Thailand has become the first Asian country to eliminate mother-to-child transmission (MTCT) of HIV, thanks to a pragmatic multi-sector response backed by strong political commitment and heavy government investment, a study published in Paediatrics and International Child Health reports.
Such an early, concerted response allowed the country to successfully address the four prongs of the recommended World Health Organization (WHO) elimination strategy. As a result, MTCT rates were reduced from 20-40% in the mid-1990s to 1.9% in 2015 (surpassing the WHO elimination target of <2%).
The WHO strategy focuses on the following four prongs: primary prevention of HIV in women of childbearing age; prevention of unintended pregnancies in women living with HIV; prevention of HIV transmission from an HIV-infected woman to her infant; and provision of appropriate treatment, care and support to women and children living with HIV.
In Thailand, initiatives to promote condom use, provide information about the risk of transmission and introduce testing for pregnant and post-partum women were successfully implemented. For example, the 100% Condom Programme, which promotes 100% condom use by male patrons of commercial sex workers, has played a crucial role in preventing HIV infection in women of reproductive age.
The success of such initiatives resulted in part from strong political leadership - the national AIDS policy of Thailand was transferred from the Ministry of Public Health to the Office of the Prime Minister in 1991 - and greatly increased investment, with government spending on the HIV/AIDS programme rising from US$684,000 in 1988 to US$82 million by 1997.
The high rate of antenatal care provision in Thailand is also key. A voluntary HIV test with same-day results is offered at the first clinic visit, followed by re-testing later in pregnancy for HIV-negative women. For HIV-infected pregnant women, antiretroviral therapy (ART) is provided as soon as possible. Such treatment is now available at much lower cost, thanks to legislative changes which have allowed the non-commercial production of generic ART in Thailand. Counselling services at antenatal clinics also promote the use of dual methods of contraception to prevent unintended pregnancy in women with HIV.
The study's author, Professor Usa Thisyakorn of Chulalongkorn University, Bangkok said: "Thailand has achieved WHO elimination of mother-to-child HIV transmission targets with early and concerted efforts of all sectors of Thai society. This provided numerous lessons learned in working together to safeguard children. Since children are the country's future, how the country responds to the problems created for them indicates how highly the country values its future."
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Paediatrics and International Child Health, DOI: 10.1080/20469047.2017.1281873