Thailand national PrEP program: moving towards sustainability

BACKGROUND: In Thailand, PrEP drugs are provided free of charge through government health care providers and key population-led health services (KPLHS) with external donor funding from The Global Fund, Thai Red Cross, and research projects. Thailand aims to gradually increase government funding and integrate PrEP service in the universal health coverage (UHC) benefit package, provided by the National Health Security Office (NHSO).
DESCRIPTION: To address PrEP service sustainability through government funds, the country worked on key systems health requirements including sharing evidence-based advocacy with policy makers, building capacity for health care staff, identifying and replicating best practice model to deliver PrEP, establishing a national PrEP monitoring system and PrEP targets, and developing PrEP implementation guidelines.
LESSONS LEARNED: By December 2021, current PrEP users in Thailand was 15,546; corresponding to a 7.3-fold increase from 1,865 in 2017. Starting in 2020, NHSO fund was allocated to pilot free PrEP as part of UHC; the fund accounted for 15% of PrEP users that year. In 2021, 44% of current PrEP users were from NHSO funding; almost three-fold increase from when NHSO program was first introduced in 2020, and three times more than the 5,000 PrEP user target set by NHSO. Capacity building based on PrEP national guidelines was provided to 154 hospitals; 91 (59%) of these successfully set up PrEP service. 82% of current PrEP users in 2021 (n= 15,546) received PrEP services at KPLHS sites. To increase sustainability and replicate the KPLHS best practice model, government is working on a KPLHS certification process to enable KPLHS sites to establish a formal partnership with government facilities to accelerate uptake of PrEP service. Despite these enabling policies and excellent health care infrastructure, Thailand current PrEP users only reached 35% of its 44,697 PrEP 2022 implementation goal.
CONCLUSIONS: Thailand has built the foundations for PrEP program through evidence-based policy advocacy and guidelines, showing commitment through government financing of PrEP. Accelerating and promoting PrEP access and uptake through speeding PrEP service at KPLHS sites and government facilities will be key to support the scale up of PrEP in the country.