Thailand’s Mplus offers a modernized take on key population-led HIV service delivery
This isn’t your mother’s clinic.
From banners to brochures, all promotional materials are slick and cheerful. There are smiling faces and toned torsos everywhere. The purple theme is taken seriously. Even files and staff face masks are colour coordinated. A pair of Facebook Live hosts have the good looks and energy of K-pop stars. And the organization’s slogan is decidedly upbeat: “where community fulfills your happiness”.
Over almost two decades, Thailand’s Mplus Foundation has refined a unique approach to providing comprehensive HIV services to key population clients including men who have sex with men and transgender women.
Their method goes far beyond a cool brand identity. Mplus has leveraged domestic and international partnerships to create a key population-led health service with impressive results. They dispense more than half of the PrEP in Thailand’s Chiang Mai province.
This year they tested 95% of the almost 8000 people they reached with face-to-face services. Of those who tested positive, 91% were placed on treatment while the other 9% are in follow-up case management. And 100% of their clients who received viral load testing were found to be virally suppressed.
“Community organizations can best reach key populations to receive services. We find that people who do not want to get tested at the hospital are comfortable with peers who they know understand their life,” explained Pongpeera Patpeerapong, Director of the Mplus Foundation.
Since its formation in 2003 Mplus has evolved to deliver a full range of services. They now have health centres in four provinces, while their mobile testing units serve clients in another five districts. They support a local hospital in each province, linking people to care and helping them with adherence. Mplus provides rapid testing, CD4 and viral load monitoring, and is also authorized to dispense medication. A small fleet of motorcycles even makes PrEP deliveries to clients in remote areas.
Both their online and offline engagements are anchored by a peer-led strategy. Their social media presence is commanding—everything from Twitter to Tik Tok. There are closed Facebook groups and special applications for clients to connect with community. Offline, they go beyond information booths to host parties and sport meet-ups. These aren’t just bonding exercises. Clients book appointments online and face-to-face interactions usually result in receiving an HIV test.
Mplus also provides technical assistance to other countries. It has supported an organization in Laos with online interventions and helped community groups in Cambodia develop campaigns to promote PrEP.
They played a key role in advocating nationally for the accreditation of community health workers. All Mplus staff are certified by the Department of Disease Control following a rigorous programme of study, evaluation and practice.
The programme continues to progress. Mplus is strengthening their mental and emotional health support offering, and is working towards becoming certified to provide HIV and sexually transmitted infection (STI) treatment.
While in the past the programme was more heavily funded by the U.S. President’s Emergency Plan for AIDS Relief through the United States Agency for International Development, today half of their investments come from branches of the National Health Security Office.
“Domestic funding is very important to develop our systems,” Mr. Patpeerapong said. “Community-based organizations have to be able to access domestic funding to cover more issues, including stigma and discrimination.”
Empowering key population-led health services has been crucial in improving Thailand’s HIV programme results. One of five people living with HIV in Thailand were identified and referred by a key population-led health service under the domestic health financing scheme. Four out of five people on PrEP in the country are served by community-led organizations. These services play a critical role in Thailand’s strategy of Reach, Recruit, Test, Treat, Prevent, Retain.
“Thailand is well-positioned to be a leader in addressing the need for a sustainable community-led response as a critical part of the health infrastructure,” said UNAIDS Country Director for Thailand, Patchara Benjarattanaporn. “By creating an enabling system for health outreach we can address the challenge of late diagnosis and better reach key population communities with services.”
Thailand has integrated HIV services into its Universal Health Coverage scheme and increased investments in key population- and community-led health services. UNAIDS Programme Coordinating Board (PCB) members visited Mplus and other community-led health services ahead of the 51st PCB meeting in Chiang Mai, Thailand.