Page 283 - EPREP book

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 CBO, PrEP is not among the top priority among
this population as there are other significant competing priorities in PWID lives.

4. Summary and policy recommendations
The national PrEP implementation for populations with substantial risk is essential to increase
long-term use of PrEP resulting in reducing the number of HIV-infected individuals and stopping

AIDs endemic in Thailand. The research team proposed policy recommendations as follows.
1. NHSO should consider including PrEP into the universal health coverage scheme (UHC)

for high-risk population at 18 years of age or over or from 15 years of age among
individuals with increased risk of HIV acquisition who have interest in taking PrEP.
2. The number of PrEP service centers under KPLHS with high potential and standard in

delivering PrEP service certified by the Department of Disease Control, Ministry of Public
Health especially in provinces or settings with high HIV prevalence should be increased.
In terms of service distribution, there should be at least one PrEP center in each province

from 2022 onwards. The CBOs reach-recruit to hospitals model should be encouraged in
reaching and recruiting more potential PrEP clients.
3. More support of operation coverage including subsidizing the cost of medications to

enable same-day PrEP, increasing coverage of additional necessary laboratory tests e.g.,
HIV testing, anti-HCV, renal function tests for special cases, providing lubricants and

[220] Executive Summary