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. 2025 Jan;28(1):e26406.
doi: 10.1002/jia2.26406.

The impact of same-day and rapid ART initiation under the Universal Health Coverage programme on HIV outcomes in Thailand: a retrospective real-life cohort study

Sirinya Teeraananchai  1   2 , David C Boettiger  3 , Cheewanan Lertpiriyasuwat  4 , Rattaphon Triamwichanon  5 , Patchara Benjarattanaporn  6 , Nittaya Phanuphak  7
Affiliations

The impact of same-day and rapid ART initiation under the Universal Health Coverage programme on HIV outcomes in Thailand: a retrospective real-life cohort study

Sirinya Teeraananchai et al. J Int AIDS Soc. 2025 Jan.

Abstract

Introduction: Antiretroviral therapy (ART) initiation, regardless of CD4 count, has been recommended in Thailand since 2014, with same-day initiation recommended since 2021. We assessed HIV treatment outcomes among Thai people living with HIV (PLHIV) by the time from HIV diagnosis to ART initiation under the Universal Health Coverage (UHC) programme and identified factors associated with virological failure (VF).

Methods: PLHIV aged ≥15 years initiating ART between 2014 and 2022 were included from the UHC database. We categorized participants into four groups using the duration from HIV diagnosis to ART initiation: (1) ≤ 7 days (same-day ART); (2) 8 days to <1 month; (3) 1-3 months; and (4) >3 months. Viral load (VL) was measured 6 months after starting ART, and annually thereafter. VF was defined as VL ≥1000 copies/ml. Factors associated with VF were analysed using competing risk models considering death and loss to follow-up (LTFU) as competing events.

Results: Among 252,239 PLHIV who started ART, the median age at initiation was 34 years (interquartile range [IQR]: 26-43 years). The median (IQR) pre-ART CD4 count was 233 (76-420) cells/mm3. ART initiation occurred within 7 days for 25% (17% on the same day, 8% in 2-7 days), 24% in 8 days to <1 month, 23% in 1-3 months and 28% in >3 months. ART initiation within 7 days increased from 20% (2014-2016) to 32% (2021-2022). VF occurred with a rate of 3.11 (95% CI 3.07-3.159) per 100 person-years (PYs). PLHIV initiating ART 8 days to 1 month were at lower risk of VF (aSHR 0.52, 95% CI 0.50-0.54) when compared to ART initiation >3 months. ART initiation within 7 days resulted in the lowest mortality (6%: 1.28 [95% CI 1.24-1.32] per 100 PYs), but the highest rate of LTFU (12%: 2.69 [95% CI 2.63-2.75] per 100 PYs) when compared to other ART initiation groups.

Conclusions: Although ART initiation within 7 days has increased in Thailand, the overall rate of early initiation remains low. ART initiation within 1 month significantly lowered the risk of VF. ART initiation within 7 days significantly reduced mortality. To further optimize health outcomes, innovative strategies are urgently needed to promote earlier ART initiation in Thailand.

Keywords: HIV; antiretroviral therapy; linkage to care; rapid ART; same‐day ART; virological failure.

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Conflict of interest statement

ST was funded as a grantee (Grant No. RGNS 65 – 041) from the Office of the Permanent Secretary, Ministry of Higher Education, Science, Research and Innovation, Thailand from 2022 to 2024.

Figures

Figure 1
Figure 1
Cumulative incidence of virological failure by ART initiation group.
Figure 2
Figure 2
Proportion of virological suppression after ART initiation. Note: The denominator was the number of PLHIV having VL tests.
See this image and copyright information in PMC

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