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“Getting to Zero: Thailand’s Experience with E-MTCT”. THAILAND. Petchsri Sirinirund Advisor on HIV/AIDS Policy and Programme Department of Disease Control, Thailand

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“Getting to Zero: Thailand’s Experience with E-MTCT”

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    1. “Getting to Zero: Thailand’s Experience with E-MTCT” THAILAND PetchsriSirinirund Advisor on HIV/AIDS Policy and Programme Department of Disease Control, Thailand Validating the Elimination of Mother-to-Child Transmission has been Achieved:  What is the Global Criteria and Current Regional and Country Status? Satellite session sponsored by UNICEF and WHO, 21 July 2014 The 20thInternational AIDS Conference, Melbourne

    2. Presentation Overview • E-MTCT - component of the national plan to end AIDS • Progress towards E-MTCT in Thailand • Estimation of MTCT rates • Thailand’s approach to E-MTCT THAILAND

    3. "Ending AIDS” • Certain number of new HIV infections per year <1,000 cases (90% reduction) • Mother to child transmission is virtually eliminated • All PLHIV receive ART at early stage for their quality of life as well as prevention of transmission to partners • AIDS is accepted by society as a chronic medical condition THAILAND

    4. Progress toward e-mtct THAILAND

    5. Option B and B+ for subpopulations National PMTCT Policy in Thailand B+ for CD4<500 serodiscordant couples, coinfection of TB, HBV, HCV Option B CD4<350 HAART for all HIV-infected pregnant women and couples counseling Option A • HAART for mother (CD4<200,symptoms) during ANC • -Tail regimen (AZT+3TC) • DNA PCR for infant diagnosis • Formula feeding (18 months) • New PMTCT policy (AZT (28wks) +SD NVP) • CD4 antepartum and every 6 mos • Care for partners and family National PMTCT policy -Short course AZT (34 wks) -VCT -Formula feeding (12 mos) -HIV testing for infants born to HIV+mother 2000 2002 2004 2006 2008 2010 2012 2013 Prepared by RangsimaLolekha, TUC, 2013

    6. Thailand PMTCT Program Coverage 2013 Mother: ARV prophylaxis coverage Newborn: ARV prophylaxis coverage HIV testing coverage in women giving birth • Estimated 804,484 deliveries • Nearly all Thai pregnant women attending ANC (93.7% for non Thai) • HIV prevalence among pregnant women =0.7% Source: 2014 Thailand AIDS Response Report (Department of Health: PHIMS) Updated from slide prepared by RangsimaLolekha, TUC, 2013

    7. Key Indicators THAILAND

    8. Estimation of MTCT rates THAILAND

    9. Estimation of MTCT rates • Calculate number of HIV+ve mothers from percentages got from program reports • ANC rates • HIV+ve rates among ANC / non ANC • Calculate percentages of HIV+ve mothers receiving ARV from percentages got from program reports • No ARV, each regimen • Multiply calculated percentages of HIV+ve mothers not receiving and receiving ARV with MTCT rate got from the survey THAILAND

    10. 2733 women with HIV were reviewed 1779 (63%) infants had HIV outcomes (Yr 2008-2011) THAILAND

    11. THAILAND

    12. To improve the validity of the calculation of MTCT rates • Real time monitoring • Only for HIV+ve pregnant women • Pilot test on using LINE application • Develop specific application • Monitored by hospitals and the Department of Health • Using as an alert system THAILAND

    13. Thailand’s approach to e-mtct

    14. Key interventions for ending AIDS • Extend combination prevention (BCC and HTC) to cover 90% of key populations • Treat all PLHIV early at any CD4 level (Option B+ for PMTCT) • Support ARV adherence • Adapt data management towards strengthened case management and retention of individuals in care • Normalize HIV THAILAND

    15. Elimination of MTCT – Global criteria Impact indicators • ≤ 50 new pediatric HIV cases per 100,000 live births and (Thailand ≤ 400 cases ) • < 2% MTCT rate Process indicators (2 out of 3) • ≥ 95% ANC coverage at least 1 visit • ≥ 95% HIV testing of pregnant women • ≥ 90% ART coverage of HIV - positive pregnant women THAILAND

    16. E-MTCT in National Operational Plan to end AIDS, 2015-2019 • Encourage and support provinces to achieve respective E-MTCT targets • Data by province • Data by hospitals in each province • Thai and non Thai • Active case management of exposed and infected infants • ANC through testing for babies and ART initiation for positive children THAILAND

    17. Sub-national targets THAILAND

    18. Sub-national targets - 2 THAILAND

    19. Challenges for EMTCT • Late ANC, particularly for known HIV+ cases • Late ART initiation for HIV+ infants • Limited insurance for Non-Thai families • Strategic information (separate databases, under reported services, particularly from university and private hospitals) THAILAND

    20. Thank you • Hospitals and provincial health offices • Department of Health: Bureau of Health Promotion • Thailand MOPH-US CDC Collaboration (TUC) • Department of Disease Control: National AIDS Management Center • UNICEF THAILAND