Correspondence
Thailand’s commitment
to support community-
led HIV services
Sima Barmania’s recent feature story,
Successes and challenges in Thailand’s
HIV response, 1 questioned the
Thailand Ministry of Public Health’s
commitment to support community-
led HIV services. The report stated that
“the new guidelines by the Ministry
of Public Health revoke authorisation
of [pre-exposure prophylaxis] PrEP
by lay people” and that two new
requirements—which were “only
government doctors can prescribe
PrEP” and “key-population-led clinics
cannot stock PrEP medicine”—pose
a real threat to community-led clinics.1
In 2019, the Ministry of Public
Health issued three ministerial
regulations that permitted certified
community health workers to
provide HIV services under the
supervision of health professionals.2
These regulations allowed community
health workers to screen for HIV and
to give prescribed antiretrovirals to
those who need them, which non-
medical personnel had never been
permitted to do before. These changes
reflect the Ministry of Public Health’s
commitment to enable and engage
civil society in the provision of HIV
services.
In 2023, the Ministry of Public
Health issued a guideline on
PrEP service delivery for civil
society organisations (community-
led organisations). The guideline
aimed to integrate civil society
organisations through service pairing
with government health facilities.
However, the guideline did not limit
private doctors to prescribe PrEP
at private clinics. With this pairing
model, civil society organisations
can work under professional super­
vision through telehealth services,
offer counselling, screening, and
stock prescribed PrEP at civil society
organisations before delivery to
PrEP recipients.3
www.thelancet.com/hiv Vol 11 March 2024
However, there are limitations
for community-led clinics that are
registered as medical technology
clinics. These clinics must comply
with the Medical Facilities Act,
B.E. 2541 (1998) and the Medical
Technology Profession Act, B.E. 2547
(2004), which only permit these
clinics to do laboratory investigations,
analysis, research, and report on the
examination of medical specimens.4,5
We declare no competing interests.
Cheewanan Lertpiriyasuwat,
*Suchada Jiamsiri, Plearnpit Prommali
sjiamsiri@outlook.com
Division of AIDS and STIs, Department of Disease
Control, Ministry of Public Health,
Nonthaburi 12000, Thailand
1 Barmania S. Successes and challenges in
Thailand’s HIV response. Lancet HIV 2023;
10: e699–700.
2 Ministerial regulations on community health
worker providing HIV/STIs services.
Nonthaburi: Division of AIDS and STIs. 2019.
https://ddc.moph.go.th/das/pagecontent.
php?page=1511&dept=das (accessed
Nov 22, 2023).
3 Guideline on PrEP service delivery at
community-led facility. Nonthaburi: Division
of AIDS and STIs. March 24, 2023. https://ddc.
moph.go.th/uploads/ckeditor2//files/
Guideline.pdf (accessed Nov 22, 2023).
4 Medical Facilities Act, B.E. 2541 (1998).
https://www.ocs.go.th/council-of-state/#/
public/doc/VTJGc2RHVmtYMTlkMG5Bdk0va
ndTbTEzWEYrb25qYlp1VjJMNFdleitmQT0%
3D (accessed Nov 22, 2023).
5 Medical Technology Profession Act, B.E. 2547
(2004). https://www.ocs.go.th/council-of-
state/#/public/doc/VTJGc2RHVmtYMTlkMG5B
dk0vandTbzhXQWVjU2g1cFhISHZLL3NWK0x
YMD0%3D (accessed Nov 22, 2023).
Response to Thailand’s
commitment to support
community-led HIV
services
Cheewanan Lertpiriyasuwat and
colleagues 1 argue that Thailand’s
Ministry of Public Health made
a commitment to enable and
engage civil society in HIV services
as providers by the issuance in 2019
of three ministerial regulations,
which permitted certified community
health workers to provide HIV
services under the supervision of
health professionals. This action is Published Online
truly commendable as it had been February 6, 2024
a long process to achieve formalised
https://doi.org/10.1016/
S2352-3018(24)00012-2
partnerships between civil society
and government with the mutual
goal of ending AIDS in Thailand.2
However, the Ministry of Public
Health’s 2023 guideline on pre-
exposure prophylaxis (PrEP) service
delivery at community-led facilities,
with the intention to integrate
civil society organisations through
service pairing with government
health facilities,1 inadvertently and
detri­m entally affected Thailand’s
cost-effective, key-population-led,
same-day PrEP service.3,4 EpiC Thailand
data reveal a 21% decrease in the
number of new clients receiving
PrEP after 3 months of guideline
implementation, given an 11–12%
upward trend in previous quarters.
This is a negative effect of the
guideline as it not only disallows
non-government doctors to pre­
scribe PrEP in key-population-led and
community-led PrEP service delivery
but also prevents PrEP medication to
be stocked at key-population-led and
community-led clinics.
We believe that it is crucial to engage
non-government doctors in the key-
population-led PrEP service delivery
because over the past 8 years finding
enough government doctors who
feel comfortable enough to prescribe
PrEP for clients at key-population-
led clinics has been challenging.
Therefore, most key-population-led Published Online
clinics have made creative and valuable February 6, 2024
partnerships with non-government
https://doi.org/10.1016/
doctors who perform tele prescription
S2352-3018(24)00013-4
for clients receiving PrEP. As stated by
Lertpiriyasuwat and colleagues,1 non-
government or private doctors can still
prescribe PrEP at private clinics, but
they cannot do so at key-population-
led clinics even though they do not
receive any reimbursement for such
services.
Since 2023, the Ministry of Public
Health’s guideline does not allow
PrEP medication to be stocked at
key-population-led clinics; their clinic
e141
 Correspondence
staff now need to spend extra time
and resources travelling to pick up
individually packed PrEP medication
from their paired government hospitals
and to make sure that the medication
is ready to be distributed to clients
scheduled each day. The guideline
unnecessarily made same-day PrEP
service delivery at key-population-led
clinics no longer possible for new or
unscheduled clients.
To allow their services to be
formally accredited and reimbursed
by the National Health Security
Office, key-population-led clinics are
registered as medical technology
clinics. Lertpiriyasuwat and colleagues1
mentioned that these clinics are
only permitted to do laboratory
investigations. If the Ministry of Public
Health translates this statement
into its guideline, further frustration
will be caused for those wanting to
see PrEP scaled up, especially since
more than 80% of people who use
PrEP in Thailand are receiving services
e142
at key-population-led clinics. 5 We
would like to remind the Ministry of
Public Health that the 2019 ministerial
regulations originally allowed well
trained and certified community
health workers to perform certain HIV
services to accelerate the ending of
AIDS in Thailand.2 To now move away
from that bold advance would be a
step backwards.
We declare no competing interests.
*Nittaya Phanuphak, Surang Janyam,
Pongpeera Patpeerapong,
Satayu Sittikan, Kittinan Daramadhaj,
Supabhorn Pengnonyang,
Rena Janamnuaysook, Inthira Suya,
Stephen Mills, Praphan Phanuphak
nittaya.p@ihri.org
Institute of HIV Research and Innovation, Bangkok
10330, Thailand (NP, SP, RJ, PPh); Service Worker In
Group Foundation, Bangkok, Thailand (SJ);
Thai NGO Coalition on AIDS, Bangkok, Thailand
(SJ); MPLUS Foundation, Chiang Mai, Thailand
(PPa); Caremat Foundation, Chiang Mai, Thailand
(SS); Rainbow Sky Association of Thailand,
Bangkok, Thailand (KD); FHI 360, Bangkok,
Thailand (IS, SM)
1 Lertpiriyasuwat C, Jiamsiri S, Prommali P.
Thailand’s commitment to support
community-led HIV services. Lancet HIV 2024;
published online Feb 6. http//:doi.
org/10.1016/S2352-3018(24)00012-2.
2 Pengnonyang S, Ramautarsing RA, Janyam S,
et al. Certification of lay providers to deliver
key population-led HIV services in Thailand’s
National Healthcare System: lessons learned.
J Int AIDS Soc 2022; 25: e25965.
3 Ramautarsing RA, Meksena R, Sungsing T,
et al. Evaluation of a pre-exposure prophylaxis
programme for men who have sex with men
and transgender women in Thailand: learning
through the HIV prevention cascade lens.
J Int AIDS Soc 2020; 23 (suppl 3): e25540.
4 Versteegh L, Amatavete S, Chinbunchorn T,
et al. The epidemiological impact and cost-
effectiveness of key population-led PrEP
delivery to prevent HIV among men who have
sex with men in Thailand: a modelling study.
Lancet Reg Health Southeast Asia 2022;
7: 100097.
5 Lertpiriyasuwat C, Jiamsiri S, Triamwichanon R,
et al. Thailand national PrEP program: moving
towards sustainability. July 29–Aug 2, 2022.
https://programme.aids2022.org/Abstract/
Abstract/?abstractid=1228 (accessed
Jan 16, 2024).
www.thelancet.com/hiv Vol 11 March 2024