Key population lay providers can successfully link men who have sex with men clients to care after diagnosing sexually transmitted infections in community-based organizations in Thailand


BACKGROUND: Through the key-population-led health services (KPLHS) model, trained key population (KP) lay providers deliver comprehensive HIV-related services in community-based organizations (CBOs) in Thailand. To increase access to services for sexually transmitted infections (STIs), we integrated point-of-care (POC) GeneXpert testing for chlamydia (CT) and gonorrhea (NG) into KPLHS in four CBOs in Thailand. Here we assess rates of successful links to treatment after diagnosis.
METHODS: POC STI testing was integrated into KPLHS in August 2019. Trained KP lay providers collected and tested single participant pooled urine, pharyngeal, and rectal samples for CT/NG using the GeneXpert assay at the CBOs, and plasma was tested with rapid treponemal test and RPR test for syphilis serology. When an STI was detected, the client was assisted to treatment services by CBO care and support staff to health care facilities with which referral routes (including the acceptance of test results from the CBOs, thereby eliminating the need for repeat testing) were previously established. Successful linkage was assessed by follow-up phone call, and the number of days between diagnosis and treatment was calculated.
RESULTS: Between August 2019 and July 2020, 1,008 participants (875 MSM [86.8%] and 133 TGW [13.2%]) were recruited. Among MSM, CT/NG/syphilis events were detected in 240/1029 (23.3%)/174/953 (18.3%)/98/961 (10.2%), of whom 206/239 (86.2%)/139/172 (80.8%)/82/98 (83.7%) successfully received treatment. Median (interquartile range-IQR) days between diagnosis and treatment was 4(1-10)/6(2-15)/4(2-7). Among TGW, CT/NG/syphilis events were detected in 33/155 (21.3%)/18/138 (13%)/16/140 (11.4%), of whom 22/33 (66.7%)/12/18 (66.7%)/7/16 (43.8%) successfully received treatment. Median (interquartile range-IQR) days between diagnosis and treatment was 4(1.5-11)/4(3-5)/4(2-6).
CONCLUSIONS: Integration of CT/NG testing into KPLHS to increase access to STI services among KPs resulted in significant STI diagnoses, with high rates of successful linkage to treatment services among MSM. Rates among TGW were lower, indicating tailored strategies to link this population to care are urgently needed. Despite acceptance of CBO test results by referral facilities, time from diagnosis until treatment completion was long. Time to treatment should be further optimized by exploring methods to expedite treatment, such as fast-track referral options or the integration of treatment services at CBOs to facilitate same-day treatment.