Thai Program to Block Mom-Baby HIV Spread Underway
By Merritt McKinney
Originally published by Reuters Health, July 9, 2002
NEW YORK (Reuters Health) — In a move that may serve as a model for other developing countries, Thailand has put in place a national program to prevent mother-to-child transmission of HIV, according to a new report.
Although it is too soon to tell how effective the program will be at keeping Thai children from being born with the AIDS virus, the initiative has increased the percentage of pregnant women who get tested for HIV as well as the percentage of newborns who receive drugs to reduce the risk of HIV infection.
"Thailand's national program can be a model for other developing countries," Dr. R. J. Simonds of the Centers for Disease Control and Prevention in Atlanta, Georgia, told Reuters Health. "Though many countries with high rates of infection may not have the same infrastructure that Thailand has, the blueprint for the national program used in Thailand can be a helpful one for other countries to follow."
Each year about 10,000 children in Thailand are born to mothers who are infected with HIV. After several clinical trials and pilot programs showed that treatment with the antiviral drug zidovudine (AZT) can drastically reduce the risk of mother-to-child transmission of HIV, the Thai government developed a national program to prevent such infections.
The aims of the program, which was started in early 2000, include offering routine HIV counseling and voluntary HIV testing to pregnant women. Under the program, HIV-positive women are given AZT during the last 6 weeks of pregnancy and during labor, and children are given the drug for 1 to 6 weeks.
To reduce the risk that a child will be infected through breast milk, women are advised to use infant formula during the child's first year. The program also aims to provide HIV testing for children whose mothers are HIV positive as well as necessary medical care for women and children.
The program seems to be off to a good start, according to a report in the July 10th issue of The Journal of the American Medical Association. During the first year of the program, about 97% of women who gave birth in public health hospitals had received prenatal care. Of the women who had received medical care during pregnancy, 93% were tested for HIV. Even among women who lacked prenatal care, 71% were tested for HIV before giving birth.
Simonds' team also reports that many HIV-positive women and their babies received treatment to prevent HIV transmission. About 70% of HIV-positive women took antiviral treatment before giving birth and about 89% of babies born to HIV-positive women received antiviral medications.
The experience with this program in Thailand "gives hope to other countries that such programs can be implemented successfully at the national level," Simonds said.
The effectiveness of the program in preventing HIV transmission remains to be seen, but Simonds' team points out that the rate of mother-to-child transmission was reduced to about 8% in two national pilot programs.
The protective effect of AZT is well known, but another antiviral drug, nevirapine, has also been shown to reduce a child's chance of being infected with HIV. The effects of a combination of the two drugs are currently being studied in Thailand.
