Majority of HIV-Infected Mothers and At-Risk Newborns Receive ZDV Treatment in Groundbreaking Thailand Prevention Program
BARCELONA, Spain - In the first year of Thailand's national program to prevent mother-to-child (perinatal) HIV transmission, more than two-thirds of HIV-infected expectant mothers who had prenatal care also received short-course zidovudine (ZDV) to prevent HIV transmission to their newborns, and nearly nine in 10 infants at risk of infection received prophylactic ZDV treatment after birth. The program is the first to be implemented nationwide in a developing country, and has reached more than 500,000 pregnant women to date.
The program, which has broad implications for the prevention of perinatal HIV transmission in developing countries, is highlighted in this week's special HIV/AIDS theme issue of the Journal of the American Medical association. The article, titled "Preventing Mother-to-Child HIV Transmission: The First Year of Thailand's National Program," is authored by the Thai Ministry of Public Health and the Centers for Disease Control and Prevention (CDC).
"The level of success achieved by this program represents a major victory in Thailand's efforts to reduce the devastating impact of HIV on our children," said Pornsinee Amornwichet of the Thai Ministry of Public Health and lead author of the report on this national program.
While cautioning that some developing countries may not have certain favorable conditions that facilitated the program's implementation in Thailand, the authors suggested that the program offers a model for implementing and monitoring national perinatal HIV prevention efforts, and should encourage other developing countries to develop and expand approaches appropriate to their circumstances.
Under the Thai initiative, 97 percent of the 573,655 women giving birth from October 2000 through September 2001 received prenatal care, with more than nine in 10 of the women tested for HIV, and 69 percent of the 6,646 HIV-infected women receiving ZDV. For women who were not tested in prenatal care, rapid testing at the time of birth helped identify additional infections so that preventive interventions could be provided. Overall, 5,682 infants received ZDV - 88 percent of all newborns of infected mothers. In addition, more than four in five of the at-risk infants received formula from the program to prevent infection through breast milk from HIV-infected mothers.
According to the authors, the impact of the program on preventing newborn infections is not yet known, but they expect results to be in line with two regional pilot programs in which the rate of mother-to-infant HIV transmission was reduced by more than half.
Study authors credit a number of conditions in Thailand that facilitated the program's successful implementation - some of which are not present in sub-Saharan African countries with high rates of mother-to-child infection. Most babies in Thailand are delivered in health facilities, the vast majority with established prenatal care systems, and the country's clean water enables healthier births and the use of infant formula to replace breastfeeding. In addition, the Thai government was able to independently fund much of the program.
"While the challenges will vary from country to country, we hope that the successes seen in Thailand can be extended to women and infants throughout the world," stated Eugene McCray, M.D., director of CDC's global AIDS programs.