TARGET ZERO
Taksin Hospital is leading the way for preventing mother- to- child HIV transmission with its care programme
Pitcha* got pregnant when she was 16, and at first, she decided to tell no one about it.
“When I started my antenatal care, I had been pregnant for five months already,” she recalled. “That was kind of late because I was so terrified of telling my mother. One day, she noticed my belly and told me to go to the hospital for a check-up.”
Pitcha signed up for prenatal care at Taksin Hospital in Bangkok. “What was more shocking was that my blood test results showed I am HIV-positive.”
She was overwhelmed by fear and had a panic attack. Doctors and counsellors tried to calm her down. The concern fell not only on her but also towards the baby she was carrying.
Thanks to medical care and medication from a team of specialists, Pitcha’s baby boy came into this world safely and is almost one-and-ahalf years old. The newborn’s HIV test during his first two months turned out negative. Next month, he is due for the last blood test before doctors can declare him HIV-free.
“When the first result showed he was HIV negative, I was so relieved,” said Pitcha. “I’m keeping my fingers crossed that the last result will turn out the same.”
Last month, Thailand was officially certified free of transmission of HIV and syphilis from pregnant mothers to their newborns, making it the first country in Asia to achieve such a milestone. The country sees only a 1.9% rate of mother-to-child HIV transmission. According to World Health Organization (WHO) global guidelines, when the rate of transmission falls below 2%, it considers mother-to-child transmission of HIV to be effectively eliminated.
To give a clearer picture, Thailand saw a sharp drop in the percentage of mother-to-child HIV transmission — from 10.3% in 2003 to 1.9% last year. In 1988, when mother-to-child HIV transmission was first discovered in the country, the rate was 33.3%.
“Those in the 1.9% are two vulnerable groups — migrants and young mums,” said Sirirath Chunnasart, adolescent HIV/Aids officer for Unicef.
“Even though migrants can access the free healthcare system, they might still be worried that they might have to disclose their identities going to hospitals. That’s why some are afraid to come for check-ups, which is why HIV or other diseases are only detected at the time of child birth and it’s too late sometimes.
“The more we can address this human rights issue, the higher chance to bring the transmission rate to zero.
“Another target group is young mothers who often lack general understanding about pregnancy. They’re also anxious about being pregnant, which makes them reluctant to come for health checks.”
Taksin Hospital is one of the state hospitals that has a strong care guidelines and demonstrates good execution when it comes to caring for HIV-infected pregnant women.
“The earlier they come to see us, the higher chance that both mother and baby can be saved,” said Dr Kanokorn Sukonthaman, an obstetrician at Taksin Hospital.
Upon registering for antenatal care, pregnant women are enrolled at the hospital’s prenatal school to be given basic knowledge about the importance of blood checks before the actual blood check, which is compulsory.
At the hospital, HIV-infected pregnant patients will be attended by three departments — obstetrics and gynaecology, infectious medicine and paediatrics.
Five years ago, only the mothers — not the fathers — were asked to have their blood tested, and those diagnosed with HIV were provided with medication. Back then, only one type of medicine was prescribed, which decreased the transmission rate from 30% to 10%. But after new medicines became available, Taksin Hospital was chosen as a pilot to prescribe the new drugs.
Fortunately, the new medicine seems to be effective in diminishing transmission rate. But the hospital aims to improve — to get to zero. Couple counselling therefore, became another approach.
“We encourage fathers to join the antenatal care, too,” said Dr Kanokorn. “First, we inform them how the parents’ blood could have an effect on their kids. Then, the test which is conducted on each parent will not only detect HIV but also thalassaemia.”
In the first year, 50% of antenatal care patients signed up for couple counselling. Thirteen discordant couples — those where one partner is HIV-positive and the other is not — were found.
Dr Kanokorn said that if the father is HIV-positive and the mother is not, chances that the virus will be transmitted to mothers through sexual intercourse during pregnancy were still high. Thus, knowing a father’s blood results is to reduce the newborn’s risk of getting the disease.
“The faster we find them, the higher chance the viral load is likely to be dropped, and the less risk their kids would have to take,” said Dr Supunnee Jirajariyavej, an infectious diseases physician.
The delivery process for HIV-infected mothers is also attended closely. Before giving birth, blood results are an important variable for a doctor’s consideration whether the mother would be able to give birth naturally or via a caesarean section.
“If the viral load is high, mothers should give birth by caesarean to avoid the newborn contacting their blood,” said Dr Kanokorn.
Paediatrician Dr Sunsanee Chatpornvorarux explained that in high-risk cases, blood checks on children need to be done from when the child is delivered to 18 months. Some babies will also be prescribed medication.
“Before the first breastfeeding, we need to double check the mother’s blood results,” added Dr Sunsanee. “If we see risks, breastfeeding will be retained as their kids could get infected through the milk.”
Vanaree* is another success story in cutting the risk of HIV mother-to-child transmission.
“My husband and I have been HIV-positive for quite some time,” said Vanaree. “Despite regular HIV treatment, we still thought having a child was out of the question. But one day a nurse asked me if I wanted to have a kid. I was quite surprised that it would be possible.”
Vanaree went to the Thai Red Cross’s HIV Anonymous Clinic, as suggested by Taksin Hospital staff, to get a consultation on being HIV-positive and becoming pregnant with the lowest risks. She then followed the protocol at Taksin Hospital.
“It’s great how people with HIV can now have kids who are not infected. Now, we can build a happy family, just like others,” said Vanaree.
“Now there is a way for them and it’s not that big deal for people with HIV to have kids,” Dr Supunnee said. “If the virus can be controlled, people with HIV can live their life normally. Before, the picture of creating their own family was so blurry but with medication and more accurate information available, they can be ensured of a good life, too.
“If they are ready, HIV shouldn’t be a problem as long as they follow advice strictly and constantly get treated.
“If the transmission from mothers to kids can be controlled, it means there will also be less HIV-infected patients in the future. Moreover, if we could bring all people with HIV to the system and help them, we could lower the chances of them spreading the virus to others.”
(* not their real names)
We encourage fathers to join the antenatal care, too