Page 17 - EPREP book

PrEP service providers
From quantitative analysis, PrEP service providers in Thailand have positive attitudes

towards PrEP. Majority of participants reported a high level of perceived knowledge in PrEP

and supported PrEP provision in all high-risk groups with residual concern regarding impact of
PrEP on anti-retroviral drug resistance. According to qualitative study, majority of PrEP service

centers performed well in delivering PrEP service. Most PrEP service providers both from
hospital and KPLHS settings had several years of experiences and high level of knowledge in

PrEP. However, there were some new PrEP service providers from hospital setting who did
not receive PrEP training. Challenges in delivering PrEP service are high workload, limited

manpower, and working space for counseling activities due to the overwhelming number of

clients. KPLHS generally has advantage in reaching and recruiting potential PrEP clients over
hospital-based setting where PrEP service in hospital setting is usually integrated with ARV, STI

clinics and VCT. Limited coverage of the benefit package remains challenges. These include

additional laboratory testing cost for clients with impaired renal functions, insufficient supplies
of lubricants and condoms at required sizes (52”, 54”, 56”). PrEP users are recruited from

social networking platform, walk-in clients, and referral-based model. KPLHS deliver mobile
VCT, and PrEP at educational institutions, department stores, and communities in reaching key

populations. However, there are limitations concerning waiting time for laboratory testing
results, and same-day PrEP initiation during mobile VCT.

PrEP uptake remains challenges in incarcerated populations. Only one PrEP center in

the study provides mobile PrEP service in male prisons through great coordination between
wardens and hospital PrEP service providers. Challenges remained include different

management between each prison section or wing, and post-incarceration PrEP access.
Monitoring and referral to nearby PrEP service centers for post-incarcerated individuals after

leaving prisons would be essential for continuity of PrEP use.

Several factors impeded PrEP utilization among people who injects drugs (PWIDs)
including forgetting to take PrEP, housing stability and safety, financial and legal issue and

stigmatization. PrEP users usually do not disclose they history of illicit drug use. Most service
providers do not have experiences in providing PrEP to PWIDs and consider them to be the

most difficult to be reached among all key populations. Community-based organizations

working with PWIDs are concentrated in some certain settings. According to informants from

รายงานการประเมินผลการด าเนินงาน PrEP ภายใต้ชุดสิทธิประโยชน์สปสช. ปีงบประมาณ 2563 [xiv]