"In Thailand, we started prioritising the prevention of mother-to-child HIV transmission about 20 years ago," says DanaiTeewanda, deputy director-general of the Department of Health at the Public Health Ministry.
"Staff in the public sector received continuous training from basic counselling skills to providing a treatment regimen," he said earlier this year
The country was recently certified by the World Health Organization (WHO) to have exceeded all its global guidelines for being free of parent-to-child transmission of HIV and syphilis.
The WHO guidelines include a mother-to-child transmission rate (MTCT)of no more than 5% in the breastfeeding[T1] population and 2% in the non-breastfeeding population, but the rate in Thailand is now just above 1%.
That compares with 32% in Indonesia, 11% in Vietnam, 14% in Myanmar and 16% in Cambodia. Thailand is the first country in the region to achieve a level of below 2%, the point at which the WHO considers mother-to-child transmission "effectively eliminated".
Thailand's universal healthcare programme has been a big contributor[T2] to the success story, but public health officials want to do even better. Their goal is to bring the MTCT rate below 1% and make Thailand mother-to-child HIV transmission-free.
Mukta Sharma, a WHO technical officer, offers four reasons for Thailand's success. First, the government has shown a strong commitment to reduce the risk rate to a number that is considered safe enoughfor a non-breastfeeding population such as Thailand, at 1.9%.
Second, the National Health Office provides a large budget for treating mothers and children with HIV, allowing for high-quality diagnosis[T3] and free antiretroviral [T4] treatment. "The cost of antiretroviral treatment in Thailand is much lower than in other countries," said Dr Sharma.
Some other countries have also seen significant successes in reducing costs in recent years. The price of medicines to prevent mother-to-child transmission[T5] of HIV fell from US$800 in 2011 to below
Third, the Public Health Ministry has very good data providing comprehensive[T6] information on the condition of HIV patients, including risk rates and risk factors, making it easy to follow up and treat problemsat the right point.
Finally, Dr Sharma said, a strong maternal and child health programme provides HIV screening and treatment to nearly all pregnant mothers and follow-ups on both mother and child. The programmeoperates[T7] in conjunction with a high-technology Perinatal HIV Intervention Monitoring System (PHIMS), a patient tracking system to monitor all pregnant women and all women who are HIV positive.
"With this technology they can monitor older cases of people living with HIV and provide them with the basic care," she said. "They can find out how things are progressing[T8] , such as the patients' condition, and make sure no one has been overlooked[T9] ."
As the political commitment to eliminating HIV/Aids is very high, the service is also provided to migrants living in Thailand.
Figures from Elimination of Parent-to-Child Transmission of Asia Pacific (EPTCT) show that Thailand has met the indicator for providing adequate[T10] coverage of HIV testing for pregnant women in the country at 95%. .
Vietnam is also making good progress with a coverage rate of 87%. The rate is 76% in Cambodia and 61% in Malaysia, but in Indonesia it is just 2%.
"If you only have free medications and nobody comes to you, it's not helpful. So what they do [in Thailand] is they screen nearly all pregnant women and once they find somebody with HIV, then they provide the drugs free," said Dr Sharma. "After that, they monitor the patients and their children to keep track of them to ensure both are doing well or to check if they need more treatment, which is ready to be provided.
"In other countries in the region, I think they don't have a very good system for reaching out to people but in Thailand we have a very good health system. It's easier for people at all levels to access services."
Overall HIV-related statistics in Asia Pacific are also declining, according to data published by UNAIDS earlier this year.
Between 2010 and 2015, the number of Aids-related deaths decreased by 24% and new HIV infections among children declined by 26%.
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