First Asian Country Eliminates Mother-to-Child HIV Transmission

It was just in December 2016 when the United Kingdom and Ireland announced record low rates of perinatal HIV transmissions. Now, Thailand is celebrating even better news.

Political commitment and heavy government investment are being credited for mother-to-child HIV transmission being eliminated in Thailand. Country officials also concentrated four prongs recommended by the World Health Organization (WHO):

• 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
• Provision of appropriate treatment, care, and support to women and children living with HIV

Medications have made an irreplaceable impact on perinatal transmission. As long as a pregnant woman with HIV takes antiretroviral therapy (ART) during pregnancy, labor, and delivery and the baby receives medication for four to six weeks, transmission risk can be 1% or less.

“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,” study author, Usa Thisyakorn, MD, a professor at Chulalongkorn University in Bangkok, Thailand, said in a news release.

In the mid-1990s, HIV infection was prevalent in 2% of pregnant women in Thailand. By 2015, that statistic dropped to 0.6%. Following suit, mother-to-child transmission reduced between those two periods—between 20% and 40% to 1.9%. The WHO’s elimination target is <2%, so Thailand is the first Asian country to hit, and surpass, that goal.

Other countries are making progress in HIV elimination as well. The United Nations Programme on HIV/AIDS (UNAIDS) developed the 90-90-90 concept to address three goals by 2020. Those goals, set forth in 2014, are: 90% of people with HIV will know their status, 90% of people diagnosed with HIV will receive sustained antiretroviral therapy (ART), and 90% of people receiving ART will achieve viral suppression. Researchers from Columbia University and the Centers for Disease Control and Prevention (CDC) found that progress towards those goals were made in Zimbabwe, Malawi, and Zambia.

Various Thai initiatives contributed to HIV elimination. Low condom usage in the 1980s and 1990s led to a national promotion of the contraceptive among sex workers. For HIV-positive pregnant women, a decision-analysis model was put into place to help women measure their risk of transmitting the virus to their baby via breastfeeding. In addition, the Thai Red Cross implemented a donation program to get zidovudine (branded as Retrovir in the United States) to pregnant women and newborns.

“Thailand has achieved WHO elimination of mother-to-child HIV transmission targets with early concerted efforts of all sectors of Thai society,” Thisyakorn concluded. “This provided numerous lessons learned in working together to safeguard children.”

The study, “Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand,” was published in the journal Paediatrics and International Child Health. The news release was provided by the Taylor & Francis Group.

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