CDCs Global AIDS Program (GAP) will in FY 2012 enter the second year of its third five-year CoAg with BMA. Specific objectives of the CoAg are to support Thailands national HIV/AIDS strategy and BMA priorities by:

1) Supporting replicable models for prevention, care, and treatment;

2) Improving the quality of prevention, care and treatment programs;

3) Increasing the collection and use of SI;

4) Sharing successful models by providing TA to other PEPFAR countries.

Expected outcomes include:

1) Strengthening health systems, human capacity, guidelines and protocols, and QA/QI systems to best enable the RTG to finance and manage programs;

2) Supporting replicable and scalable models for interventions;

3) Improving prevention, care and treatment programs;

4) Increasing collection and use of SI;

5) Sharing successful models with other PEPFAR countries.

This approach follows GHI principles, including promoting sustainable, locally-owned programs, prioritizing M&E, and fostering research and innovation. All GAP technical support is for programs that are, or will be, fully integrated into routine, BMA-managed public health programs.

CoAg activities focus on Bangkok, which administers some hospitals and clinics not run by MoPH. Target populations include MARPs (IDU, MSM); pregnant women (PMTCT); children (early diagnosis); and efforts that strengthen capacity overall (HCT systems; HIV care; lab systems, PwP; and SI).

As a TA-based CoAg, costs continue to be low for this implementing mechanism. Model development and evaluation are supported for a time-limited period, and then other donor or government funding is leveraged for program expansion and integration.This CoAg may be a model for countries transitioning to PEPFAR 2 and GHI approaches.

Strengthening Health Management Information System and Building Human Resource Capacity on Utilization of Strategic Information to Promote Effective HIV/AIDS Program Management, Bangkok Metropolitan Administration

RTG is committed to preventing the spread of HIV/AIDS, eliminating AIDS-related deaths, and eliminating discrimination in society. BMA is one of five operational research provinces for the intensive implementation and evaluation of effective mechanisms to achieve those goals. To guide development of effective strategies and operational plans, evidence about the status of the HIV/AIDS epidemic and the ongoing response is needed.

In past years, GAP Thailand provided TA to BMA to strengthen existing national surveillance and monitoring systems through innovative epidemiological and informatics approaches. However, challenges remain, especially regarding infrastructure and human resources with sufficient epidemiological and informatics skills to assist in collecting, managing, interpreting, and using SI for policy and program planning. Building human resource and infrastructure capacity are needed. For those reasons, GAP will provide TA to enhance BMA capacity to use HIV SI to promote the effective implementation of the draft national HIV/AIDS strategic plan. In FY 2013, GAP plans to undertake the following activities:

1. Strengthen HIV sero-incidence surveillance using BED-CEIA among pregnant women in Bangkok, considering lessons learned from evaluating a new laboratory approach (Limiting antigen avidity assay) and the adjustment of False Recent Rate in FY 2012.

2. Develop and implement HIV drug resistance surveillance, using experiences learned from the pilot models conducted with GFATM support and ART infrastructure in BMA.

3. Coordinate with Bureau of Epidemiology to ensure that BMA and national behavioral surveillance systems are aligned.

4. Implement HMIS to monitor BMAs facility-based harm reduction program and assess the feasibility of integrating key monitoring data with the monitoring systems for outreach interventions, HCT, care and treatment, and serosurveillance among IDU.

5. In collaboration with MoPH and NHSO, strengthen HMIS to utilize NAP data for ART program monitoring, PMTCT outcome monitoring and case reporting surveillance, and increase cooperation between BMA, MoPH, university and private facilities.

6. Develop and implement guidelines on synthesis and triangulation of SI for situation analysis, monitoring of program implementation, MARP population size estimation, and estimation of key parameters for policy making and program planning for BMA.

7. Increase capacity of human resources at BMA through workshop trainings and field supervisions. Expected outputs include increasing their capability to use SI to describe HIV epidemics and responses and guide policy making, and developing communication skills needed to engage policy-makers in ways that proactively promote improvements to current evidence-based programs.

8. Establish a web-based information bank to link data on HIV epidemics and responses (key indicators for program outputs, outcomes and impacts).

9. Train 120 BMA staff to implement HIV Incidence surveillance, BSS, HIV drug resistance (HIVDR) surveillance and Early Warning Indicator of HIVDR.

CDC and BMA support highly trained scientists and public health officials to share knowledge and experience to promote and support development of high-quality HIV care and treatment and sustainable laboratory capacities, among others. Projects focus on building the capacity of staff to improve work performance via sponsoring staff to attend conferences and workshops in-country and international trainings, meetings, conferences and workshops. Because projects in Thailand focus on model development, strong human resources capacity is needed for better programs. Projects include PMTCT services, quality of HIV care and treatment, HIV counseling and testing (including couples counseling at antenatal care centers), STD diagnosis and treatment including MARP-friendly services, and collection, interpretation, and use of strategic information. Others will develop training material for laboratory activities that improve the quality of all HIV-related testing, as well as the quality of laboratory systems and laboratory training, meetings, and workshops for activities in Thailand. Reliability of laboratory results are fundamental to supporting HIV prevention, care and treatment.

According to evidence of MSM and TG in BMA is very high prevalence of HIV infection. HIV prevalence among MSM is as high as 30% in Bangkok, A peer-based approach to treatment for HIV-positive MSM is an effective option to ensure quality and consistency to ARV in HIV clinic by helping health care providers in ARV clinics to get the continuum of prevention, care and treatment. GAP Thailand will closely collaborate with eight ARV clinics in Bangkok metropolitan administration (BMA) and four public health centers, particularly on linking prevention with testing, care and support services. GAP Thailand TA will complement this with training of health care workers (HCW) in same day result counseling and HIV testing, prescribing ARVs and care providing, especially for HIV-positive MSM and TG.

HIV Prevention for IDUs in Bangkok - Peer Outreach

Evidence has shown that many IDU have increasingly injected multiple drugs, including methamphetamine. IDU surveys conducted in Bangkok showed that methamphetamine was the most common drug injected.

Treatment for methamphetamine users employs therapeutic approaches including the Matrix program, which involves counseling, recovery skills, relapse prevention and family education. Prevention of HIV transmission and harm reduction may be discussed during the program, but the content of these HIV-related sessions are typically not standardized nor tailored to address risks including HV transmission for methamphetamine injectors.

In response to HIV risk and possible transmission among methamphetamine injectors, in FY 2012 the Office of Drug Abuse Prevention and Treatment (ODAPT) under BMA and GAP Thailand plan to conduct a formative assessment of methamphetamine injection. This assessment will provide information on factors driving methamphetamine users, who have historically taken the drug orally, to switch to injecting. This assessment will also explore existing methamphetamine prevention and treatment options, and identify gaps in services in relation to HIV prevention for methamphetamine injectors.

The results of the assessment, along with information on the current situation of methamphetamine abuse from other data sources, will be translated into recommendations and interventions for HIV prevention, VCT and other HIV-related services for methamphetamine injectors in Bangkok and other areas that are identified as major areas for methamphetamine injectors (e.g., North of Thailand). Part of the assessment will be to strengthen the capacity of BMA drug treatment clinic staff in providing HIV-related services.

Quality Improvement for Prevention of Mother-to-Child HIV Transmission (PMTCT) Program through the Establishment of BMA PMTCT Monitoring and Evaluation System

BMA is unique in Thailand as it runs some of the hospitals and clinics in Bangkok under its own jurisdiction rather than MoPH jurisdiction. Moreover, more than 100,000 deliveries/year (approximately 12% of annual births in Thailand) are in Bangkok. There are 9 hospitals under direct BMA jurisdiction, as well as more than 60 private hospitals, 5 MoPH hospitals, 3 military and 3 university hospitals in Bangkok. BMAs Bureau of Health and Bureau of Medical Services will be the focal points for PMTCT services and HIV program coordination.

GAP Thailand will provide TA to BMA to implement the same PMTCT monitoring systems as the MoPH national program. These include a Web-based centralized database system (PHIMS v3) and a PMTCT outcome database, with data generated from the National AIDS Program (NAP) database used in all 9 BMA hospitals and 5-10 public tertiary care hospitals in the Bangkok area. In FY 2013, the PHIMS v3 Web-based system will be implemented in 8 BMA hospitals, including a data utilization system for feedback on hospital performance and promotion of QI in PMTCT programs. BMA hospitals will be trained on systematic data review, gap analysis and QI for PMTCT.