Presented by Wipas Wimonsate Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand

1. Successful start of a preparatory HIV cohort study among men who have sex with men (MSM) in Bangkok, Thailand: preliminary baseline, follow-up and HIV incidence data Presented by Wipas Wimonsate Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand

2. % HIV infected Background • HIV-1 prevalence among MSM in Bangkok increased from 17.3% in 2003 to 30.7% in 2007 • MSM in Bangkok are an important population for HIV prevention activities and treatment and care services • Cohort development among MSM in Bangkok may help to evaluate biomedical interventions (prophylaxis, vaccines) • However, we have no information on HIV-1 incidence, STI prevalence, follow-up rates, and risk factors for HIV infection

3. Study design • Longitudinal cohort study • 3 years follow up at 4 monthly intervals • Oral fluid HIV testing, ACASI questionnaire and risk reduction counseling at every visit • STI evaluation at baseline • Blood draw at month 0, 12, 24 and 36 for storage and future testing

4. Study population • Inclusion criteria for eligibility are: • Thai national • Male at birth • Resident of Bangkok or periphery • At least 18 years of age • Have had oral or anal sex with another man in the preceding six months • Availability and commitment for at least 36 months of follow-up • Willing to provide written informed consent

5. Expected and actual number of participants, HIV positivesand HIV seroconvertors during year 1, year 2, and year 3 of the study * the study is currently in year 2

6. Study location Silom Community Clinic, 3rd Floor Bangkok Christian Hospital, Silom, Bangkok, Thailand Bangkok

7. Recruitment of study participants Existing VCT clients Onsite recruitment Community Based Organization Website(www.silomclinic.in.th)

8. Statistical methods • Risk factors for HIV infection at baseline • Logistic regression analysis • HIV incidence • Incidence density calculation (# of HIV seroconversions / total number of person years of follow up during interval) • Kaplan-Meier analysis

9. Number of study participants and visitsApril 2006 – July 2008 Visits 7698 (average 45/day) Enrollment completed Participants 1292 2006 2007 2008

10. Demographic characteristics at baseline April 2006 – January 2008 N=1292

11. HIV, HBV, HAV, HCV, HSV-1, HSV-2, TP, rectal CT and rectal NG prevalence at baselineApril 2006 – January 2008 % infected HBV* HIV HAV HCV HSV-1 HSV-2 Syphilis CT NG * excluding those positive for Anti-HBs alone and those negative for all markers (HBsAg, Anti-HBc, and Anti-HBs)

12. Risk factors for prevalent HIV infection at baseline April 2006 – January 2008 Multivariate

13. Multivariate

14. Follow-up ratesamong the HIV negative fraction of the BMCS(July 2008) Improves as study progresses Fixed

15. HIV incidence density (54 cases, July 2008) Per 100 person-years Improves as study progresses Fixed Mean age at HIV seroconversion: 24 yrs Range 18 – 42 yrs

16. Cumulative HIV incidence, Kaplan-Meier method (July 2008) Percent survival 90.6% After 780 days of study, cumulative HIV incidence 9.4%; 90.6% HIV free Days (4months = 120 days)

17. Conclusions A preparatory HIV cohort study was successfully started among MSM in Bangkok High HIV and STI prevalence at baseline High HIV incidence Good follow-up rates Risk factors for HIV infection are not different from those seen elsewhere An appropriate population for the evaluation and implementation of HIV preventive interventions

18. Thank you Co-authors: Supaporn Chaikummao, Jaray Tongtoyai, Chonticha Kittinunvorakoon, Anuwat Sriporn, Anchalee Varangrat, Pasakorn Akarasewi, Patchara Sirivongrangson, Janet McNicholl, Frits van Griensven Thailand MOPH – U.S. CDC Collaboration: Warunee Thienkrua, Tareerat Chemnasiri, Patnaree Oungprasertgul, Pechpailin Khlaimanee, Atitaya Sangiamkittikul, Rinda Wongbenchaporn, Waraporn Feangfu, Narongritt Tippanont, Somsak Yafant, Rutt Chuachoowong, Wannee Chonwattana, Michael Martin, Robert Linkins, Michael Malison Rainbow Sky Association of Thailand: Kamonsate Kenkarnrue, Rapeepan Jommareuang, Danai Linjongrat, Thanachai Chaisewi, Dejchapol Kanlayanamitr Disclaimer The data and conclusions presented are those of the authors and do not necessarily represent the views of the US Centers for Disease Control and Prevention

19. Chatuchak Ramkhumheang Rattanakosin Sukhumvit Silom Silom Community Clinic MSM hot spots in Bangkok, Thailand

20. Silom Community Clinic: Tue – Sat, 4 – 10 PM • Services (free of charge): HIV VCT If HIV positive: CD4 count, TB evaluation, referral for ARV HBV testing and vaccination HAV testing Syndromic STI evaluation • Development of community relations Community Based Organization (CBO) Community Advisory Board (M-CAB)

21. Number of clients and visits to the Silom Community Clinic September 2005 – July 2008 (VCT) Number Clients Visits

22. HIV, HBV, HAV and TP prevalence among VCT clients,September 2005 – July 2008 (VCT) % infected HIV HAV RPR-TP HBV (Anti-HBs+)

23. Current intervention: condom use counseling % Consistent condom use with all male partners in the past 4 months Fixed Improves as study progresses

24. Future study:PrEP clinical trial: Truvada Currently studying the possibility and willingness to participate in the intermittent Pre and Post exposure prophylaxis clinical trial of 1,500 MSM participants in the Bangkok Metropolitan area

25. Sexual characteristics at baseline April 2006 – January 2008 N=1292

26. N=1292