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Background Cardiovascular diseases (CVD) due to atherosclerosis have become one of the major causes of death among people living with HIV (PLHIV) since effective antiretroviral therapy (ART) has been available throughout the world. However, the epidemiologic evidence of this problem from the Asia-Pacific region remains unclear. We conducted a systematic review of the situation and risk factors for CVD among PLHIV in countries with the greatest impact of CVD attributable to HIV in the Asia-Pacific region. Methods A systematic search in PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews databases for articles published before 2019 was conducted. Publications reported situations and risk factors both traditional and HIV-specific for CVD among PLHIV in the region were included. Two reviewers working on duplicate and quality assessments, independently extracted data, and thematically analyzed the data. Results Among PLHIV, the prevalence of subclinical CVD ranged from 10 to 28% and the incidence rate of clinical CVD ranged from 0.37 to 1.17 /100 person-years. Clinical CVD was frequently observed in the early era of the highly active antiretroviral therapy. A higher prevalence of subclinical CVD such as abnormal cIMT and carotid plaques was frequently observed in the PLHIV rather than in the nonHIV population and a high proportion of early onset of CVD was found among young PLHIV adults. The traditional risk factors for CVD such as hypertension, diabetes and smoking behavior were prevalent in both PLHIV and nonHIV populations ranging from 5 to 45%. HIV-specific risk factor, and lower CD4 presented almost twice the significantly increased risks for CVD while the synergistic interaction among traditional risk factors, i.e., diabetes mellitus, dyslipidemia and family history steeply increased the risk for CVD among PLHIV by almost 20 times. Conclusion The limited existing data suggested the risk of early CVD among PLHIV. We identified the crucial gaps in HIV/CVD work from the Asia-Pacific region and recommended longer prospective studies with larger sample sizes or meta-analyses to better capture CVD risk and interactions of crucial risk factors of this vulnerable population in this region. Registration number INPLASY202290108 ( https://inplasy.com/inplasy-2022-9-0108/ ).

Background Metabolic syndrome (MetS) elevates the risk of heart disease and stroke. In recent decades, the escalating prevalence of MetS among people living with HIV/AIDS (PLWHA) has garnered global attention. Despite MetS development being associated with both traditional and HIV-related factors, evidence from prior studies has shown variability across geographical regions. This study aimed to conduct a systematic review and meta-analysis of MetS burdens in adult PLWHA at the regional and global levels, focusing on the common effect size of HIV infection and antiretroviral therapy (ART) on MetS. Methods This review followed the PRISMA 2020 guidelines. A comprehensive search and review of original articles related to MetS and HIV published in peer-reviewed journals between January 2000 and December 2023 were conducted. A random effects model was used to calculate the pooled prevalence/incidence of MetS and the common effect size of HIV infection and ART exposure on MetS. Results A total of 102 studies from five continents comprising 78,700 HIV-infected participants were included. The overall pooled prevalence of MetS was 25.3%, 25.6% for PLWHA on ART, and 18.5% for those not receiving treatment. The pooled incidence of MetS, calculated from five studies, was 9.19 per 100 person-years. The highest pooled prevalence of MetS was observed in the Americas (30.4%), followed by the Southeast Asia/Western Pacific regions (26.7%). HIV-infected individuals had 1.6 times greater odds of having MetS than non-HIV-infected individuals did (pooled OR = 1.604; 95% CI 1.154–2.230), and ART exposure had 1.5 times greater odds of having MetS than nontreatment had (pooled OR = 1.504; 95% CI 1.217–1.859). Conclusions HIV infection and ART exposure contribute significantly to the increased burden of MetS. Regions with a high burden of HIV and MetS should prioritize awareness and integrated care plans for major noncommunicable diseases (NCDs), such as heart disease and stroke. The implementation of integrated care for HIV/AIDS patients and NCDs is essential for addressing the high burden of multimorbidity in PLWHA. Registration number INPLASY202290018

This cross-sectional study investigated the mental health outcomes and associated factors among Bangladeshi migrants in Thailand. A sample of 360 participants completed questionnaires assessing depressive symptoms, anxiety, and stress using the DASS-21 scale, along with sociodemographic and acculturative factors. Results revealed that 35.8%, 42.2%, and 17.8% of participants experienced symptoms of depression, anxiety, and stress, respectively. Lower education levels were associated with increased risk of all three mental health outcomes. Unexpectedly, assimilation as an acculturation strategy and higher Thai language proficiency were linked to poorer mental health. Experiences of discrimination and low social support significantly increased the likelihood of mental health issues. Difficulty accessing healthcare services was also associated with worse mental health outcomes. These findings highlight the complex interplay between acculturation, social factors, and mental health among migrant populations, emphasizing the need for culturally sensitive mental health services and policies to support Bangladeshi migrants in Thailand.

Background Suicide is a significant public health concern globally, with disproportionate impacts in low- and middle-income countries. Thailand’s suicide rate has risen steadily, particularly in northern provinces such as Lamphun. In response, the Lamphun Provincial Health Office developed the “Four Pillars,” a community-based, multisectoral suicide prevention strategy. This study evaluates the feasibility and effectiveness of the Four Pillars using the RE-AIM framework. Methods A convergent parallel mixed-methods study was conducted across three districts in Lamphun Province. Quantitative data included suicide surveillance reports from 2020–2022 and a community survey of 600 adults. Qualitative data were collected through in-depth interviews ( n = 36), three focus group discussions ( n = 21), and document reviews. The RE-AIM framework guided tool development, data collection, and analysis, evaluating the strategy across five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance Results Reach: A total of 2,876 individuals at suicide risk were identified and received integrative interventions. Effectiveness: None subsequently exhibited suicidal behavior. Suicide rates in Lamphun declined modestly post-implementation, though not significantly ( p  = 0.331). Adoption: Adoption varied due to cultural beliefs, resource limitations, and stigma; survey findings revealed lower suicide literacy and persistent stigma in ethnic communities ( p  < 0.01). Implementation: Community-based surveillance was successfully adapted across contexts (e.g., via local language dissemination, engaging monks and street vendors as gatekeepers) with high fidelity to the model’s core principles. Strong partnerships were critical. Conclusions The Four Pillars strategy is a feasible and promising approach to reduce suicide risk through a community-based integrated surveillance and response system. Strategic local adaptations enhanced its feasibility without compromising core components. Addressing stigma, improving literacy, and strengthening multisectoral capacity are critical for broader scale-up and sustainability in Thailand and similar settings.

Background The healthcare services for non-communicable diseases (NCD) are commonly affected by public health crises like the COVID-19 pandemic. During the pandemic, all healthcare facilities in Bangkok had been overwhelmed by the extreme caseload of COVID-19. Health service resiliency is crucial for the continued service of healthcare facilities post pandemic. This study aims to explore the impacts of COVID-19 on NCD service disruption and addressed the resilience of healthcare services at the operational level. Methods Healthcare facility-based surveys and in-depth interviews were conducted among representatives of the facilities in Bangkok from April 2021 to July 2021. The web-based, self-administered questionnaire, was sent to directors or authorities of all healthcare facilities in Bangkok Thailand (n = 169). Two healthcare facilities from three levels of health services were purposively selected. The directors or medical doctors and nurses who are in charge of the NCD service, and working at the six selected health facilities, were invited to participate in the in-depth interviews. Descriptive statistics were used to analyze the survey data, and thematic analysis was used to analyze the data from the in-depth interviews. Results The impact of COVID-19 on NCD service disruption in the second wave (2021) was more severe than in the first wave (2020). The main reasons for NCD service disruptions are insufficient staff, and the closure of some services offered by the healthcare facilities. Surprisingly, both the budget and medical supply for healthcare facilities in Bangkok are less affected by the COVID-19 pandemic. Our study revealed resilience capability i.e. absorptive, adaptive, and transformative capabilityamong the healthcare facilities that provide a continuum of care by increasing availability and accessibility to healthcare services for chronic illness as DM. The service disruption in Bangkok may alter from other provinces because of variations in COVID-19 incidence and health services contexts. Conclusion During the public health crisis, using affordable and common digital technologies to ensure DM patients can access a continuum of care and providing alternative services such as mobile medical laboratories, medication delivery, and medical refill at drug stores can increase consistent monitoring of glycemic levels and use of prescribed medication.

Objectives We conducted a matched case‐control study of informal workers to determine the association between occupational classification and selected types of noncommunicable diseases (NCDs). Method We extracted data of patients aged ≥18 years from the Thai National Health Security Office database (NHSO) during 2011‐2014. Cases were patients who had a primary diagnosis of: diabetes mellitus (E10‐E14), hypertension (I10‐I15), ischemic heart disease (I20‐I25) or stroke (I60‐69), or thyroid gland disorder (E00‐E07). Controls were patients who had a primary diagnosis of intestinal or parasitic infections (A00‐A09 and B25‐B99), and were randomly matched 1:1 with cases of the same age and residential area. The four‐digit occupation codes recorded in the NHSO were grouped and recoded based on the submajor groups of International Standard Classification of Occupations (ISCO‐08) as follows: agricultural workers, unskilled workers, service, and sales workers. Analysis was performed using multivariable conditional logistic regression. Results Occupation and sex inequalities were present among all the selected NCDs. Higher risk for the four selected NCDs was found among unskilled workers. Stronger risk for cardiovascular disease was present among males, while females had a higher risk for metabolic disorders. Conclusions There is a need to understand what are the key factors that increase the risk for NCDs among informal sector workers. Health promotion campaigns are needed to raise awareness among economically and social disadvantaged informal workers about the risk for NCDs. This will require collaboration between public health and the workforce, and allocation of government budgets to address the needs of these workers.

Background This study aimed to evaluate associations among countries’ self-reported International Health Regulation 2005 (IHR 2005) capacity assessments and infectious disease control outcomes. Methods Countries’ self-reported assessments implemented by percentages as IHR Monitoring Tools (IHRMT) in 2016 and 2017 were used to represent national capacity regarding infectious disease control. WHO Disease Outbreak News and matched diseases reports on ProMED-mail were collected in 2016 to represent disease control outcomes of countries. Disease control outcomes were divided in good, normal and bad groups based on the development of outbreaks listed in the reports. The Human Development Index (HDI), density of physicians and nurses, health expenditure, number of arrivals of international tourists were also collected for control. Chi-square test and logistic regression were applied for analysis. Results A total of 907 cases occurred in 92 countries. For all diseases, cases occurring in high international travel volume countries presented twice the risk of having a bad disease control outcomes than cases occurring in low international travel volume countries (OR = 2.19 for IHR 2016, OR = 2.97 for IHR 2017). Cases occurring in low IHR average score countries had significant higher risk (OR = 7.83 for IHR 2016 and OR = 2.23 for IHR 2017) of having a bad disease control outcomes than countries with high IHR average scores. For only human diseases, cases occurring in high international travel volume countries presented twice the risk of having a bad disease control outcomes than cases occurring in low international travel volume countries for IHR 2017 (OR = 2.79). Cases occurring in low IHR average score countries had significant higher risk (OR = 11.16 for IHR 2016 and OR = 3.45 for IHR 2017) of having a bad disease control outcomes than countries with high IHR average scores. The HDI, health workforce density and total health expenditure were all positively associated with disease control outcomes. Conclusions Countries’ self-reported infectious disease control capacities positively correlated with their disease control outcomes. While the self-reported IHR scores were accountable to some degree, this approach was useful for understanding global capacity in infectious disease control and in allocating resources for future preparedness.

Thailand has made notable progress in HIV prevention, yet challenges persist, particularly among high-risk groups. Pre-exposure prophylaxis (PrEP) is a proven biomedical strategy to prevent HIV, but its uptake remains below national targets. This study examined whether PrEP knowledge mediates the relationship between PrEP-eligible behaviors and intention to use PrEP among clients accessing voluntary counseling and testing (VCT) services at government health facilities in Thailand. A cross-sectional, web-based survey was conducted between October 2024 and March 2025. A two-stage sampling approach was used to select 62 public hospitals across country. There were 2,007 eligible VCT clients voluntarily participated the study. Mediation analysis was performed using the SPSS PROCESS macro. Results showed that PrEP-eligible behaviors significantly predicted both PrEP knowledge (β = 0.42, p  < 0.001) and intention to use PrEP (β = 0.38, p  < 0.001). PrEP knowledge was also positively associated with intention to use PrEP (β = 0.47, p  < 0.001) and partially mediated the relationship between eligibility and intention (indirect effect = 0.20, 95% CI [0.15, 0.26]). These findings underscore the importance of enhancing PrEP knowledge to drive preventive behavior. Targeted educational strategies and improved integration of PrEP services into public health infrastructure are essential to expand uptake and meet Thailand’s goal of eliminating AIDS as a public health threat by 2030.

Background The time between discharge from hospital and transition to community and home is a critical period for health status among patients with a mental illness, including patients with schizophrenia. This study aimed to investigate crucial patient factors (patient-level) and hospital factors (hospital-level) affecting health status and see whether patient factor effects on health status vary with hospital factors, 30 days after hospital discharge. Methods This is a prospective study of 1255 patients with schizophrenia and their primary caregivers from 13 public mental hospitals across Thailand. Logistic regression and multi-level logistic regression was used to investigate the effects of patient and hospital factors simultaneously on health status, 30 days after hospital discharge. Results The intraclass correlation coefficient indicated that 14% of the change in health status was explained by the differences between hospital. Poor health status was identified in 14.26% of patients, 30 days after hospital discharge. The majority of participant patients were male (69.8%), single (71.87%), and the average age was 38.09 (SD = 9.74). The finding also showed that the patient factors; being female (OR adj .53, 95%CI .31,.92), perceived moderate and high levels of positive aspect of caregiving (OR adj .24, 95%CI .14,.42 and OR adj .05, 95%CI .02,.09), perceived readiness for hospital discharge (OR adj .21, 95%CI .13,.33), partial and full adherence to treatment (OR adj .24, 95%CI .14,.42 and OR adj .31, 95%CI .20,.47) showed a reduced likelihood of developing poor health status except substance use (OR adj 1.55, 95%CI .98, 2.44). Hospital factors; discharge planning process and nurse-patient ratio (OR adj 1.64, 95%CI 1.17, 2.30 and OR adj 1.16, 95%CI 1.09, 1.22) showed an increased likelihood of developing poor health status, 30 days after hospital discharge. Conclusions Findings provide relevant information on how both patient and hospital factors determine health status. These results might lead to better targeting of mental health service policy and enable more precise information gathering and allocation of resources. However, future research should be more focused and continue investigating the pathways through which hospital factors influence health status post-discharge.

Background Thailand’s Tak and Mae Hong Son (MHS) provinces, bordering Myanmar, are critical entry points for individuals seeking employment or healthcare. The COVID-19 pandemic and Myanmar’s political instability have significantly impacted the health and performance of border-area health systems. This analysis examines the current state of the health sector, border health challenges resulting from cross-border movement, and identifies key gaps through data from health organizations and interviews in Tak and MHS provinces. Methods A mixed-method situational analysis was conducted, incorporating documentary analysis (quantitative health facility data, national reports, and online survey data) and key informant interviews in five districts: Umpang, Mae Ramat, and Tha Song Yang (TSY) in Tak province, and Mueang and Pang Mapha in MHS province. A purposive sample of 42 participants, including community health workers and service providers, was interviewed on-site. Thematic analysis was used to interpret patterns within the interview data. Results The non-Thai population makes up 20–30% of Tak and MHS provinces, with varying compositions across districts. Umpang has a high number of hill tribe ethnic minorities, TSY sees many cross-border patients, Mae Ramat has a large migrant worker population, and Mueang and Pang Mapha host people displaced by conflict. Between 2020 and 2023, malaria cases surged in Umpang and TSY, while TB incidence spiked in TSY, with non-Thais being 2–3 times more affected than Thais. This puts significant financial pressure on local health systems, as many non-Thais, including cross-border Myanmar nationals, lack health insurance, limiting access to subsidized healthcare. Additionally, resource shortages and insufficient healthcare staff further strain border health management. To bridge these gaps, many non-governmental organizations actively work to support healthcare services in Tak province. Addressing these challenges requires coordinated efforts to ensure equitable healthcare access and sustainable resource allocation in border regions. Conclusion The study highlights significant health challenges in Tak and MHS provinces, particularly in districts with high non-Thai populations. Diseases like malaria and TB are more prevalent in these areas, straining local health systems. Financial and staffing challenges underscore the need for proactive government support and cross-sector collaboration to improve health equity in these culturally diverse border communities. Key messages Tak and MHS provinces face significant healthcare challenges due to a large non-Thai population, particularly Myanmar nationals, who frequently seek care due to conflict and instability. Informal border crossings and lack of health insurance coverage for undocumented migrants strain local health systems. There are barriers to Thailand’s Social Security Scheme (SSS) and Migrant Health Insurance Scheme (MHIS) for non-Thais, including limited awareness and employer reluctance. Border hospitals are overwhelmed with rising costs, unpaid treatment, and staffing shortages. NGOs play a vital role in providing essential services and disease control. To improve healthcare, stronger collaboration between health authorities, NGOs, and better funding and workforce support are essential.