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11 July 2004
U.S., Thailand Collaborate in Fighting Spread of HIV-AIDS
Embassy fact sheet highlights joint efforts over more than a decade
The U.S. Embassy in Thailand has issued a fact sheet documenting more than a decade of collaboration between U.S. and Thai health and military officials in fighting the spread of HIV and AIDS.
The July 9 fact sheet notes that, since 1990, their joint efforts have succeeded in decreasing the number of new infections to an estimated 25,000 per year.
"International collaboration has been especially important since the 1997 Asian financial crisis, when Thailand cut its budget for HIV and AIDS by nearly 30 percent," said the fact sheet.
It cited work by the U.S. Army component of the Armed Forces Research Institute of Medical Sciences (AFRIMS), a joint U.S.-Thai military tropical medicine research laboratory, including monitoring of HIV prevalence among military recruits and preventative interventions that reduced the number of cases of sexually transmitted diseases to one-seventh of the previous level.
In what it described as the world's largest trial of a preventive HIV vaccine, the fact sheet said, "The U.S. Army and the TAVEG (Thai AIDS Vaccine Evaluation Group) have carried out a series of clinical evaluations of HIV vaccines which have been made specifically to resist the strain of HIV found in Thailand."
According to the fact sheet, collaboration between the U.S. Centers for Disease Control (CDC) and the Thai Ministry of Public Health (MoPH) beginning in 1990 focused on HIV prevention research in 4 key areas: behavioral science, and sexual, parental, and mother-to-child HIV transmission (PMTCT).
"CDC's Global AIDS Program in Thailand (GAP) was launched in 2001. Under a Five-Year Country Plan developed in collaboration with the Thai MoPH, HHS/CDC provides support for projects to strengthen HIV/AIDS prevention and care activities," the fact sheet said.
Additionally, it reported, "In 2002, CDC-GAP initiated an Asia Regional Program to coordinate and facilitate technical support, training, and information exchange workshops among the five GAP countries in the Asia region (Vietnam, Cambodia, China, Thailand, and India), as well as countries in the Asia region without bilateral CDC programs on HIV/AIDS."
USAID contributed to HIV/AIDS prevention efforts by funding Family Health International's (FHI) AIDSCAP project targeting lower-income people between the age of 15 and 29. The fact sheet noted that the program has had considerable impact throughout Asia, by allowing FHI to facilitate cross-border linkages and improvements in the capacity of countries in the Asia region to respond to HIV/AIDS.
Other USAID efforts including the opening of the HIV/AIDS-Health Office (HHO) in Bangkok June 2003 to implement regional HIV/AIDS activities, with a primary focus on six countries in the Mekong region: Burma, Cambodia, China (Yunnan and Guangxi provinces), Laos, Thailand and Vietnam. HHO Bangkok will help plan, design, award, manage, monitor, evaluate and report on USAID's HIV/AIDS program activities, in close collaboration with National AIDS Programs, other donors and NGO implementing partners.
The fact sheet also cited joint projects between Johns Hopkins University (JHU) and Thailand's Chiang Mai University (CMU) that, it said, improved research on studies to describe the pattern and transmission of HIV infection in northern Thailand.
Following is the text of the fact sheet:
(begin fact sheet)
Fact Sheet on U.S.-Thai health collaboration, especially on HIV/AIDS
Thailand's first AIDS case was discovered in 1984. By the late 1980s, one-third of Thailand's 200,000-400,000 injecting drug users had been infected by HIV. A thriving sex industry and intravenous drug use had facilitated the disease's rapid spread through the general population. In 1990, the number of new HIV infections in Thailand was almost 150,000 annually. Since that time, Thailand has actively fought the epidemic and succeeded in decreasing the number of new infections to an estimated 25,000 per year.
For over a decade, the U.S. Army Component of the Armed Forces Research Institute of Medical Sciences (AFRIMS) and the Atlanta-based Centers for Disease Control and Prevention (CDC) have collaborated with their colleagues in the Thai Armed Forces and the Ministry of Public Health (MoPH), as well as the academic sector, to fight HIV and AIDS. Their projects range from vaccine trials to studies of the prevention of mother to child transmission (PMTCT) of HIV. Many of these studies have also involved collaboration with a joint team of Johns Hopkins University (JHU) and Chiang Mai University (CMU) researchers working in northern Thailand. The JHU-CMU collaboration has more recently received funding from the U.S. National Institutes of Health. International collaboration has been especially important since the 1997 Asian financial crisis, when Thailand cut its budget for HIV and AIDS by nearly 30 percent. This year, the U.S. Agency for International Development (USAID) opened a Bangkok Health Office to implement regional HIV/AIDS activities.
AFRIMS collaborative efforts on HIV /AIDS.
For more than 40 years AFRIMS has worked closely with Thailand providing outstanding research, training and technology transfer. Beginning in 1958 when a group of Thai and U.S. scientists undertook a joint study on a cholera epidemic in Thailand, the collaboration was later established as the Southeast Asia Treaty Organization (SEATO) Medical Research Laboratory. In 1977, it became AFRIMS, a joint U.S.-Thai military tropical medicine research laboratory.
- Internationally recognized for its research in malaria, dengue, diarrheal diseases, HIV and other viral diseases, the laboratory's contributions have included anti-malarial drugs, and pivotal studies on Hepatitis A and Japanese B encephalitis vaccines.
AFRIMS has extensive collaborative relationships with academic, military, and MoPH organizations in Thailand, exemplified by ongoing HIV vaccine research efforts.
- In the early 1990s, AFRIMS collaborated with the Royal Thai Army and Air Force, the MoPH, and the JHU-CMU research team, with additional support from the Rockefeller
Foundation, to describe the HIV epidemic among Thai army recruits. The team found that HIV prevalence was 12 percent among 21-year-old conscripts in some parts of northern Thailand, and that risk factors were behavioral: sex with sex workers, alcohol use, and other drug use.
- This team also developed preventive interventions, first piloted in 1993 among military recruits that were shown to have a significant impact on the epidemic among Thai soldiers. HIV incidence in this group dropped by half from the previous year. Incidence of sexually transmitted diseases dropped to one-seventh the previous level, and risk-taking through alcohol use and commercial sex declined dramatically.
- Monitoring of the HIV prevalence among military recruits continues to be one of the key elements of national surveillance of the HIV/AIDS epidemic in Thailand, and continues to demonstrate declines in the prevalence of HIV infections among young Thai men.
-The U.S. Army and the TAVEG (Thai AIDS Vaccine Evaluation Group) have carried out a series of clinical evaluations of HIV vaccines which have been made specifically to resist the strain of HIV found in Thailand. Based on these studies, the collaborative effort has advanced to the large field-testing of a vaccine combination; lead investigators
are from the Ministry of Public Health, Mahidol University and the Royal Thai Army, and sponsorship from the U.S. DOD and NIH. This phase III trial, which will be the world's largest trial of a preventive HIV vaccine, began in September, 2003, and will continue for five years.
CDC collaboration with the Ministry of Public Health.
Since 1980, the MoPH, HHS/CDC and the World Health Organization collaborated on field epidemiology training in Thailand. A formal partnership known as the Thailand MoPH - U.S. CDC Collaboration (TUC) began in 1990.
- Joint activities have focused on HIV prevention research in 4 key areas: behavioral science, and sexual, parental, and mother-to-child HIV transmission (PMTCT). Some key activities over the past 14 years have included: systematic analyses of sentinel surveillance data which track HIV prevalence among groups at highest risk for HIV infection; field studies of vulnerable populations, including youth, intravenous drug users, prostitutes, and military recruits; studies on the molecular epidemiology of HIV and its subtypes which provide valuable data for HIV vaccine development, and the study of biomedical interventions including clinical trials evaluating anti-retroviral drugs to decrease mother to child HIV transmission (e.g., the landmark 1998 Bangkok Regimen); the world's first HIV vaccine efficacy trial conducted in a developing country; and safety and acceptability studies of vaginal microbicides which moved one promising new product forward to a phase III efficacy trial in Africa this year.
- CDC's Global AIDS Program in Thailand was launched in 2001. Under a Five-Year Country Plan developed in collaboration with the Thai MOPH, HHS/CDC provides support for projects to strengthen HIV/AIDS prevention and care activities by focusing on work in seven technical areas: 1) training, health communications and partnerships, 2) care and counseling, 3) prevention and care for families, 4) prevention and care for special populations, 5) surveillance, monitoring and evaluation, 6) laboratory services, and 7) information systems.
- A unique feature of Thailand's Global AIDS Program is the ability to put the Collaboration's research findings into public health practice. Examples of this include the Collaboration's monitoring and evaluation system for Thailand's highly touted, national PMTCT program, and recent work in piloting HIVQUAL, a simple system designed for monitoring and evaluation of Thailand's National Access to Care Program targeting Highly Active Anti-Retroviral Treatment (HAART) for 50,000 Thais in 2004.
- In 2002, CDC-GAP initiated an Asia Regional Program to coordinate and facilitate technical support, training, and information exchange workshops among the five GAP countries in the Asia region (Vietnam, Cambodia, China, Thailand, and India), as well as countries in the Asia region without bilateral CDC programs on HIV/AIDS.
- The International Emerging Infections Program (IEIP) was added to TUC in 2001, with a mission of strengthening Thai capacity to identify and control emerging infections. IEIP focuses on four main areas of activity -- surveillance, research, training, and outbreak support. Ongoing surveillance and research activities provide much needed data on the causes of respiratory illness, febrile illness and encephalitis that will help guide treatment and prevention efforts and pave the way for new vaccines.
- In 2003, IEIP was heavily engaged in the SARS response in Asia, dispatching teams to Taiwan, Laos, Hong Kong, Beijing, and Singapore. In Thailand, IEIP worked closely
with the MoPH; specimens obtained from a case were sent to CDC, resulting in identification of a novel coronavirus as the cause of the global epidemic.
- Another emerging disease, avian influenza, struck Asia in 2004. Thailand and Vietnam reported a total of 34 human cases and 23 deaths, with more than 100 million commercial poultry killed or euthanized. IEIP epidemiologists worked with both countries to help control the spread in humans. In addition, IEIP helped organize an urgently needed regional training course.
USAID support to Thailand's HIV/AIDS program.
USAID's support to Thailand to address HIV/AIDS began in 1987 through funding to Family Health International's (FHI) AIDSTECH program in collaboration with the Thai MOPH. During that 5 year program 20 research and intervention projects were implemented and included such important issues/ topics as: behavioral and epidemiological research; cohort study of sex workers in Chiang Mai and male sex workers in Bangkok; assessment and upgrading of private STD clinics; workshops for condom logistic management; and HIV/AIDS education and prevention interventions for vulnerable communities. These efforts assisted the MOPH in the early establishment of effective HIV interventions in Thailand which has been used a model across the Asia region.
- From 1992 to 1997, USAID funded FHI's AIDSCAP project targeting lower-income people between the age of 15 and 29 in their workplaces, health facilities, and households in Bangkok. Additionally, Behavioral Surveillance Surveys (BSS) were pioneered in Thailand and five rounds were carried out to monitor the trends in sexual behavior showing an increase in safer behavioral practices.
- Although this project ended in 1997 when USAID closed its Bangkok Office, USAID support continued for FHI's Regional Program based in Bangkok through 2000. This program has had considerable impact throughout Asia. For example, USAID funds have allowed FHI to: facilitate cross-border linkages and lessons learned to improve the capacity of countries in the Asia region to respond to HIV/AIDS; work with local and international partners to coordinate and strengthen the local capacity to conduct second generation surveillance and monitor the epidemic; assess the dynamics of the epidemic among vulnerable populations and develop strategies for working with them; and establish national networks of people living with HIV/AIDS and support advocacy and networking through the Asia-Pacific region.
- In 2001, USAID funds were again made available for direct assistance to Thailand. This support through FHI's IMPACT project provided for: strengthening programs that address HIV and drug use among Akha villages in Northern Thailand; developing a model intervention aimed at reducing male-to-male HIV transmission in northern Thailand; increasing HIV counseling, prevention of mother-to-child transmission efforts and community outreach for Burmese migrants in Mae Sot and Tak (northern Thailand); and assessing the risk behavior of female sex workers, military and police at the Thailand/Myanmar border and developing peer education, sexual health services and interventions to prevent the spread of HIV among them.
- Under AIDSMARK, Population Services International (PSI) Thailand received funding to design, develop and market a high-quality, affordable condom brand (One condom) and water-based lubricant targeted to high risk male youth, indirect sex workers and their clients, drug users and their sex partners, and migrants in Northern Thailand. The International HIV/AIDS Alliance (IHAA) received funding to carry out skills building workshops with drug user using the Participatory Assessment and Response Approach; and develop pilot projects in HIV and amphetamine drug use among at-risk youth in Chiang Mai.
- USAID's HIV/AIDS-Health Office (HHO) opened in Bangkok in June 2003 to implement regional HIV/AIDS activities, with a primary focus on six Mekong countries: Burma, Cambodia, China (Yunnan and Guangxi Provinces), Laos, Thailand and Vietnam. Cambodia, one of USAID's four HIV/AIDS rapid scale-up countries, will act in an advisory role to support regional activities. With Vietnam being assigned the fifteenth PEPFAR country, USAID's new role in this process is presently being redefined. For the other four countries (without USAID missions), HHO Bangkok will help plan, design, award, manage, monitor, evaluate and report on USAID's HIV/AIDS program activities, in close collaboration with National AIDS Programs, other donors and NGO implementing partners.
- The budget for the Mekong Regional program is approximately $20 million annually; Cambodia alone has an annual HIV/AIDS budget of $13 million. As needed, HHO staff will assist mission staff in South Asian and Pacific missions to develop high-impact programs and to act as a clearinghouse for sharing expertise and ideas derived by these programs.
U.S. NIH-funded projects through the Johns Hopkins University-Chiang Mai University research collaboration.
Medical researchers from JHU and CMU have been working together for 15 years on HIV/AIDS. Initial work focused on epidemiologic studies to describe the pattern and transmission of HIV infection in northern Thailand. Current studies, centered at the Research Institute for Health Sciences (RIHES), CMU, form part of major international collaborative efforts to test prevention and treatment interventions that would be applicable worldwide. This research center is one of the most prominent in Thailand that have received HIV/AIDS research grant support from U.S. NIH.
- Over the years, through July 2004, the USG has provided approximately $25 million in support to this collaboration. Through 2007, an additional $25 million in USG funding support is projected. In addition, numerous Thai leaders in the medical and public health fields have received professional training at Johns Hopkins, one of the most prominent being Dr. Vallop Thaineua, the current permanent secretary of the MoPH and former vice-chair of the Global Fund. Over the past 15 years funding through the U.S. NIH Fogarty AIDS International Training and Research Program has supported 13 physicians and researchers in obtaining advanced degrees at JHU and short-term training for an additional 54 Thai medical and public health officials. CMU and the individuals trained under this program are beginning to assist other countries in Asia, particularly Laos and China, in building programs in HIV/AIDS prevention, treatment and research.
Ongoing and upcoming USG-funded research projects at RIHES include:
- A landmark, six-country study to test whether antiretroviral medications can prevent sexual transmission of HIV within couples with one infected and one uninfected partner. Supported by the HIV Prevention Trials Network (HPTN) of the National Institute of Allergy and Infectious Disease (NIAID), NIH.
- A four-country study to test whether providing mobile voluntary counseling and HIV testing, outreach and education can reduce HIV infection rates in remote communities. Supported by the National Institute of Mental Health.
- Separate studies to assess whether group counseling that trains injection drug users (HPTN-supported) and methamphetamine users (supported by the National Institute on Drug Abuse) to teach their friends about risk reduction, can reduce HIV infection, drug use, and risk behaviors.
- Continuing small, Phase I studies to test the safety of possible HIV vaccines. (Supported by the HIV Vaccine Trials Network of NIAID)
- A study of the effectiveness of once-a-day antiretroviral medication regimens (Supported by the Adult AIDS Clinical Trials Group of NIAID)
Other major NIH-sponsored activities in Thailand include:
- A recently approved, 5-year $15 million CIPRA grant to The Thai Red Cross AIDS Research Centre for HIV research in Thailand and Cambodia. The Thai Red Cross is one of the three groups, which make up the HIV-NAT research collaboration. The others are The National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia and the International Antiviral Evaluation Centre, Amsterdam, The Netherlands
- HIV-NAT is also National Trials Coordinator in Thailand for the NIAID-sponsored, 18-country clinical trial to determine whether interleukin-2, a substance which stimulates the proliferation of CD4 and CD8 T-lymphocytes, can delay progression to AIDS and extend survival among HIV-infected individuals (the ESPRIT study). The Thai portion of the trial received $725,000 in NIAID support in FY 1993. Of the 4,000 subjects worldwide in this trial, 365 are enrolled in Thailand.
- The Program for HIV Prevention and Treatment (PHPT), a research group with joint sponsorship from Harvard University and the French Institut de Recherche pour le Developpement, conducts HIV/AIDS research in a network of 41 Thai hospitals. PHPT has received support from the National Institute for Child Health and Human Development (NICHHD) to study short-course antiviral drug regimens for prevention of mother-to-child-transmission of HIV infection (PMTCT) and for monitoring of highly active antiretroviral therapy (HAART). Their most recent Phase III study demonstrated that adding nevirapine to the existing short-course zidovudine regimen used in Thailand for PMTCT could reduce mother-to-child transmission rates from 6.3% to 1.1% -- a rate comparable to that observed when using full HAART throughout pregnancy in developed countries. PHPT has been receiving about $1.6 million a year in NICHHD funds.
- PHPT's research network and Siriraj children's hospital in Bangkok are two research sites of NIAID's worldwide Pediatric AIDS Clinical Trials Group (PACTG), which collaborate on a variety of clinical research related to HIV/AIDS in mothers and children. One PACTG project in Thailand, a study of Amphotericin B in treatment of AIDS-associated cryptococcal meningitis, is receiving $725,000 in NIAID support over 3 years.
(end fact sheet)
(Distributed by the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)
