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A greater understanding of the antibody response to SARS-CoV-2 in an infected population is important for the development of a vaccination. To investigate SARS-CoV-2 IgA and IgG antibodies in Thai patients with differing severities of COVID-19. Plasma from the following patient groups was examined: 118 adult patients with confirmed SARS-CoV-2 infections, 49 patients under investigation (without confirmed infections), 20 patients with other respiratory infections, and 102 healthy control patients. Anti-SARS-CoV-2 enzyme-linked immunosorbent assay (ELISA) from EUROIMMUN was performed to assess for IgA and IgG antibodies. The optical density (OD) ratio cutoff for a positive result was 1.1 for IgA and 0.8 for IgG. Additionally, the association of the antibody response with both the severity of disease and the date after onset of symptoms was analyzed. A total of 289 participants were enrolled and 384 samples analyzed from March 10 to May 31, 2020. Patients were categorized, based on their clinical manifestations, as mild (n = 59), moderate (n = 27), or severe (n = 32). The overall sensitivity of IgA and IgG from the samples collected after day 7 of the symptoms was 87.9% (95% CI: 79.8-93.6) and 84.8% (95% CI: 76.2-91.3), respectively. Compared to the mild group, the severe group had significantly higher levels of spike 1 (S1) antigen-specific IgA and IgG. All patients in the moderate and severe groups had S1-specific IgG, while 20% of the patients in the mild group did not have any IgG detected after two weeks after the onset of symptoms. Interestingly, in the severe group, the SARS-CoV-2 IgG level was significantly higher in males than females (p = 0.003). The serological test for SARS-CoV-2 has a high sensitivity more than two weeks after the onset of illness. Additionally, the serological response differs among patients based on sex as well as the severity of infection.

ObjectiveTo explore the barriers that hinder and the facilitators that strengthen the implementation of the antimicrobial stewardship (AMS) programme at paediatric units in academic hospitals in Thailand.DesignA qualitative study using thematic analysis of interviews with healthcare staff.SettingFive paediatric units in academic hospitals in Thailand.Participants20 healthcare workers and 10 AMS service providers who actively participated in the AMS programme in the sampled hospitals were included from purposive criterion.Primary outcome measuresQualitative, interpretive description with semistructured individual interviews were digitally recorded and transcribed. The MAXQDA software was used to facilitate content analysis.ResultsIn total, 4 themes emerged from the data: (1) organisational hierarchical culture and individual behaviours influence the acceptance and adherence to AMS implementation, (2) changing healthcare workers’ mindset to improve stewardship is crucial, (3) effective communication and collaboration among healthcare teams are the key to implementing the AMS programme and (4) dedication to antimicrobial stewardship despite resource limitations is important to improve AMS programme implementation.ConclusionsTo implement antimicrobial stewardship in a paediatric setting, there are many issues to overcome. The key barriers to focus were organisational hierarchical culture and perception of healthcare workers. Support from hospital policy and effective communication with contextualised strategies should be considered to improve AMS programme implementation plans.

The healthcare transition during adolescence and young adulthood has consistently been reported as a critical period for attrition and adverse health outcomes. The study assessed HIV-related stigma and transition experiences among young people living with perinatal HIV (YPHIV) in Thailand. We conducted a mixed-methods cross-sectional study at two research sites in Chiang Mai and Bangkok, Thailand from December 2023 to February 2024. We recruited YPHIV aged between 18–30 years who remained under care in pediatric HIV clinics (group A), those who had transitioned to adult care from those clinics (group B), and caregivers of group B participants (group C). We assessed HIV-related stigma using the validated 8-item Thai Internalized HIV-related Stigma Scale brief (Thai-IHSS brief) and transition-related experiences through in-depth interviews and focus group discussions. Thirty YPHIV (median age 23 years [IQR 22–26]) and ten caregivers were enrolled. The Thai IHSS brief score revealed a low level of internalized stigma in the study participants (median score 14; IQR 11–17). Anticipated negative thoughts and negative self-thoughts were common. HIV-related stigma experiences of YPHIV and caregivers were grouped into 3 themes: internalized, anticipated, and enacted stigma/discrimination. Transition experiences of YPHIV in both groups included hesitation to navigate care in adult clinics and feeling unprepared, perceived loss of support, and demotivation from being in care. Anticipated stigma and social problems were expressed by YPHIV and caregivers. In the focus groups, YPHIV indicated their need to learn about the transition beforehand, to be guided to the new clinic while staying connected to their original clinics, and to extend time in the pediatric clinic until they were more confident with transitioning care. In conclusion, we found many stigma issues started since childhood, plus collective experience while growing up. The internalized HIV-related stigma influenced the healthcare transition journey of YPHIV. Healthcare providers need additional guidance on how to manage transition in YPHIV, including individualized transition plans for those at increased risk of adverse outcomes, interventions to manage internalized stigma, and follow-up strategies after transition.

The interaction between the above social, physical and mental health burdens faced by adolescents living with HIV are additive, resulting in “syndemics” that further contribute to disproportionate disease burdens [13]. The context is readily conceptualized within a social ecological model, which acknowledges the intersecting elements impacting health behaviours and outcomes, including individual, interpersonal, environmental and macrosocial factors [1]. Integration of mental health services into existing HIV services builds on established patient-provider rapport and improves access to mental healthcare. Table 1 Selection of evidence-based interventions for adolescent mental healtha Intervention Description Examples in practice Cognitive-behavioural therapy (CBT) Education on the link between thoughts, feelings and behaviours; guidance to interrupt unhelpful thinking cycles and replace with helpful thoughts Mindfulness stress reduction programme Use of mindfulness to increase present moment awareness, manage stress Management of stigma, enhancement of self-concept Peer-led support Counselling delivered by adolescents who have training in communication skills, mental health and HIV knowledge to provide mental healthcare and linkage to further services if needed Community adolescent treatment supporters Youth training on adherence and psychosocial support counselling Weekly home visits to provide adherence and psychosocial support Family-strengthening interventions Education on increasing understanding of psychosocial needs of family members, health knowledge and communication skills Family strengthening intervention for HIV Promotion of parent-child relationships in families with adolescents living with HIV Manualized, delivered by bachelor-level counsellors Eight sessions of 90-minute home-visits Integration of mental health and psychosocial support with HIV services Mental health services are incorporated into the functioning of another established service Collaborative care model: primary care teams guided by specialists to deliver what previously were referral-level clinical services through task-shifting Benefits: Allows teams to leverage existing patient-provider rapport Reduces the need for psychiatrist-managed care Builds primary team capacity Cost-effective Implementation of adolescent services can employ simple, standardized tools, such as the patient health questionnaire (PHQ-9) to screen for depression and suicidality, and SSHADESS, a holistic strengths-based psychosocial assessment which asks about Strengths, School, Home, Activities, Drugs, Emotions, Sexuality and Safety.

Introduction The Thai National AIDS programme (NAP) treatment guidelines have recommended rapid antiretroviral therapy (ART) initiation, regardless of CD4 count since 2014. We assessed treatment outcomes among youth living with HIV (YLHIV), initiating first‐line ART and assessed the association between virological failure (VF) and timing of ART initiation. Methods We retrospectively reviewed data for YLHIV aged 15–24 years, initiating non‐nucleoside reverse transcriptase inhibitor‐based ART from 2014 to 2019, through the NAP database. We classified the timing of ART into three groups based on duration from HIV‐positive diagnosis or system registration to ART initiation: (1) <1 month (rapid ART); (2) 1–3 months (intermediate ART); and (3) >3 months (delayed ART). VF was defined as viral load (VL) ≥ 1000 copies/ml after at least 6 months of first‐line ART. Factors associated with VF were analysed using generalized estimating equations. Results Of 19,825 YLHIV who started ART, 78% were male. Median (interquartile range, IQR) age was 21 (20–23) years and CD4 count was 338 (187–498) cells/mm3. After registration, 12,216 (62%) started rapid ART, 4272 (22%) intermediate ART and 3337 (17%) delayed ART. The proportion of YLHIV starting ART <30 days significantly increased from 43% to 57% from 2014–2016 to 2017–2019 (p < 0.001). The median duration of first‐line therapy was 2 (IQR 1–3) years and 89% started with efavirenz‐based regimens. Attrition outcomes showed that 325 (2%) died (0.73 [95% CI 0.65–0.81] per 100 person‐years [PY]) and 1762 (9%) were loss to follow‐up (3.96 [95% CI 3.78–4.15] per 100 PY). Of 17,512 (88%) who had VL checked from 6 to 12 months after starting treatment, 80% achieved VL <200 copies/ml. Overall, 2512 experienced VF 5.87 (95% CI 5.65–6.11) per 100 PY). In a multivariate model, the adjusted incidence rate ratio for VF was 1.47 (95% CI 1.33–1.63, p < 0.001) in the delayed ART group and 1.14 (95% CI 1.03–1.25, p< 0.001) in the intermediate ART group, compared to YLHIV in the rapid ART group. Conclusions Rapid ART initiation after diagnosis was associated with significantly reduced risks of VF and death in YLHIV, supporting the implementation of rapid ART for optimizing health outcomes.

Background Long-acting cabotegravir/rilpivirine (LA-CAB/RPV) is the only available approved injectable antiretroviral therapy (ART) for youth living with HIV (YLHIV). However, it is not yet available through the Thai National AIDS Program (NAP). This study assessed Thai YLHIV attitudes toward LA-CAB/RPV and identified the proportion of medically eligible YLHIV within the NAP. Methods Two cross-sectional studies were conducted, the first study conducted in an HIV clinic in Bangkok involving YLHIV aged 13–24 years, assessing attitudes via questionnaires. The second study analyzed medical eligibility among 14,670 youth aged 12–24 years in the NAP, defined by current HIV RNA < 50 copies/ml, no prior treatment failure (HIV RNA < 1,000 copies/ml) and no suspected archived resistance to CAB/RPV. Logistic regression was performed to identify factors associated with willingness and eligibility. Results From April to June 2024, 100 YLHIV (median age 20 years; IQR 19.0-21.7) were enrolled, 71% had non-perinatally acquired HIV (non-PHIV). Overall, 85% expressed willingness to use LA-CAB/RPV. Non-PHIV youth showed significantly higher interest (93.0% vs. 65.5%); OR 6.9 [95% CI: 2.1–22.8], despite a shorter median treatment duration (2.7 vs. 14.3 years). LA-CAB/RPV was considered more convenient than pills by 76%, although 42% anticipated injection-site reactions. Among YLHIV in the NAP (median age 22 years; IQR 20–23), 64% were medically eligible, non-PHIV youth also had a higher eligibility proportion (70% vs. 32%) with an aOR 2.0 [95% CI: 1.7–2.4]. Conclusion The majority of Thai YLHIV showed positive attitudes towards LA-CAB/RPV, with two-thirds meeting medical eligibility criteria. Enhancing access to generic formulations of this regimen could significantly impact lifelong HIV management.

This study aimed to explore willingness to use and preference for long-acting injectable PrEP (LAI-PrEP) among Thai youth at risk of HIV. A cross-sectional study was conducted in 100 Thai youth aged 18 to 24 years attending a sexual health clinic in Bangkok, Thailand. Participants received information about oral and LAI-PrEP before completing a questionnaire. Of the 98 participants willing to use pre-exposure prophylaxis, 47 preferred the injectable form. Preference for the injectable form was higher among individuals not currently using oral pre-exposure prophylaxis, affordability and longer injection intervals were key for acceptance of long-acting injectable pre-exposure prophylaxis.

To assess and compare the prevalence of persistent hepatic abnormalities, including nonalcoholic fatty liver disease (NAFLD) and/or hepatic fibrosis, among perinatally HIV-monoinfected Asian adolescents with history of abnormal hepatic enzymes to those without, using noninvasive diagnostic tools. A multicenter cohort study was conducted in Thailand and Indonesia. Adolescents aged 10-25 years who were on antiretroviral treatment (ART), had virologic suppression (HIV RNA<400 copies/mL within the past 6 months), and had no history of chronic hepatitis B/C infection were enrolled. Participants were pre-classified into 2 subgroups (1:1 ratio) as participants with history of elevated versus normal aminotransferase enzymes. NAFLD was defined as hepatic steatosis (any severity) evaluated by liver ultrasonography. Significant hepatic fibrosis was defined as liver stiffness ≥7.4 kPa evaluated by transient elastography. Participants who met the criteria for protocol-defined NAFLD and/or hepatic fibrosis were re-assessed to evaluate disease progression (persistent versus transient hepatic abnormalities) at one year later. Of 120 participants, 62 (51.7%) were male, 7 (5.8%) had central obesity, and 19 (15.8%) had insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] >3.16). At enrollment, the median age and duration of ART (IQR) were 17.0 (14.6-19.2) years and 10.5 (7.1-12.0) years, respectively. Persistent hepatic abnormalities were identified in 5/60 participants listed in the group having history of elevated aminotransferases, corresponding to the prevalence of 8.3% (95% CI: 2.8-18.4%), whereas none (0/60) were among the group having history of normal hepatic enzymes. All 5 participants had persistent aminotransferase elevation (≥2 episodes within the past 12 months). Baseline alanine aminotransferase (ALT) >30 U/L (adjusted odds ratio [aOR]: 29.1; 95% CI: 1.7-511.8), and HOMA-IR >3.16 (aOR: 17.9; 95% CI: 1.1-289.7) were independently associated with persistent hepatic abnormalities. Among perinatally HIV-monoinfected Asian adolescents with history of elevated aminotransferase enzymes, persistent hepatic abnormalities are not uncommon. Screening for liver complications by noninvasive diagnostic tools might be considered in at risk individuals, including those with persistent ALT elevation and insulin resistance.

HIV disproportionately affects young Thai men who have sex with men (YMSM). Recent studies report a high incidence and prevalence of HIV among Thai YMSM. The Thai national guidelines have recommended pre-exposure prophylaxis (PrEP) since 2014 for key populations; free PrEP has been piloted since 2019. Smartphone-based mobile health (mHealth) interventions provide an optimal platform for innovative PrEP adherence interventions for Thai YMSM. This study aims to adapt the P3 (Prepared, Protected, emPowered) app, developed with YMSM and transwomen in the United States to improve PrEP adherence and persistence for YMSM in Thailand. The app aims to provide daily adherence support and addresses gaps in staff available for large-scale PrEP rollout needed to see population-level effects of HIV prevention. We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand, to investigate PrEP adherence facilitators and barriers, preferences for functions and features in mHealth apps among YMSM, and how to best adapt the P3 app to the Thai context. We conducted four FGDs with 4-8 participants per group and 15 KIIs. For FGDs, 23 YMSM participated with a mean age of 20 years (range 18-21), 96% (22/23) enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60) years; most were state health service providers, with the majority being counselors (6/15, 40%) and physicians (6/15, 40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM globally including the United States. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3 Thailand adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand, these findings were balanced with resource limitations resulting in the prioritization of minor modifications: changes in app esthetics (color scheme, iconography, and imagery) and changes in the presentation of information in two of the app's features. FGDs identified similar PrEP adherence facilitators and barriers to those already addressed within the app. The core elements of the P3 app address major PrEP facilitators and barriers for Thai YMSM; however, changes to the app features, including stylistic presentation, were needed to appropriately customize the app to the Thai context. Given the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end users and key informants provides a promising approach. However, partnerships with local app designers and developers can improve the adaptation process and final product. ClinicalTrials.gov NCT04413708; http://clinicaltrials.gov/ct2/show/NCT04413708.

Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and <18 years of age at ART initiation from 2011 to 2020 at 17 HIV clinics in six countries. Incidence rates of opportunistic infections (OIs) in the first two years of triple-drug ART (≥3 antiretrovirals) was also reported. Competing risk regression analysis was performed to identify factors associated with first occurrence of OI. In 2,027 children and adolescents (54% males), median age at ART initiation increased from 4.5 years in 2011–2013 to 6.7 in 2017–2020, median CD4 count doubled from 237 cells/μl to 466 cells/μl, and proportion of children who initiated ART as severely immunodeficient decreased from 70% to 45%. During follow-up, 275 (14%) children who received triple-drug ART as first treatment and had at least one clinic visit, developed at least one OI in the first two years of treatment (9.40 per 100 person-years). The incidence rate of any first OI declined from 12.52 to 7.58 per 100 person-years during 2011–2013 and 2017–2020. Lower hazard of OIs were found in those with age at first ART 2–14 years, current CD4 ≥200 cells/μl, and receiving ART between 2017 and 2020. The analysis demonstrated increasing number of children and adolescents starting ART with high CD4 count at ART start. The rate of first OI markedly decreased in children who started ART in more recent years. There remains a clear need for improvement in HIV control strategies in children, by promoting earlier diagnosis and timely treatment.