Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand.
In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.
a Faculty of Medicine, Department of Paediatrics , Chulalongkorn University , Bangkok , Thailand.
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Thisyakorn
D003140:Communicable Disease Control / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D013785:Thailand / Q000453:epidemiology
AEM, Asian Epidemic Model; ANC, antenatal care; ART, anti-retroviral therapy; Asian epidemic model; CDC, communicable disease control; CMR, child mortality rate; EID, early infant diagnosis; EPP, Estimation and Projection Package; FSW, female commercial sex worker; HAART, highly active anti-retroviral therapy; HIV; HSM, heterosexual men; IDU, intravenous drug users; MOPH, Ministry of Public Health; NGO, non-government organisation; PACTG, Paediatric AIDS Clinical Trials Group; PCR, polymerase chain reaction; PHIMS, Perinatal HIV Intervention Monitoring System; PHOMS, Perinatal HIV Outcome Monitoring System; PLWHA, people living with HIV/AIDS; PROM, premature rupture of membranes; STI, sexually transmitted infection; TDR, triple-drug regimen; TRCS, Thai Red Cross Society; Thailand; WLWHA, women living with HIV/AIDS; elimination; mother-to-child; policy; transmission; vertical