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

Thisyakorn, Usa

doi:10.1080/20469047.2017.1281873

Cited by 37 publications

(34 citation statements)

References 22 publications

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“…Today, thanks to outstanding HIV mother-to-child transmission prevention programs in Thailand, few children born from HIV-infected mothers are HIV-infected themselves (32). Our study was carried out at a time when ART provision was still limited, and most adolescents had initiated their treatment late in childhood.…”

Section: Discussionmentioning

confidence: 99%

School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

Merville

Puangmala²,

Suksawas

et al. 2020

Preprint

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Background: In the HIV/AIDS pandemic, the perinatally HIV-infected children, who are surviving to adolescence, constitute a particular group, with specific needs to manage HIV disease and to prepare their future. Adolescents living with perinatal HIV (ALPHIV) often experience difficult living circumstances that can impact educational achievement and thus, insertion in the adult life. We explore the school trajectories of ALPHIV and determine the relative contribution of HIV-infection and the contextual environment to their schooling situations.Methods: We used data from the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional case-control study, conducted from 2011 to 2014 in Thailand. We analysed data for 707 ALPHIV (cases) aged 12–19 years, receiving antiretroviral therapy in 20 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected in the general population and individually matched for sex, age and residence. Schooling disruption was defined as ≥1 year academic delay or early school dropout. Logistic regression was used to assess factors independently associated with schooling disruption and to estimate the attributable fraction of school disruption related to HIV-infection. We used multivariate imputations by chained equations to manage missing data and we performed two sensitivity analyses to evaluate the reliability of our main model.Results: ALPHIV were 5 times more likely to experience schooling disruption than controls after adjustment on sociodemographic factors ( ORA=5.2 [3.7-7.2]). About 50% of schooling disruption could be attributed to HIV-infection. Boys and adolescents living in institutions were more likely to experience schooling disruption (ORA =1.8 [1.3-2.4] and ORA =11.0 [7.7-15.8], respectively). Among ALPHIV, mental and growth delays were significantly associated with schooling disruption (ORA =3.3 [2.1-5.2] and =1.8 [1.3-2.6], respectively). For ALPHIV living in family, schooling disruption was also associated with stigmatization experiences (ORA =1.9 [1.2-3.1]) and caregiver’s low education (ORA =2.1 [1.1-3.9]). Conclusions: HIV and contextual factors combine to aggravate ALPHIV educational disadvantage. Further research is needed to clarify the pathways leading to a disrupted school trajectory among ALPHIV. The impact of this educational disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be explored in future research.

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Section: Discussionmentioning

confidence: 99%

School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

Merville

Puangmala²,

Suksawas

et al. 2020

Preprint

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“…Its coverage expanded to 77% of Thai and non-Thai deliveries in 92% of government hospitals. 12 The Global AIDS Program (GAP)-Thailand and the US CDC provide technical support to the Thai government. 13 The Perinatal HIV Outcome Monitoring System (PHOMS) program was implemented a year later in 2001 and scaled-up to 191 facilities across 14 provinces in 2004.…”

Section: Monitoring Surveillance and Active Case Managementmentioning

confidence: 99%

“…11 The implementation and expansion of PHIMS, PHOMS and NAPS over the last two decades have allowed the Thai government to identify real-time gaps in service provision, monitor the efficacy of the PMTCT program longitudinally, and make evidenceinformed changes to national PMTCT guidelines. 12,14 Early Infant Diagnosis (EID) involves testing infants born to HIV-positive mothers. Thailand implemented EID in 2006.…”

Section: Monitoring Surveillance and Active Case Managementmentioning

confidence: 99%

Reaching the Hard to Reach in Thailand: Eliminating Mother-To-Child HIV Transmission

Wong

Macikunas

Manduric

et al. 2019

Health Systems & Reform

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Thailand is the first country in the Asia-Pacific region to be validated by the World Health Organization as having eliminated mother-to-child transmission (MTCT) of HIV. The Thai government made health-and specifically addressing the HIV/AIDS crisis-a political priority. The Thailand experience, from the emergence of the HIV/AIDS epidemic in the 1980s through the present, provides an important case study of successful MTCT elimination. To eliminate MTCT requires that health interventions reach those who are hardest to reach: the poorest of the poor, geographically distant and rural, and marginalized. This policy report highlights key factors for successfully reaching the hard to reach in Thailand, including the importance of national public policy as well as investments in health care infrastructure, such as access to antenatal care, the creation of effective monitoring and surveillance systems, and strengthening local health capacity. Increased availability and affordability of antiretroviral therapies was also critical to Thailand's success in addressing MTCT. The Thailand case offers important policy lessons for achieving universal health. This policy report draws on secondary research and key informant interviews in Thailand to highlight factors for success in eliminating MTCT of HIV.

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“…Overall there are scarce data comparing neurodevelopmental outcomes in PHIV and PHEU children from developing countries. Thailand is an upper middle income country with free universal healthcare coverage that reached the World Health Organization's targets for elimination of mother to child transmission of HIV in 2016 . Since 2010, the Thai National Guideline recommends HIV DNA PCR for early infant diagnosis and immediate ART in those infected regardless of symptoms and CD4 + T cell .…”

Section: Introductionmentioning

confidence: 99%

Low risk of neurodevelopmental impairment among perinatally acquired HIV‐infected preschool children who received early antiretroviral treatment in Thailand

et al. 2019

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Introduction Antiretroviral therapy ( ART ) is recommended in perinatally HIV‐infect ed ( PHIV ) infants immediately upon diagnosis. We aimed to compare neurodevelopmental outcomes between PHIV children who initiated ART within 12 months of life and perinatally HIV‐ exposed uninfected ( PHEU ) children and to assess neurodevelopmental outcomes by timing of ART . Methods This prospective cohort study included Thai children aged 12 to 56 months who were assessed with the Mullen Scales of Early Learning ( MSEL ) at enrolment and at 48 weeks. Global Developmental Impairment ( GDI ) was defined as Early Learning Composite ( ELC ) ≤ 70 on the MSEL ; typical developmental pattern was defined as ELC > 70 at both visits. Logistic regression was used to compare prevalence of any GDI . Predictors of changing ELC scores were analysed with generalized estimating equations linear regression model. Results From 2016 to 2017, 50 PHIV (twenty‐seven early ART within three months and twenty‐three standard ART within three to twelve months) and 100 PHEU children were enrolled. Median ( IQR ) age at first assessment was 28 (19 to 41) months. PHIV children had lower age‐relevant Z scores for weight, height and head circumference compared to the PHEU group ( p < 0.05). The prevalence of overall GDI was 18% (95% CI 11 to 27) and 32% (95% CI 20 to 47) in PHEU and PHIV children respectively ( p = 0.06). In subgroup analysis, 22% (95% CI 9 to 42) of early ART PHIV children and 44% (95% CI 23 to 66) of standard ART PHIV children had overall GDI . There was a higher rate of GDI in standard ART PHIV children ( p = 0.01), but not in the early ART group ( p = 0.62) when compared with PHEU children. The standard ART PHIV group demonstrated lower typical developmental pattern than both the early ART P...

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

Cited by 37 publications

References 22 publications

School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

Reaching the Hard to Reach in Thailand: Eliminating Mother-To-Child HIV Transmission

Low risk of neurodevelopmental impairment among perinatally acquired HIV‐infected preschool children who received early antiretroviral treatment in Thailand

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