HIV incidence and associated risk factors among key populations accessing routine testing through the national health coverage system in Thailand: A nationwide real-world study

Abstract

Purpose: To assess HIV incidence and associated factors among key populations (KPs) including men who have sex with men (MSM), transgender women (TGW), sex workers (SW), and people who inject drugs (PWID) using data from the Universal Health Coverage program. Methods: HIV testing data were collected from KP individuals aged ≥ 15 years diagnosed HIV-negative at least once between 2015 and 2022. Flexible parametric survival analysis was used to estimate HIV incidence and identify associated factors. Results: Among 373,300 individuals tested, 65 % were MSM, 26 % SW, 8 % PWID, and 2 % TGW. HIV incidence rates were highest among MSM (2.23 per 100 person-years, PYs), followed by TGW (2.06 per 100 PYs), PWID (0.46 per 100 PYs), and SW (0.41 per 100 PYs). In multivariable analysis, MSM had significantly higher risk compared to PWID (adjusted hazard ratio (aHR 0.13), SW (aHR 0.20), and TGW (aHR 0.77). Youth among KPs had a 7.30-fold higher risk compared to those aged ≥ 50 years. A decline in incidence was observed in more recent years. Conclusions: HIV incidence is declining all KPs but remains highest among MSM and TGW, particularly youth, highlighting the need for targeted prevention to end HIV in Thailand.