Evolution of medical services for HIV/AIDS in Thailand

Thailand started the anti-retroviral supply program in 1992 primarily for low income groups. The budget has increased but coverage has decreased due to the large number of cases requesting supply. Rapid advancement of HIV therapy has resulted in higher drug cost which is not affordable to people in developing countries. The cost effectiveness review in 1995, conducted by staff of the World Bank, World Health Organization, and Ministry of Public Health (MOPH), demonstrated high cost with limited benefit. It encouraged program evolution, from "supply for services" to "supply for research". Faced with an expanding AIDS epidemic and economic set back, Thailand has to adapt its program to fit scientific, ethic, and economic situations.

The program now extends to (a) adapting current therapeutic regimens, (b) developing new treatment and (c) natural history study of people with HIV/AIDS who receive anti-retrovirals (ARV), anti-opportunistic infections (anti OIs), or alternative care. Laboratory issues, and prevention activities are also included. To allocate an approximately 300 million baht budget each year, participating hospitals were invited to submit proposals for consideration. Proposals were ranked and supported according to scores and research priority. A clinical research network was set up in 1996 and supply was shipped out in 1997 on double combination for 1,200 cases, with triple combination for 40 cases, all in 58 sites. Investigators were trained for Good Clinical Practices (GCP) to reassure data handling quality. Psychological and social support were encouraged through the health system research network. Until 15 Jan 98, 49 proposals were submitted (42 ARV, 1 herbal medicine, 6 pediatrics/perinatals). A working group consisting of local experts from medical schools, and the MOPH together ranked these proposals. Those with high scores received medical supplies while the low scores received technological advice in order to increase their capability to participate in research in the near future.

Central supply encouraged physicians to treat more cases but discouraged their hospitals to set up their own budget. The clinical research network allowed team and infrastructure building up which can be adapted for drug, vaccine trials and observational databases. More training is needed. For other developing countries, Thailand's experiences should be perceived as an example not a model.