From 2005-2006, the team conducted a review of existing programs, activities, literature, and guidelines related to HIV disclosure. Needs assessment tools were developed and assessments were conducted among key stakeholders through focus groups and discussions. The results were analyzed and evaluated and a draft disclosure model and accompanying package of educational materials and tools was completed.
In early 2006, prior to piloting the model at QSNICH and Siriraj hospitals, a workshop was conducted with providers in the two hospitals to ensure they understood and became familiar with the model and tools. At these workshops, providers were trained on the disclosure model, as well as about how to educate children and caretakers about HIV and antiretroviral treatment adherence through educational classes and individual discussions.
Piloting of the model at QSNICH and Siriraj Hospital began in 2006. The model was integrated into routine clinical services at the two hospitals during implementation. All steps in the model took place during the patients’ regularly scheduled visits to assure that the model was feasible and accepted by children, caretakers, and providers.
During the pilot, the initiative organized day trips for caretakers and HIV-infected children and conducted home visits, follow-up by telephone, and preliminary evaluation of the disclosure model, educational classes and the materials. Workshops for children, their caretakers, and providers facilitated group discussions and further sharing of ideas and opinions.
Between 2006-2008, standard measurements (including psychometric tests) were used to evaluate the outcomes of disclosure by this model to ensure that it was beneficial and practical.
In 2008, the disclosure model and educational tools were finalized and preparations for national scale up began. In collaboration with four regional hospitals (Chiangrai Prachanukroh, Hat Yai, Prachomklao, and Srinagarin hospitals), a training curriculum was developed to train healthcare providers in the MOPH and Bangkok Metropolitan Administration (BMA) settings between 2008-2013, through the Pediatric HIV Care Quality Improvement Project supported by BATS and the NHSO. To date, the training has been conducted for 456 providers from 258 hospitals throughout Thailand, as well as providers from other countries, including Indonesia, Malaysia, Myanmar, and Vietnam.
The Pediatric HIV disclosure manual was first published in Thai in 2008 and later was translated into English with a second Thai edition in 2010.