Increasing uptake of HIV counseling and testing (HCT) among men who have sex with men in Bangkok through service quality improvement
S. Noriega Minichiello1, K. Casey1, J. Khienvichit1, G. Carl2, P. Phanuphak2, P. Smutraprapoot3, S. Jittjang1
1Family Health International, Asia Pacific Regional Office, Bangkok, Thailand, 2Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 3Health Center 28, Bangkok Metropolitan Administration Health Department, Bangkok, Thailand
Issues: HIV prevalence is 31% among MSM in Bangkok yet less than one-third of men who have sex with men (MSM) have been tested in the previous year. A quality improvement project was launched to identify barriers and increase uptake of HCT at two clinics: Thai Red Cross Anonymous Clinic and the Bangkok Metropolitan Administration 28 clinic.
Description: A baseline assessment of barriers to uptake was done using community surveys (n=35), key informant interviews (n=17), six focus group discussions, four quality assurance checklists, facility surveys, and client satisfaction questionnaires (n=59). Interventions addressing identified barriers were implemented: packaging of same-day HIV testing with general health services, MSM sensitivity and awareness training, training on MSM sexual health and psycho-sexual issues, and the development and implementation of a phased communication strategy. A follow-up assessment including community surveys (n=161), key informant interviews (n=19), two quality assurance checklists, and client satisfaction surveys (n=106) was carried out. Client satisfaction surveys showed almost 100% of men indicated greater comfort discussing same sex relations with counselors and counselors self-reported feeling comfortable discussing same-sex risks. Observations of counseling and client satisfaction surveys revealed counselors were better able to provide risk reduction and psychosocial support to MSM. A third of clients used packaged services. The community survey indicated 73% of respondents were exposed to components of the communication efforts but word-of mouth was still a significant mode of sharing information on services. Uptake increased compared to the pre-intervention period.
Lessons learned: Data collection approaches including the target population and service providers informs development of feasible, comprehensive, and appropriate approaches. Targeted, phased service promotion strategies including MSM sensitization for providers improved HCT uptake.
Next steps: Continue capacity building including data utilization to identify issues impacting uptake of services. Foster linkages between the community and clinics through mobile HCT services.
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