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Elimination of mother-to-child transmission of HIV: lessons learned from…
Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand
Introduction
Acquired immune deficiency syndrome (AIDS) was initially recognised in 1981 in homosexual men in North America, thereafter becoming a global epidemic.
The first AIDS case in Thailand was reported in a Thai man in September 1984.
Conclusion
The prevalence of HIV in pregnant women has decreased substantially during the past two decades. MTCT has been drastically reduced by early and concerted efforts in many sectors.
The shared commitment, decisionmaking, resources and efforts by all sectors of Thai society to achieve the goals of elimination of MTCT have been necessary.
Lessons learned
The Asian epidemic model
Addressing the four prongs of the WHO PMTCT strategy
Prong 3: Prevention of HIV transmission from a woman living with HIV to her infant.
Prong 4: Provision of appropriate treatment, care and support to women and children living with HIV and their families.
Prong 2: Prevention of unintended pregnancies in women living with HIV.
Prong 1: Primary prevention of HIV in women of childbearing age.
Monitoring systems
The future challenges and evolution of PMTCT in Thailand
The chain of transmission to infants
A chain of transmission in Thailand eventually leading to mother-to-child transmission of HIV (MTCT) to an infant is demonstrated by the epidemiological surveys conducted on the HIV epidemic in Thailand from 1988 to 1997. These describe some of the sexual practices in Thai culture relating to MTCT.
National prevention of mother-to-child transmission of HIV policy (2000 to the present)
In 2004, a triple-drug regimen (TDR) of zidovudine and lamivudine with one of nevirapine, efavirenz or lopinavir/ritonavir was introduced, achieving a transmission rate as low as 1.1% in 1832 pregnant women between 2004 and 2010 at a duration of TDR of 10.4 (7.3–13.4) weeks.
Zidovudine for 6 weeks postpartum and free infant formula until 12 months of age have also been provided for all TRCS regimens.
The ART regimens
Early responses in the prevention of mother-to- child transmission of HIV (1988–1999)
National public health promotion campaign and the 100% condom programme
Infant formula for HIV-infected mothers
Early epidemiological surveys of perinatal HIV infection in Thailand
Thai Red Cross zidovudine donation programme