{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:27:59Z","timestamp":1793294879517,"version":"4.5.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Department of Disease Control, Ministry of Public Health","award":["Grant No. 7\/2563"],"award-info":[{"award-number":["Grant No. 7\/2563"]}]},{"DOI":"10.13039\/501100018734","name":"The Joint United Nations Programme on HIV\/AIDS","doi-asserted-by":"crossref","award":["Grant No. 2020\/1025705"],"award-info":[{"award-number":["Grant No. 2020\/1025705"]}],"id":[{"id":"10.13039\/501100018734","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>HIV Pre-exposure prophylaxis (PrEP) has demonstrated efficacy and effectiveness among high-risk populations. In Thailand, PrEP has been included in the National Guidelines on HIV\/AIDS Treatment and Prevention since 2014. As a part of the national monitoring and evaluation framework for Thailand\u2019s universal coverage inclusion, this cross-sectional survey was conducted to assess knowledge of, attitudes to and practice (KAP) of PrEP service providers in Thailand.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>We conducted a cross-sectional survey to explore knowledge of, and attitudes towards PrEP among providers from hospital and Key Population Led Health Services (KPLHS) settings. The questionnaire was distributed online in July 2020. Descriptive and univariate analysis using an independent-sample t-test were applied in the analyses. Attitudes were ranked from the most negative (score of 1) to the most positive (score of 5).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Overall, there were 196 respondents (158 from hospitals and 38 from KPLHS) in which most hospital providers are female nurse practitioners while half of those from KPLHS report current gender as gay. Most respondents report a high level of PrEP knowledge and support provision in all high-risk groups with residual concern regarding anti-retroviral drugs resistance. Over two-fifths of providers from both settings perceive that PrEP would result in risk compensation and half of KPLHS providers are concerned regarding risk of sexual transmitted infections. Limited PrEP counselling time is a challenge for hospital providers.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Service integration between both settings, more involvement and distribution of KPLHS in reaching key populations would be essential in optimizing PrEP uptake and retention. Continuing support particularly in raising awareness about PrEP among healthcare providers and key populations, facilities and manpower, unlimited quota of patient recruitment and PrEP training to strengthen providers\u2019 confidence and knowledge would be essential for successful PrEP implementation.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0268407","type":"journal-article","created":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T17:38:47Z","timestamp":1652377127000},"page":"e0268407","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["A comparison of attitudes and knowledge of pre-exposure prophylaxis (PrEP) between hospital and Key Population Led Health Service providers: Lessons for Thailand\u2019s Universal Health Coverage implementation"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5961-8978","authenticated-orcid":true,"given":"Ajaree","family":"Rayanakorn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sineenart","family":"Chautrakarn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2704-9595","authenticated-orcid":true,"given":"Kannikar","family":"Intawong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chonlisa","family":"Chariyalertsak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Porntip","family":"Khemngern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Olson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suwat","family":"Chariyalertsak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"pone.0268407.ref001","unstructured":"The Joint United Nations Programme on HIV and AIDS. AIDSinfo 2018 [cited 2020 21 April]. Available from: http:\/\/aidsinfo.unaids.org\/."},{"key":"pone.0268407.ref002","unstructured":"Centers for Disease Control and Prevention, US Public Health Service. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States\u20142017 Update: A Clinical Practice Guideline 2018 [cited 2020 21 April]. Available from: https:\/\/www.cdc.gov\/hiv\/pdf\/risk\/prep\/cdc-hiv-prep-guidelines-2017.pdf."},{"issue":"5","key":"pone.0268407.ref003","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1056\/NEJMoa1108524","article-title":"Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women","volume":"367","author":"JM Baeten","year":"2012","journal-title":"N Engl J Med"},{"issue":"9","key":"pone.0268407.ref004","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S1473-3099(14)70847-3","article-title":"Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study","volume":"14","author":"RM Grant","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"pone.0268407.ref005","first-page":"4","article-title":"Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: An observational cohort study.","author":"J-M Molina","year":"2017","journal-title":"Lancet HIV"},{"key":"pone.0268407.ref006","volume-title":"Economic evaluation of HIV Pre-Exposure Prophylaxis","author":"Health Intervention Technology Assessment Programme","year":"2019"},{"key":"pone.0268407.ref007","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12981-015-0053-z","article-title":"Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2014","volume":"12","author":"W Manosuthi","year":"2015","journal-title":"Thailand. AIDS Res Ther"},{"key":"pone.0268407.ref008","unstructured":"PrEP innovation and implementation in Asia and the Pacific: Virtual regional discussion 15\u201316 December 2020. UNAIDS, Unitaid and WHO in association with the Institute of HIV Research and Innovation (IHRI), 2020."},{"key":"pone.0268407.ref009","unstructured":"PrEPWatch. Thailand\u2014PrEPWatch 2021 [cited 2021 25 June]. Available from: https:\/\/www.prepwatch.org\/country\/thailand\/."},{"issue":"6","key":"pone.0268407.ref010","doi-asserted-by":"crossref","first-page":"e25535","DOI":"10.1002\/jia2.25535","article-title":"Give the community the tools and they will help finish the job: key population-led health services for ending AIDS in Thailand.","volume":"23","author":"R Vannakit","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"6","key":"pone.0268407.ref011","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1071\/SH18065","article-title":"Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand.","volume":"15","author":"N Phanuphak","year":"2018","journal-title":"Sex Health"},{"issue":"1","key":"pone.0268407.ref012","article-title":"Correlates of nonadherence to key population-led HIV pre-exposure prophylaxis services among Thai men who have sex with men and transgender women.","volume":"19","author":"P Seekaew","year":"2019","journal-title":"BMC Public Health [Internet]."},{"issue":"1","key":"pone.0268407.ref013","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12981-019-0240-4","article-title":"Leveraging early HIV diagnosis and treatment in Thailand to conduct HIV cure research","volume":"16","author":"C Muccini","year":"2019","journal-title":"AIDS Res Ther"},{"issue":"1","key":"pone.0268407.ref014","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/S2055-6640(20)30235-1","article-title":"HIV rapid diagnostic testing by lay providers in a key population-led health service programme in Thailand.","volume":"4","author":"R Wongkanya","year":"2018","journal-title":"J Virus Erad"},{"key":"pone.0268407.ref015","unstructured":"Thailand Working Group on HIV\/AIDS Projection. Projection for HIV\/AIDS in Thailand 2010\u20132030: The Thai Working Group on HIV\/AIDS Projections; 2010. Available from: https:\/\/www.aidsdatahub.org\/sites\/default\/files\/resource\/projection-hiv-aids-thailand-2010-2030.pdf."},{"key":"pone.0268407.ref016","unstructured":"Practical meeting for quality improvement in PrEP services. Department of Disease Control, Ministry of Public Health; 2022."},{"key":"pone.0268407.ref017","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1186\/1471-2334-13-217","article-title":"Attitude towards antiretroviral Pre-Exposure Prophylaxis (PrEP) prescription among HIV specialists","volume":"13","author":"V Puro","year":"2013","journal-title":"BMC Infect Dis"},{"key":"pone.0268407.ref018","first-page":"15","article-title":"Healthcare providers\u2019 knowledge of, attitudes to and practice of pre\u2010exposure prophylaxis for HIV infection","author":"M Desai","year":"2015","journal-title":"HIV Med"},{"key":"pone.0268407.ref019","unstructured":"Kaspersky. QR Code Security: What are QR codes and are they safe to use? 2021 [cited 2021 14 August]. Available from: https:\/\/www.kaspersky.com\/resource-center\/definitions\/what-is-a-qr-code-how-to-scan."},{"key":"pone.0268407.ref020","unstructured":"What is LINE Application: IGI Global Publisher of Timely Knowledge; 2021 [cited 2021 14 August]. Available from: https:\/\/www.igi-global.com\/dictionary\/line-application\/75571."},{"key":"#cr-split#-pone.0268407.ref021.1","unstructured":"Thai Traditional Medical Professions Act, B.E. 2556 (2013): Government Gazett"},{"key":"#cr-split#-pone.0268407.ref021.2","unstructured":"2013 [cited 2022 27 February]. Available from: https:\/\/thaimed.or.th\/home\/wp-content\/uploads\/2017\/05\/Thai-Traditional-Medical-Professions-ActB.E.2013.pdf."},{"key":"pone.0268407.ref022","author":"Joint United Nations Programme on HIV\/AIDS","year":"2015"},{"issue":"2","key":"pone.0268407.ref023","doi-asserted-by":"crossref","first-page":"e25471","DOI":"10.1002\/jia2.25471","article-title":"Ending discrimination in healthcare","volume":"23","author":"JJ Amon","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"7","key":"pone.0268407.ref024","doi-asserted-by":"crossref","first-page":"e25338","DOI":"10.1002\/jia2.25338","article-title":"Drug-drug interactions between feminizing hormone therapy and pre-exposure prophylaxis among transgender women: the iFACT study","volume":"22","author":"A Hiransuthikul","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"10","key":"pone.0268407.ref025","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1089\/apc.2013.0173","article-title":"Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices","volume":"27","author":"D Tellalian","year":"2013","journal-title":"AIDS Patient Care STDS"},{"issue":"5996","key":"pone.0268407.ref026","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1126\/science.1193748","article-title":"Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women","volume":"329","author":"Q Abdool Karim","year":"2010","journal-title":"Science"},{"issue":"12","key":"pone.0268407.ref027","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1093\/cid\/cir684","article-title":"Pre-Exposure Prophylaxis and Antiretroviral Resistance: HIV Prevention at a Cost?","volume":"53","author":"CB Hurt","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pone.0268407.ref028","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1093\/infdis\/jiu233","article-title":"HIV-1 drug resistance in the iPrEx preexposure prophylaxis trial","volume":"210","author":"T Liegler","year":"2014","journal-title":"J Infect Dis"},{"issue":"3","key":"pone.0268407.ref029","doi-asserted-by":"crossref","first-page":"e1001613","DOI":"10.1371\/journal.pmed.1001613","article-title":"Early Experiences Implementing Pre-exposure Prophylaxis (PrEP) for HIV Prevention in San Francisco","volume":"11","author":"A Liu","year":"2014","journal-title":"PLoS Med"},{"issue":"4","key":"pone.0268407.ref030","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/j.japh.2020.01.026","article-title":"Community pharmacy delivered PrEP to STOP HIV transmission: An opportunity NOT to miss!","volume":"60","author":"MI Lopez","year":"2020","journal-title":"J Am Pharm Assoc"},{"issue":"1269","key":"pone.0268407.ref031","article-title":"Transformation of Australian Community Pharmacies Into Good Clinical Practice Compliant Trial Pharmacies for HIV Pre-Exposure Prophylaxis","volume":"10","author":"L Lal","year":"2019","journal-title":"Front Pharmacol"},{"issue":"1","key":"pone.0268407.ref032","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1016\/S2352-3018(19)30347-9","article-title":"Key populations and power: people-centred social innovation in Asian HIV services","volume":"7","author":"F Yang","year":"2020","journal-title":"Lancet HIV"},{"key":"pone.0268407.ref033","author":"R. Pebody","year":"2019","journal-title":"Six innovative models for PrEP services: NAM Aidsmap"},{"key":"pone.0268407.ref034","first-page":"1","article-title":"PrEP for key populations: results from the first PrEP demonstration project in the Democratic Republic of the Congo","author":"J Franks","year":"2021","journal-title":"AIDS Care"},{"issue":"2","key":"pone.0268407.ref035","doi-asserted-by":"crossref","first-page":"e033852","DOI":"10.1136\/bmjopen-2019-033852","article-title":"Introducing pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Sweden: insights from a mathematical pair formation model","volume":"10","author":"D Hansson","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0268407.ref036","author":"S Chariyalertsak","year":"2021"},{"issue":"3","key":"pone.0268407.ref037","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0000000000002243","article-title":"HIV Preexposure Prophylaxis Cascades to Assess Implementation in Australia: Results From Repeated, National Behavioral Surveillance of Gay and Bisexual Men, 2014\u20132018","volume":"83","author":"M Holt","year":"2020","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"7","key":"pone.0268407.ref038","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1093\/cid\/cit946","article-title":"A cost-effectiveness analysis of HIV preexposure prophylaxis for men who have sex with men in Australia","volume":"58","author":"K Schneider","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"6","key":"pone.0268407.ref039","doi-asserted-by":"crossref","DOI":"10.1097\/JNC.0000000000000073","article-title":"Health Care Provider Perspectives on Pre-exposure Prophylaxis: A Qualitative Study.","volume":"30","author":"S Przybyla","year":"2019","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"43","key":"pone.0268407.ref040","doi-asserted-by":"crossref","first-page":"e17716","DOI":"10.1097\/MD.0000000000017716","article-title":"Low awareness and use of pre-exposure prophylaxis among adolescents and young adults in high HIV and sexual violence prevalence settings.","volume":"98","author":"AI Ajayi","year":"2019","journal-title":"Medicine (Baltimore)."},{"issue":"4","key":"pone.0268407.ref041","doi-asserted-by":"crossref","first-page":"158","DOI":"10.3390\/tropicalmed5040158","article-title":"PrEP Use Awareness and Interest Cascade among MSM and Transgender Women Living in Bali, Indonesia.","volume":"5","author":"R Cempaka","year":"2020","journal-title":"Trop Med Infect Dis"},{"key":"pone.0268407.ref042","article-title":"Pre-exposure prophylaxis uptake for HIV infection prevention among young men who have sex with men and transgender women in Bangkok, Thailand","author":"N Auemaneekul","year":"2020","journal-title":"J Health Res"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T13:14:30Z","timestamp":1700572470000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268407"}},"subtitle":[],"editor":[{"given":"Benjamin R.","family":"Bavinton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,12]]},"references-count":43,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0268407","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,12]]}}}