healthcare System: lessons learned.J Int AIDS Soc. 2022; 25e25965 Crossref PubMed Scopus (6) Google Scholar However, the Ministry of Public Health's 2023 guideline on pre-exposure prophylaxis (PrEP) service delivery at community-led facilities, with the intention to integrate civil society organisations through service pairing with government health facilities,1Lertpiriyasuwat C Jiamsiri S Prommali P Thailand's commitment to support community-led HIV services.Lancet HIV. 2024; (published online Feb 6.)http://doi.org/10.1016/S2352-3018(24)00012-2Summary Full Text Full Text PDF Scopus (1) Google Scholar inadvertently and detrimentally affected Thailand's cost-effective, key-population-led, same-day PrEP service.3Ramautarsing RA Meksena R Sungsing T et al.Evaluation of a pre-exposure prophylaxis programme for men who have sex with men and transgender women in Thailand: learning through the HIV prevention cascade lens.J Int AIDS Soc. 2020; 23e25540 Google Scholar, 4Versteegh L Amatavete S Chinbunchorn T et al.The epidemiological impact and cost-effectiveness of key population-led PrEP delivery to prevent HIV among men who have sex with men in Thailand: a modelling study.Lancet Reg Health Southeast Asia. 2022; 7100097 PubMed Google Scholar EpiC Thailand data reveal a 21% decrease in the number of new clients receiving PrEP after 3 months of guideline implementation, given an 11–12% upward trend in previous quarters. This is a negative effect of the guideline as it not only disallows non-government doctors to prescribe PrEP in key-population-led and community-led PrEP service delivery but also prevents PrEP medication to be stocked at key-population-led and community-led clinics. We believe that it is crucial to engage non-government doctors in the key-population-led PrEP service delivery because over the past 8 years finding enough government doctors who feel comfortable enough to prescribe PrEP for clients at key-population-led clinics has been challenging. Therefore, most key-population-led clinics have made creative and valuable partnerships with non-government doctors who perform tele prescription for clients receiving PrEP. As stated by Lertpiriyasuwat and colleagues,1Lertpiriyasuwat C Jiamsiri S Prommali P Thailand's commitment to support community-led HIV services.Lancet HIV. 2024; (published online Feb 6.)http://doi.org/10.1016/S2352-3018(24)00012-2Summary Full Text Full Text PDF Scopus (1) Google Scholar non-government or private doctors can still prescribe PrEP at private clinics, but they cannot do so at key-population-led clinics even though they do not receive any reimbursement for such services. Since 2023, the Ministry of Public Health's guideline does not allow PrEP medication to be stocked at key-population-led clinics; their clinic staff now need to spend extra time and resources travelling to pick up individually packed PrEP medication from their paired government hospitals and to make sure that the medication is ready to be distributed to clients scheduled each day. The guideline unnecessarily made same-day PrEP service delivery at key-population-led clinics no longer possible for new or unscheduled clients. To allow their services to be formally accredited and reimbursed by the National Health Security Office, key-population-led clinics are registered as medical technology clinics. Lertpiriyasuwat and colleagues1Lertpiriyasuwat C Jiamsiri S Prommali P Thailand's commitment to support community-led HIV services.Lancet HIV. 2024; (published online Feb 6.)http://doi.org/10.1016/S2352-3018(24)00012-2Summary Full Text Full Text PDF Scopus (1) Google Scholar mentioned that these clinics are only permitted to do laboratory investigations. If the Ministry of Public Health translates this statement into its guideline, further frustration will be caused for those wanting to see PrEP scaled up, especially since more than 80% of people who use PrEP in Thailand are receiving services at key-population-led clinics.5Lertpiriyasuwat C Jiamsiri S Triamwichanon R et al.Thailand national PrEP program: moving towards sustainability.https://programme.aids2022.org/Abstract/Abstract/?abstractid=1228Date: July 29–Aug 2, 2022Date accessed: January 16, 2024Google Scholar We would like to remind the Ministry of Public Health that the 2019 ministerial regulations originally allowed well trained and certified community health workers to perform certain HIV services to accelerate the ending of AIDS in Thailand.2Pengnonyang S Ramautarsing RA Janyam S et al.Certification of lay providers to deliver key population-led HIV services in Thailand's National Healthcare System: lessons learned.J Int AIDS Soc. 2022; 25e25965 Crossref PubMed Scopus (6) Google Scholar To now move away from that bold advance would be a step backwards. We declare no competing interests. Thailand's commitment to support community-led HIV servicesSima Barmania's recent feature story, Successes and challenges in Thailand's HIV response,1 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. Full-Text PDF