Contents -- Boxes, Figures, Maps, and Tables -- Dedication -- Foreword by Sombat Thanprasertsuk, M.D. -- Acknowledgments -- Abbreviations -- Executive Summary -- 1. Introduction -- 2. The Thai AIDS Epidemic Now -- 3. HIV/AIDS and Antiretroviral Therapy -- 4. The Effects of Thailand's Current AIDS Policy -- 5. Policies to Strengthen Treatment Programs: Evaluating the Costs and Benefits of Alternative Policy Scenarios -- 6. Sensitivity of the Policy Rankings to Key Assumptions -- 7. Major Findings and Recommendations -- Appendix A: Impact of ART on Survival -- Appendix B: Costs of Antiretroviral Therapy -- Appendix C: Costs of Support Groups of People Living with HIV/AIDS -- References -- Boxes -- 1.1 Suchada's Story: "ART Is a Great Contribution to Lessen Discrimination" -- 1.2 Kamman's Story: The "Miracle" of ART -- 1.3 Parichart's Story: "Before ART, I Did Not Want to Live Any Longer" -- 1.4 Alternatives to ART -- 2.1 Youth and HIV/AIDS in Thailand -- 3.1 Key Challenges for Second-Line ART in Thailand -- 3.2 Pediatric HIV/AIDS in Thailand -- 3.3 Behavioral Aspects of Adherence to ART in Thailand based on Results from Interviews and Focus Groups with PHAs -- 3.4 Can Direct Observed Therapy Strategies Be Applied to Provide More Effective ART? -- 3.5 The Effect of a Comprehensive Care Program for PHA, Supported by MSF, in Ban Laem District Hospital -- Figures -- 2.1 HIV Prevalence among Pregnant Women, Blood Donors, and 21-Year-Old Male Conscripts -- 2.2 HIV Prevalence among Direct and Indirect Sex Workers -- 2.3 HIV Prevalence among IDUs -- 2.4 Projected Annual New AIDS Cases -- 2.5 Projected HIV Infections in the Absence of Successful Prevention Effort -- 2.6 Condom Use among Commercial Sex Workers -- 2.7 Access to HIV/AIDS Medical Care -- 2.8 People Living with AIDS and Public ART Provision -- 2.9 Sources of HIV/AIDS Program Financing, 2000-03.

2.10 National AIDS Budget Allocation, 1996-2004 -- 3.1 Decline in CD4 Count by Year of Follow-Up, Siriraj University Hospital, Thailand -- 3.2 Persistence Assumptions for Patients Receiving Public and Augmented Public ART -- 3.3 Survival Assumptions for Patients Receiving Public and Augmented Public ART -- 3.4 Survival of a Model Cohort of Patients across First-Line and Second-Line Treatment Regimens If They Are Recruited Early or Late -- 3.5 Thai Doctors' Estimates of Patients Who Started ART with CD4 Counts of Less Than 50 Cells per mm3 -- 4.1 From Polices to Epidemiology to Performance -- 4.2 Choice of Treatment Mode among Symptomatic HIV-Positive Adults -- 4.3 Demand for Voluntary Counseling and Testing and Choice of Treatment Mode among Asymptomatic HIV-Positive Adults -- 4.4 Supply and Demand for ART by Treatment Mode -- 4.5 Stylized Structure of the AEM: Transmission -- 4.6 Client Compartment of the AEM with ART -- 4.7 Demand for Public ART as a Function of its Price to the Patient -- 4.8 Demand for VCT as a Function of the Price of Public Sector ART: Baseline, NAPHA, and VCT Scenarios -- 4.9 Projected Effects of the NAPHA Policy on Demand for VCT and ART -- 4.10 Projected Current HIV Cases -- 4.11 Projected Annual AIDS Deaths -- 4.12 Projected Number of HIV-Positive People on ART -- 4.13 Projected Annual Flow of Life-Years Saved under NAPHA -- 4.14 Projected Net Costs of ART under NAPHA -- 4.15 Projected Total Cost of Public ART under NAPHA by Line of Treatment -- 4.16 Percentage of Total Cost of NAPHA Attributable to Second-Line ART -- 4.17 Benefit (Life-Years Saved) and Costs of NAPHA Relative to Baseline -- 4.18 Cost Effectiveness of NAPHA at Different Discount Rates -- 5.1 Projected Current HIV Cases under Alternative Scenarios Relative to NAPHA -- 5.2 Projected Deaths Averted under Alternative Scenarios Relative to NAPHA.

5.3 Projected HIV-Positive People on ART under Alternative Scenarios Relative to NAPHA -- 5.4 Projected Annual Life-Years Saved under Alternative Scenarios Relative to NAPHA -- 5.5 Projected Net Cost of ART for all Four Scenarios -- 5.6 Cost-Effectiveness of NAPHA and Alternative Scenarios Relative to Baseline -- 5.7 Cost-Effectiveness of Alternative Scenarios Relative to NAPHA -- 5.8 ART Cost of NAPHA and Alternative ART Scenarios -- 5.9 Affordability of ART by Income Level -- 5.10 Projected ART Costs of NAPHA Scenarios with and without Second-Line ART -- 5.11 Projected Annual Costs and Benefits of NAPHA Scenario without Second-Line ART -- 5.12 Cost-Effectiveness of NAPHA Scenarios with and without Second-Line ART -- 6.1 New HIV Cases by Infectivity Rates among People on ART: NAPHA Scenario -- 6.2 Net Present Value of Cost per Life-Year Saved by Infectivity Scenario -- 6.3 Sensitivity of the Cost-Effectiveness Analysis to Prices of First- and Second-Line ART -- 6.4 Sensitivity of the Cost Effectiveness of NAPHA Policy to Risk Behavior -- Maps -- 2.1 Prevalence of HIV/AIDS in Thailand by Province -- 2.2 Prevalence of HIV/AIDS in Thailand by District -- 2.3 Coverage of ART Programs for Symptomatic HIV by Province, March 2004 -- 2.4 Symptomatic HIV by District- and Province-Level ART Coverage -- 2.5 Expansion of NAPHA, 2001-03 -- 2.6 Rate of ART Use at NAPHA Hospitals -- 2.7 NAPHA Hospitals and Presence of Patient Support Groups by District, 2004 -- Tables -- 1.1 Policy Scenarios for NAPHA -- 2.1 Estimated Cumulative Numbers for HIV/AIDS, 2004 -- 2.2 Declining Minimum Prices of ART in Thailand -- 2.3 Estimated Cases of People Living with AIDS, AIDS Cases, Reported AIDS Cases in Public Hospitals, and Access to Public ART -- 2.4 Number of Patients on ART in Thailand by Region, March 2004 -- 2.5 Number of Patients on ART by Type of Provider, March 2004.

2.6 Sales of GPO-vir by Sector, 2002-04 -- 2.7 Health Insurance Schemes in Thailand -- 2.8 National AIDS Expenditure by Function, 2000-03 -- 3.1 Selected Characteristics and Disease Progression Rates in a Cohort of HIV-Infected Patients Managed at Chulalongkorn University Hospital, Thailand, 1998 -- 3.2 Average Transmission Risk of HIV by Mode of Transmission -- 3.3 Prevalence of Selected OIs in Australia, India, Thailand, the United States, and Zaire, 1998 -- 3.4 Number of HIV-Positive Attendees at the Thai Red Cross Anonymous Clinic, Stratified by CD4 Cell Count, 1997-2003 -- 3.5 Anonymous Clinic Attendees of Thai Red Cross Anonymous Clinic Whose CD4 Count Was Less Than 200 Cells mm3, 1997-2003 -- 3.6 CD4 Count and Interquartile Range at the Fifth 15-Week Follow-up Compared with the Baseline -- 3.7 Clinician Opinions on Reasons for Poor Adherence to ART -- 3.8 Possible Effects of ART on HIV transmission -- 3.9 Costs of ARV Drugs Per Patient by Types of Regimens in Thailand, 2004 -- 3.10 Average Cost of OI Treatment per Non-ART Patient-Year in Thailand -- 3.11 Annual Cost of PHA Support Groups per 200 PHA Groups, 2004 -- 3.12 Annual Cost per Patient by Types of Drug Regimens -- 3.13 Average Costs of ART per Patient by Types of Service Providers, 2004 -- 4.1 Calibrated Values of the Parameters That Characterize Patient Choice of Treatment Mode in Thailand -- 4.2 Calibrated Values of the Parameters That Characterize Patient Choice of VCT -- 4.3 Major Policy Inputs to the Policy Model That Generate Alternative Scenarios: 18 Projected Variables -- 4.4 Outputs from the Policy Model That Drive the AEM for Each Scenario: 18 Projected Variables -- 4.5 Potential Baseline Scenarios or Counterfactuals to NAPHA -- 4.6 Assumptions for Baseline and NAPHA Scenarios -- 4.7 Projected Costs of the NAPHA Policy for ART, Including Second-Line Therapy, 2001-25.

4.8 Projected Costs of the NAPHA Policy for ART, Including Second-Line Therapy, as Percentage of AIDS Budget and Health Budget, 2001-25 -- 5.1 Typology of Four Major Policy Alternatives for ART Policy Scenarios for the NAPHA Program -- 5.2 Policy Assumptions for the VCT, Augmented, and Both Scenarios -- 5.3 Affordability of First- and Second-Line ART by Household Income -- 6.1 Proportion of Risky Sexual Acts Protected by Condoms: Alternative Behavioral Responses to Treatment Availability Assumptions for Behavioral Change.