#AIDS2016 | @AIDS_conference

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

20 July 2016Durban, South Africa

Dr. Sarawut Boonsuk

Chief of Maternal and Child Health,

Department of Health, Thailand

#AIDS2016 | @AIDS_conference

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

#AIDS2016 | @AIDS_conference

Health Service Delivery System in Thailand

Health centers9,892 #

Municipality Medical Centers

486 #

District hospitals780 # (714*)

Provincial/General hospitals 83 # (83*)

Private clinics6,421 #

Other Public Hospitals116 # (34*)

Private Hospitals

342 #

(164*)

Regional hospitals 33# (33*)

Other MoPHhospitals 57# (13*)

MOPH Facilities

Sub-district

District

Province

Source: 1. Thailand Health Profile: MOPH Calendar 20162. #Number of health service facilities3. * Number of facilities providing delivery services: source Bureau of Policy and

Strategy, MoPH: http://www.hrm.moph.go.th/healthmap/gmap.php#result

Other Gov’t Facilities

Private Facilities

(137 # (55*) hos)(953# (843*) hos)

Pharmacy

14,576 #

University Hospitals 21 #

(21*)

#AIDS2016 | @AIDS_conference

Thai National PMTCT Policy Evolution

2000 2004 2005 2007 2010 2014

PMTCT infant AZT x 4 wks

AZT x 4 wksorAZT/3TC 6 wks

+NVP 2-4 wks

AZT x 4 wks orAZT/3TC/NVP 6 wks

PMTCTPregnant women Short course

AZT(34 wks)

AZT 28 wks+ NVP 1 dose

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

AZT 28 wks+ NVP 1 dose and HAART for eligible women

VCT/PITC

Couples HIV testing and counselingVCT

Infant formula (12 mo) - Infant formula (18 mo)Infant feeding

DNA PCR (2 times)

- HIV antibody at 12-18 months

Early infant diagnosis DNA PCR based on risk

of MTCT

1993-2000 VCT and infant formula x 12 mo

#AIDS2016 | @AIDS_conference

Goal for Elimination Mother-to-Child HIV Transmission, in Thailand by 2016

1. 50% reduction in number of new pediatric HIV infection

2. 50% reduction of AIDS mortality rate among HIV+

mothers and babies

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

Reduction of new HIV infection among women

15-45 years for 2/3 of estimated number

Reduction of unmet family planning

need to zero

Reduce MTCT rate to < 2%

95% of HIV+mothersand family refer to treatment and care

Prong 1 target

Prong 2target

Prong 3target

Prong4target

sarawut boonsuk DOH,MOPH 2012

#AIDS2016 | @AIDS_conference

HIV MTCT Rates (GARP report 2008-2015)

4.6

3.93.4

3.12.7 2.3 2.1

2.3 2 1.9

0

1

2

3

4

5

2008 2009 2010 2011 2012 2013 2014 2015

National adjusted MTCT rate

SPECTRUM v. 5.4

(2013-2015 used SPECTRUM data)

0.0

0.7 0.71.0 1.0

1.4 1.51.8

1.6

2.3

1.81.7

1.51.7

1.5 1.4 1.41.2 1.1

0.9 0.9 0.80.7 0.6 0.6 0.6

0

1

2

3

4

5

6Sentinel

PHIMS-ANC

PHIMS-No ANC

Sources: serosentinel surveillance, BoE PHIMS, Department of Health

HIV Prevalence in Pregnant Women by ANC Status

15

#AIDS2016 | @AIDS_conference

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

#AIDS2016 | @AIDS_conference

#AIDS2016 | @AIDS_conference

Partnerships for EMTCT of HIV/SY Thailand

#AIDS2016 | @AIDS_conference

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

#AIDS2016 | @AIDS_conference

#AIDS2016 | @AIDS_conference

Acknowledgements• 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

• All hospitals submitted PMTCT reports and implemented PMTCT services

• Members of the

– National validation committee

– EMTCT working groups

• Global AIDS Program Thailand/Asia Regional office• Dr. Rangsima Lolekha• Ms. Benjamas Baipluthong• Dr. Chonticha Kittinunvorakoon• Dr. Michael Martin• Dr. Thierry Roels

• UNICEF Thailand and UNICEF EPRO• Dr. Beena Kuttparambil• Ms. Wing-Sie Cheng

• NGOs and human right working group• Dr. Suchada Taweesith• Ms. Sulaiporn Chonwilai

• UNAIDS Thailand• Ms. Tatiana Shommulan• Dr. Patchara Benjarattanaporn• Mr. Sompong Chareonsuk

• WHO Thailand and SEARO• Dr. Mukta Sharma• Dr. Razia Narayan Pendse

• NHSO, SSS, CSMB, and BPS• Dr. Suchada Chaiwut

#AIDS2016 | @AIDS_conference