Elimination of Mother-to-Child Transmission of HIV — Thailand

Lolekha, Rangsima; Boonsuk, Sarawut; Plipat, Tanarak; Martin, Michael; Tonputsa, Chaweewan; Punsuwan, Niramon; Naiwatanakul, Thananda; Chokephaibulkit, Kulkanya; Thaisri, Hansa; Phanuphak, Praphan; Chaivooth, Suchada; Ongwandee, Sumet; Baipluthong, Benjamas; Pengjuntr, Wachira; Mekton, Sopon

doi:10.15585/mmwr.mm6522a2

Cited by 40 publications

(47 citation statements)

References 7 publications

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“…Adolescents (10-19 years) living with HIV numbered 74,000 in CCASA and 220,000 in AP in 2015, with 210,000 and 600,000, respectively, aged 15-24 years according to UNAIDS estimates [1]; the epidemic in EE and Central Asia is smaller (estimated 80,000 15-24 year olds), but the only one globally where overall incidence continues to rise substantially. Successes in prevention of mother-to-child transmission (PMTCT) have been uneven across countries in these regions [2][3][4][5][6][7] and alongside a perinatally HIV-infected (PHIV) population aging into adolescence and young adulthood [8][9][10], there is ongoing vulnerability of young people in marginalized key populations to behavioural HIV acquisition. Almost a third of new infections in CCASA in 2014 were in men who have sex with men (MSM), while in EE and Central Asia, over half of new infections are currently among people who inject drugs (PWID) [6]; young people within key population groups are particularly vulnerable to HIV acquisition and barriers to care [11,12].…”

Section: Introductionmentioning

confidence: 99%

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Bailey

Cruz

Songtaweesin

et al. 2017

Journal of the International AIDS Society

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Introduction: The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities.Methods: We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes.Results and discussion: The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed.Conclusions: Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

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Section: Introductionmentioning

confidence: 99%

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Bailey

Cruz

Songtaweesin

et al. 2017

Journal of the International AIDS Society

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“…Those with a standard risk receive zidovudine for 4 weeks. Infants at high risk, namely maternal plasma HIV viral load >50 copies/mL or infants of mothers taking HAART for <4 weeks before delivery, are offered zidovudine, lamivudine and nevirapine for 6 weeks [38]. Both standard and high-risk infants receive HIV DNA polymerase chain reaction (PCR) testing at 1, 2 and 4 months.…”

Section: National Prevention Of Mother-to-child Transmission Of Hiv Pmentioning

confidence: 99%

“…From 2001 to 2012, these rates included HIVexposed infants who were not tested for HIV or whose test results were not reported. Adjusted MTCT rates from 2013 to 2015 have been calculated using SPECTRUM version 5.4 [38].…”

Section: Thai Red Cross Zidovudine Donation Programmementioning

confidence: 99%

“…HIV prevalence in pregnant women has decreased from 2% in the mid-1990s to 0.6% in 2015, and MTCT has fallen from 20-40% to 1.9% (WHO elimination target <2% in non-breast-feeding populations). The use of ART for PMTCT has increased from 64.6% in 1998 to 95.6% in 2015 (WHO elimination target >90%) [38].…”

Section: Addressing the Four Prongs Of The Who Pmtct Strategy Prong 1mentioning

confidence: 99%

“…However, a national reproductive health survey in 2009 reported that 16.2% of ever-married women aged 19-49 years had had an unintended last pregnancy [47], which is less than the global estimated prevalence (38% in the year 2010) [53]. [38]. The Thai 2014 national PMTCT guidelines are in accordance with WHO recommendations for Prongs 3 and 4, and these overlap in interventions aimed at them.…”

Section: The Future Challenges and Evolution Of Pmtct In Thailandmentioning

confidence: 99%

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Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand

Thisyakorn

2017

Paediatrics and International Child Health

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Implementation of an active case management network to identify HIV‐positive infants and accelerate the initiation of antiretroviral therapy, Thailand 2015 to 2018

Lolekha¹,

Pavaputanon

Puthanakit

et al. 2020

J Intern AIDS Soc

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Introduction Early initiation of antiretroviral therapy (ART) can reduce HIV‐related morbidity and mortality in HIV‐positive infants. We implemented an Active Case Management Network to promote early ART initiation Aiming for Cure (ACC) in August 2014. We describe ACC implementation, early infant diagnosis (EID) coverage and ART initiation during August 2014 to July 2018 compared with a national EID survey during October 2007 to September 2011 (pre‐ACC). Methods Thailand's 2014 HIV Treatment Guidelines recommend that HIV‐exposed infants have HIV polymerase chain reaction (PCR) testing at birth, one month and at two to four months. Testing is done at 14 national HIV PCR laboratories. When an HIV‐positive infant (HIV PCR+) is identified, PCR laboratory staff send the result to the hospital staff responsible for the infant's care and to the national laboratory case manager (CM). As part of ACC, the national laboratory CM alerts a regional CM who contacts the hospital staff caring for the infant to offer technical support with ART initiation and ART adherence. CMs enter clinical, demographic and laboratory data into the national ACC database. We analysed the ACC data from August 2014 to July 2018 to assess the ACC's impact on EID coverage, ART initiation and time‐to‐ART initiation. Results The uptake of EID increased from 64% (pre‐ACC) to >95% in 2018 (ACC). The number of HIV‐positive infants born declined from 429 cases (pre‐ACC) to 267 cases (ACC). Median age at the first‐positive PCR declined from 75 days (pre‐ACC) to 60 days (ACC); P < 0.001. Among 429 infants diagnosed before ACC was started, 241 (56%) received ART; during ACC, 235 (88%) of 267 HIV‐positive infants received ART. The median age at ART initiation declined from 282 days before ACC to 83 days during ACC (P < 0.001) and the median time from blood collection to ART initiation declined from 168 days before ACC to 23 days during ACC (P < 0.001). Conclusions An innovative case management network (ACC) has been established in Thailand and results suggest that the network is promoting EID and early ART initiation. The ACC model, using case‐managed PCR notification and follow‐up, may speed ART initiation in other settings.

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Elimination of Mother-to-Child Transmission of HIV — Thailand

Cited by 40 publications

References 7 publications

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand

Implementation of an active case management network to identify HIV‐positive infants and accelerate the initiation of antiretroviral therapy, Thailand 2015 to 2018

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