Elimination of Mother-to-Child Transmission of HIV, Examples of Success from Thailand

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1 Elimination of Mother-to-Child Transmission of HIV, Examples of Success from Thailand 20 July 2016 Durban, South Africa Dr. Sarawut Boonsuk Chief of Maternal and Child Health, Department of Health, Thailand

2 Outlines Performance of the PMTCT program in Thailand Overview of PMTCT of HIV and syphilis program o Roles and responsibilities of MOPH and others at national and sub national level o How the program is resourced and monitored Main challenges and ways forward

3 Health Service Delivery System in Thailand MOPH Facilities Other Gov t Facilities Private Facilities Province District Regional hospitals 33 # (33*) Other MoPH hospitals 57 # (13*) Provincial/General hospitals 83 # (83*) District hospitals 780 # (714*) (953 # (843*) hos) University Hospitals 21 # (21*) Other Public Hospitals 116 # (34*) (137 # (55*) hos) Private Hospitals 342 # (164*) Sub-district Health centers 9,892 # Municipality Medical Centers 486 # Private clinics 6,421 # Source: 1. Thailand Health Profile: MOPH Calendar #Number of health service facilities 3. * Number of facilities providing delivery services: source Bureau of Policy and Strategy, MoPH: Pharmac y 14,576 #

4 Thai National PMTCT Policy Evolution Early infant diagnosis - HIV antibody at months DNA PCR (2 times) DNA PCR based on risk of MTCT Infant feeding Infant formula (12 mo) - Infant formula (18 mo) PMTCT infant AZT x 4 wks AZT x 4 wks or AZT/3TC 6 wks +NVP 2-4 wks AZT x 4 wks or AZT/3TC/NVP 6 wks PMTCT Pregnant women Short course AZT (34 wks) AZT 28 wks+ NVP 1 dose AZT 28 wks+ NVP 1 dose and HAART for eligible women HAART for all pregnant women (14 wks) and continue for eligible women HAART for all ASAP and continue HAART for all who are willing to take ART VCT VCT/PITC Couples HIV testing and counseling #AIDS2016 VCT and infant formula x 12 mo

5 Goal for Elimination Mother-to-Child HIV Transmission, in Thailand by 2016 Prong 1 target 1. 50% reduction in number of new pediatric HIV infection 2. 50% reduction of AIDS mortality rate among HIV+ mothers and babies Prong 2 target Prong 3 target 50% reduction of AIDS mortality in children -Promote early infant diagnosis -Early access to Rx and care -Improve quality of pediatric HIV treatment, promote ARV adherence and reduce complication Prong4 target Reduction of new HIV infection among women years for 2/3 of estimated number Reduction of unmet family planning need to zero Reduce MTCT rate to < 2% 95% of HIV+mothers and family refer to treatment and care sarawut boonsuk DOH,MOPH 2012

6 HIV MTCT Rates (GARP report ) National adjusted MTCT rate SPECTRUM v. 5.4 ( used SPECTRUM data) HIV Prevalence in Pregnant Women by ANC Status Sentinel PHIMS-ANC PHIMS-No ANC Sources: serosentinel surveillance, BoE PHIMS, Department of Health 15

7 The Thai government provides most of the budget for PMTCT of HIV (>90%) National spending for PMTCT in 2008 was 4.4 million USD, declining to 2.3 million USD in 2013 NASA 2014

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9 Partnerships for EMTCT of HIV/SY Thailand

10 Conclusions: Success and Sustainability of EMTCT of HIV and Syphilis in Thailand National ownership and leadership Sustained political commitment A favorable legal and policy environment A well-developed national health system The consistent strengthening of its building blocks Enhancement of community systems The strengthening of community interface with health systems

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12 Acknowledgements All hospitals submitted PMTCT reports and implemented PMTCT services Members of the National validation committee EMTCT working groups NHSO, SSS, CSMB, and BPS Dr. Suchada Chaiwut Global AIDS Program Thailand/Asia Regional office Dr. Rangsima Lolekha Ms. Benjamas Baipluthong Dr. Chonticha Kittinunvorakoon Dr. Michael Martin Dr. Thierry Roels WHO Thailand and SEARO Dr. Mukta Sharma Dr. Razia Narayan Pendse UNICEF Thailand and UNICEF EPRO Dr. Beena Kuttparambil Ms. Wing-Sie Cheng Department of Health Dr. Danai Teewanda Dr. Sarawut Boonsuk Ms. Chaweewan Tondputsa Department of Medical Science Dr. Busarawan Sriwantana Ms. Hansa Thaisri Department of Diseases Control Dr. Petchsri Sirinirund Dr. Sumet Ongwandee Dr. Nisit Kongkergkiat Thai red cross AIDS research center Dr. Praphan Phanuphak NGOs and human right working group Dr. Suchada Taweesith Ms. Sulaiporn Chonwilai UNAIDS Thailand Ms. Tatiana Shommulan Dr. Patchara Benjarattanaporn Mr. Sompong Chareonsuk

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