Hiv nat promoting clinical research and rational use of antiretroviral agents in thailand
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HIV-NAT: Promoting clinical research and rational use of antiretroviral agents in Thailand. ART access in resource limited settings. AIDS progression and mortality in less-developed countries continues to rise Causes: Access to antiretroviral therapy (ART)

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HIV-NAT: Promoting clinical research and rational use of antiretroviral agents in Thailand

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HIV-NAT: Promoting clinical research and rational use of antiretroviral agents in Thailand

ART access in resource limited settings

  • AIDS progression and mortality in less-developed countries continues to rise

  • Causes:

    • Access to antiretroviral therapy (ART)

    • Poor access to voluntary counselling and testing

    • Limited public health infrastructure to support diagnosis and monitoring

    • Lack of trained staff to deliver services

HIV-NAT History

  • HIV-Netherlands-Australia-Thailand Research collaboration established 1996

  • Aims:

    • to conduct clinical research into ART

    • to develop and promote appropriate and affordable treatment strategies for people with HIV in Thailand and neighbouring countries

Research questions in resource limited settings

  • Can ‘state of the art’ clinical trials be successfully conducted?

  • Can HIV disease progression be retarded to the same degree as achieved in developed countries?

  • Can strategies be developed to maintain ART for clinical trial participants after the trials have ended?

  • How can a clinical research network successfully build local capacity and inform local policy development?

  • Are intensive monitoring strategies required in settings with considerable economic constraints?

HIV-NAT Trials

  • HIV-NAT trials have been consistent with Thai National treatment guidelines

  • Clinic visits are conducted at least 3 monthly:

    • history and physical examination, assessments of disease progression and ART toxicity

    • Blood collection for immunological, virological, haematological and biochemical tests

    • Adherence counselling

  • Early protocols HIV-NAT initiated

  • Subsequently participated in multicentre trials

Pediatric studies

1996 1997 1998 1999 2000 2001 2002 2003 2004

Prepared by John Liddy, HIV-NAT

HIV-NAT drug fund

NNRTI failure





Adult studies





Completed studies




d4T ER



004 Vanguard


T-20 PK





003 series

002 series

001 series

March 2004

HIV-NAT outcomes (1)

  • Process measures (March 2004):

    • 20 trials completed, 14 in progress

    • >1,500 currently enrolled & post-trial patients receiving ART

    • Two year retention rates on clinical trials are greater than 90%

  • Clinical Outcome measures – 001- 005 series of trials

    • Median time to follow up: 62.3 months

    • 29 of 417 patients progressed to AIDS or died

    • TB most common event defining progression

    • Outcomes equivalent to or better than developed world cohorts

HIV-NAT outcomes (2)

  • HIV-NAT drug

    – subsidized ART on a sliding scale

  • Capacity and infrastructure building

    • Laboratory practice

    • Clinical practice

    • Health personnel training

  • Influence on local policy development

WHO 3 by 5 initiative

  • Treatment gap declared a global emergency in September 2003; WHO and UNAIDS launch 3 by 5 initiative

  • Target: 3 million people on ART by 2005

  • Aim: universal access to treatment as a human right

3x5 Pillar 5

  • ‘As treatment programmes go to scale, it is critical to derive data about what works, and what does not work, and why, as fast as possible’

  • Pillar 5

    • Build on successes

    • The rapid identification and re-application of new knowledge and successes (operational research (OR) agenda)

3x5 Operational Research Agenda

  • Coordinate and help develop an appropriate operational research agenda relevant to needs of ART programmes

  • Seek data on the impact of scaling up ART on prevention and at risk behaviour; on mitigation; on stigma and discrimination

3x5 OR agenda (2)

  • To identify ways to define the externalities of ART scale-up on health systems performance

  • To identify ways to cost ART programmes and to link costs to impact and effectiveness

3x5 OR agenda (3)

  • To improve programme design and find better tools to reduce risky behaviour, the evolution of drug resistance, based on the analysis of data

  • To incorporate new knowledge rapidly back into ART programme policy and practice

HIV-NAT Summary

  • HIV-NAT is a successful clinical research network, providing:

    • Access to ART

    • Appropriate clinical care

    • Good health outcomes

    • High degree of medication adherence

    • Local capacity and expertise

    • Improved public health infrastructure

HIV-NAT policy implications (1)

  • Rational drug use (RDU):

    • right drug, right patient, right indication, right dose, right duration, lowest cost

  • HIV-NAT demonstrates that RDU can be realised and good clinical outcomes can be achieved in resource-limited settings if funding and resources are available

HIV-NAT policy implications (2)

  • Challenge for the international community to contribute funds, training and resources so that

    • Work in resource limited settings can continue

    • ART can be delivered in a rational and coordinated manner

    • Programmes can be implemented and broadened to reduce morbidity and ultimately save lives


  • Dr Stephen Kerr

  • Dr Chris Duncombe

  • Theshinee Chuenyam

  • Prof Kiat Ruxrungtham

  • Prof Joep Lange

  • Prof David Cooper

  • Prof Praphan Phanuphak

  • HIV-NAT staff

    The HIV-Netherlands Australia Thailand Research Collaboration (HIV-NAT)

    104 Rajdumri Road

    Pathumwan, Bangkok 10330


    Email: [email protected]

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