Big drop in mother-to-child HIV transmission

Today there are 34 cases of vertical transmission of mother-to-child HIV in the country

Health: Bhutan recorded a huge drop in cases of mother-to-child transmission of HIV since the initiation of the prevention of mother-to-child transmission (PMTCT) of HIV programme in 2006.

Records with the National AIDs Control Programme (NACP) under the public health department show that there are 34 cases of vertical transmission of mother-to-child HIV today.

According to NACP officials there have been significant developments in the areas of prevention for mother-to-child transmission of HIV globally.

Similarly, Bhutan also follows the World Health Organisation’s (WHO) recommendation in the implementation of the PMTCT programme. Officials said that since the initiation of the programme in Bhutan, the national PMTCT guideline was revised thrice embracing the best practices and learning from other countries especially Thailand and recommendations from a series of clinical trail studies and case studies that WHO endorsed.

“Since then, Bhutan has seen a drastic fall in the cases of mother-to-child transmission of HIV,” NACP’s progamme manager Namgay Tshering said.

Thailand is the first country in Asia and the Pacific region to eliminate mother to child transmission of HIV and syphilis. Thailand received the certificate of validation from WHO in June this year.

WHO’s medical officer for health systems strengthening, Dr Suraj M Shrestha, said that the organisation has been supporting the health ministry to prevent PMTCT in various areas. It includes providing technical assistance to develop national strategic plans, development of guidelines for prevention and management of HIV/AIDS patients, strengthening laboratory diagnostic facilities for effective management of opportunistic infections and developing capacity of health staff of the maternal and child health programme.

NACP officials said that Bhutan currently adopts option B+ treatment and management for every pregnant woman diagnosed with the HIV virus, meaning every pregnant women is put on a triple drug therapy for life irrespective of their CD4 count. Earlier, life-long treatment for pregnant women with HIV was initiated, only if their CD4 count fell below the cut-off point.

However, officials said after learning of the benefits of earlier initiation of anti-retroviral treatment, Bhutan adopted the WHO recommendation for treating all pregnant women with the HIV virus irrespective of the CD4 count.

Bhutan pledged to eliminate mother-to-child transmission of HIV by 2020 during the World AIDS Day observation on December 1, 2012 given the importance of the PMTCT programme in Bhutan.

PMTCT has also been selected as one of the key indicators of the health ministry’s Annual Performance Agreement.

“HIV and STIs screening facilities were introduced at the BHU level in 2013 and today all antenatal care (ANC) attendees are offered HIV and STIs screening during their routine ANC visits,” Namgay Tshering said. “As of today coverage of HIV and STIs screening in pregnant women nationwide is less than 90 percent.”

Despite the progress, challenges remain. NACP officials said with the increased availability of contraception methods, condom use was substantially low going by reports from health centres. A key challenge that the ministry faces is tracking pregnant women for follow-up interventions and also poor compliance.

Low level of comprehensive knowledge on HIV/AIDS in the general population (15-49 years of age), not all line-listed pregnant women attending antenatal care on time and late diagnosis of cases is reducing the efficacy of the treatment interventions to avert transmission, although rare in Bhutan.

As of June 7, there are 492 cases of HIV/AIDS reported in the country of which 252 are male and 240 female. About 88 percent of the cases are mostly concentrated among the younger age group of 20-49 years. Five percent of the total reported cases are above 50 years of age including one who is 74 years and recently diagnosed through routine medical screening.

As of today, 34 cases of mother-to-child transmission have been reported and 90 percent of the total reported cases are attributable to unsafe sexual practices followed by eight mother-to-child transmissions.

Health officials said that contact tracing followed by routine medical screening and voluntary counseling and testing are the predominant modes of HIV diagnosis.

In all, there are 386 people living with the HIV virus currently including 19 non-Bhutanese who have left the country and a Bhutanese living outside the country. There were 86 deaths while 250 people have been enrolled on life-long ART of which 29 have died while on treatment.

Meanwhile, health ministry officials said that from this year onwards, Bhutan would adopt the policy for treating all HIV positive individuals irrespective of their CD4 count. In addition, Bhutan will also be implementing TasP (treatment as prevention interventions) for key affected population groups based on their vulnerability status. For instance TasP will be initiated for sero-discordant couples, female sex workers, MSM and transgender and for the clients of sex workers, among others.

This, according to health officials, is expected to bring phenomenal change in terms of achieving the UNAIDS set target of 90-90-90, meaning 90 percent of people know their HIV status; 90 percent of those infected are put on treatment and 90 percent of those on treatment has achieved viral suppression.

WHO officials said that prevention of transmission of HIV from mother-to-child is of high priority for the country. “As today, we have diagnostic and therapeutic means to achieve zero pediatric HIV in alignment with global and regional strategies,” Dr Suraj M Shrestha said.

Dr Suraj M Shrestha also said that expansion and establishment of HIV counseling and testing centres and scaling-up of HIV rapid diagnostic testing facilities in all basic health units has been implemented to ensure that all women who are HIV positive are identified and managed early to prevent child transmission.

Kinga Dema

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