Communicable diseases department (CDS)
Comment
Thailand eliminates mother-to-child transmission of HIV
and syphilis
Associated Press
Published Online
June 8, 2016
http://dx.doi.org/10.1016/
S0140-6736(16)30787-5
2488
On June 7, 2016, WHO certified that Thailand had
eliminated mother-to-child transmission of HIV and
syphilis, becoming only the second non-Organisation
for Economic Co-operation and Development country
after Cuba to achieve these goals.1–3 WHO also validated
Belarus for eliminating mother-to-child transmission of
both HIV and syphilis on June 8.4 This is not only a public
health success story for Thailand, but also an affirmation
of how internationally agreed aspirational goals—from
WHO’s Health for All by 2000 campaign and the UN’s
2001 Declaration of Commitment on HIV/AIDS to the
Millennium Development Goals and the Sustainable
Development Goals—can help health ministries to
mobilise political will, public funds, and committed
implementation.
Thailand’s commitment to address mother-tochild transmission of HIV started in the 1980s, when
the spread of AIDS began to accelerate. The country’s
first steps were to provide family education and premarital counselling, encouraging couples to be tested
for HIV before having children. In 1990–91, some large
hospitals started routine screening for HIV in antenatal
clinics to protect health workers in the absence of
effective interventions.1
The Government of Thailand’s concern about motherto-child transmission intensified as the epidemic
worsened. By 1995, national HIV antenatal prevalence
had peaked at 2·3%, the highest ever recorded in Asia.5
However, at that time the high cost of antiretroviral
treatment with zidovudine and technical capacity
constraints prevented large-scale provision of
zidovudine within the national programme. But by
1998, domestic research trials and pilot programmes
undertaken by the government in collaboration with
WHO, UNAIDS, the US Centers for Disease Control and
Prevention, and other partners confirmed that the
use of short-course zidovudine could cut the risks of
mother-to-child transmission by half.2 Thailand then
began a countrywide programme that provided shortcourse zidovudine as a routine part of antenatal care,
tripled the budget for prevention of mother-to-child
transmission (PMTCT) services, and lowered costs by
manufacturing generic versions of zidovudine locally.
Coverage expanded rapidly, so much so that by
2001, two in three pregnant women were covered
by PMTCT services.6 In that year, the government
guaranteed universal access to PMTCT services,
integrating these into the new universal health
coverage scheme.6 Consequently, by 2009, 94% of
pregnant women were counselled and tested for
HIV, 94% of HIV-positive pregnant women received
antiretrovirals, and an estimated 62% to more than
95% of infants born to HIV-infected women received
antiretroviral prophylaxis for PMTCT.7 In 2015,
99·6% of infants born to HIV-positive mothers in
Thailand received antiretroviral prophylaxis.1 In 2011,
Thailand committed itself to the Global Plan Towards
the Elimination of New HIV Infections Among
Children by 2015 and Keeping their Mothers Alive.8
The government’s decision to provide all pregnant
women—including migrant workers, in whom
substantially higher antenatal rates of HIV have been
recorded9—free antenatal care, delivery, and PMTCT
services for HIV and syphilis pushed coverage rates
higher. This concerted action culminated in Thailand’s
certification of elimination on June 7.
WHO and UNAIDS estimate that Thailand’s efforts on
PMTCT prevented nearly 17 000 new HIV infections in
infants between 2000 and 2015.1 In 2015, for instance,
85 infants contracted HIV rather than the 1076 who
www.thelancet.com Vol 387 June 18, 2016
Comment
would have been expected to contract HIV if the
comprehensive PMTCT programme were not in place.1
Thailand’s successful elimination of mother-to-child
transmission of HIV and syphilis was possible because
of its larger achievements in reversing its severe HIV
epidemic and in providing universal health coverage.
If Thailand’s AIDS epidemic were as severe today as
it was in the 1990s—or had substantially worsened,
as once seemed likely5—the challenge of eliminating
mother-to-child transmission would have been
immeasurably greater. It is because of the far-reaching
preventive efforts sustained by the Government of
Thailand from the early 1990s onwards that millions
of HIV infections have been prevented and millions
of lives have been saved—and elimination of motherto-child transmission made possible. What has been
achieved in Thailand is relevant for other countries
and for health challenges beyond mother-to-child
transmission of HIV. Investments in the response to
AIDS must be increased to reduce new HIV infections
among women and girls, young people, and key
populations so that we do not pay a far higher price in
the future—investing US$26 billion per year by 2020
will generate innumerable returns for the coming
generations.10
The Government of Thailand’s commitment to
radically improve overall health conditions has played
a crucial part in the elimination of mother-to-child
transmission of HIV and syphilis. Universal health care
began in 2001 and was made free in 2007. The public
health system reaches even the most remote areas.
Government health-care spending in Thailand now
totals $360 per person or 6·5% of gross domestic
product.1 Nearly 99·9% of Thai citizens are covered
under government-supported health insurance
www.thelancet.com Vol 387 June 18, 2016
schemes. In 2013, government-funded insurance
schemes were extended to non-Thai residents,
including undocumented migrant workers; in 2015,
1·45 million migrants had health insurance due to
this policy.2
Michel Sidibé, *Poonam Khetrapal Singh
Joint United Nations Programme on HIV/AIDS (UNAIDS),
CH-1211, Geneva 27, Switzerland (MS); and WHO Regional Office
for South-East Asia, New Delhi, India (PKS)
serdo@who.int
MS is Executive Director of UNAIDS. PKS is Regional Director of WHO Regional
Office for South-East Asia.
© 2016. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights
reserved.
1
2
3
4
5
6
7
8
9
10
Ministry of Public Health, Royal Government of Thailand. Validation of
elimination of mother-to-child transmission of HIV and syphilis,
Thailand 2013–2015 report. Bangkok: Royal Government of Thailand,
2016.
Regional Validation Committee. Elimination of mother-to-child
transmission of HIV and congenital syphilis, Thailand validation.
New Delhi: WHO Regional Office for South-East Asia, 2016.
WHO. Thailand is first country in Asia to eliminate mother-to-child
transmission of HIV and syphilis. June 7, 2016. http://www.searo.who.int/
mediacentre/releases/2016/1627/en/ (accessed June 8, 2016).
WHO. WHO validates countries’ elimination of mother-to-child
transmission of HIV and syphilis. June 8, 2016. http://www.who.int/
mediacentre/news/statements/2016/mother-child-hiv-syphilis/en/
(accessed June 8, 2016).
Brown T. Understanding HIV prevalence differentials in southeast Asia.
Bangkok: East-West Center/Thai Red Cross Society Collaboration on HIV
Analysis, Modeling and Policy, 2003.
Kandrana S, Simonds R. National program for preventing mother-child HIV
transmission in Thailand: successful implementation and lessons learned.
AIDS 2002; 16: 953–59.
HIV and AIDS Data Hub for Asia-Pacific. Thailand country review.
Bangkok: HIV and AIDS Data Hub for Asia-Pacific, 2012.
Inter-Agency Task Team for Prevention and Treatment of HIV Infection in
Pregnant Women, Mother and Children. Global Plan. http://emtct-iatt.org/
global-plan/ (accessed June 7, 2016).
National AIDS Prevention and Alleviation Committee, Royal Government
of Thailand. UNGASS country progress report: Thailand. Bangkok:
Royal Government of Thailand, 2010.
UNAIDS. UNAIDS announces lower price tag on investments needed to
fast-track ending the AIDS epidemic. April 1, 2016. http://www.unaids.org/
sites/default/files/20160401_PR_resource_needs_en.pdf (accessed June 5,
2016).
2489
Thailand eliminates mother-to-child transmission of HIV
and syphilis
Associated Press
Published Online
June 8, 2016
http://dx.doi.org/10.1016/
S0140-6736(16)30787-5
2488
On June 7, 2016, WHO certified that Thailand had
eliminated mother-to-child transmission of HIV and
syphilis, becoming only the second non-Organisation
for Economic Co-operation and Development country
after Cuba to achieve these goals.1–3 WHO also validated
Belarus for eliminating mother-to-child transmission of
both HIV and syphilis on June 8.4 This is not only a public
health success story for Thailand, but also an affirmation
of how internationally agreed aspirational goals—from
WHO’s Health for All by 2000 campaign and the UN’s
2001 Declaration of Commitment on HIV/AIDS to the
Millennium Development Goals and the Sustainable
Development Goals—can help health ministries to
mobilise political will, public funds, and committed
implementation.
Thailand’s commitment to address mother-tochild transmission of HIV started in the 1980s, when
the spread of AIDS began to accelerate. The country’s
first steps were to provide family education and premarital counselling, encouraging couples to be tested
for HIV before having children. In 1990–91, some large
hospitals started routine screening for HIV in antenatal
clinics to protect health workers in the absence of
effective interventions.1
The Government of Thailand’s concern about motherto-child transmission intensified as the epidemic
worsened. By 1995, national HIV antenatal prevalence
had peaked at 2·3%, the highest ever recorded in Asia.5
However, at that time the high cost of antiretroviral
treatment with zidovudine and technical capacity
constraints prevented large-scale provision of
zidovudine within the national programme. But by
1998, domestic research trials and pilot programmes
undertaken by the government in collaboration with
WHO, UNAIDS, the US Centers for Disease Control and
Prevention, and other partners confirmed that the
use of short-course zidovudine could cut the risks of
mother-to-child transmission by half.2 Thailand then
began a countrywide programme that provided shortcourse zidovudine as a routine part of antenatal care,
tripled the budget for prevention of mother-to-child
transmission (PMTCT) services, and lowered costs by
manufacturing generic versions of zidovudine locally.
Coverage expanded rapidly, so much so that by
2001, two in three pregnant women were covered
by PMTCT services.6 In that year, the government
guaranteed universal access to PMTCT services,
integrating these into the new universal health
coverage scheme.6 Consequently, by 2009, 94% of
pregnant women were counselled and tested for
HIV, 94% of HIV-positive pregnant women received
antiretrovirals, and an estimated 62% to more than
95% of infants born to HIV-infected women received
antiretroviral prophylaxis for PMTCT.7 In 2015,
99·6% of infants born to HIV-positive mothers in
Thailand received antiretroviral prophylaxis.1 In 2011,
Thailand committed itself to the Global Plan Towards
the Elimination of New HIV Infections Among
Children by 2015 and Keeping their Mothers Alive.8
The government’s decision to provide all pregnant
women—including migrant workers, in whom
substantially higher antenatal rates of HIV have been
recorded9—free antenatal care, delivery, and PMTCT
services for HIV and syphilis pushed coverage rates
higher. This concerted action culminated in Thailand’s
certification of elimination on June 7.
WHO and UNAIDS estimate that Thailand’s efforts on
PMTCT prevented nearly 17 000 new HIV infections in
infants between 2000 and 2015.1 In 2015, for instance,
85 infants contracted HIV rather than the 1076 who
www.thelancet.com Vol 387 June 18, 2016
Comment
would have been expected to contract HIV if the
comprehensive PMTCT programme were not in place.1
Thailand’s successful elimination of mother-to-child
transmission of HIV and syphilis was possible because
of its larger achievements in reversing its severe HIV
epidemic and in providing universal health coverage.
If Thailand’s AIDS epidemic were as severe today as
it was in the 1990s—or had substantially worsened,
as once seemed likely5—the challenge of eliminating
mother-to-child transmission would have been
immeasurably greater. It is because of the far-reaching
preventive efforts sustained by the Government of
Thailand from the early 1990s onwards that millions
of HIV infections have been prevented and millions
of lives have been saved—and elimination of motherto-child transmission made possible. What has been
achieved in Thailand is relevant for other countries
and for health challenges beyond mother-to-child
transmission of HIV. Investments in the response to
AIDS must be increased to reduce new HIV infections
among women and girls, young people, and key
populations so that we do not pay a far higher price in
the future—investing US$26 billion per year by 2020
will generate innumerable returns for the coming
generations.10
The Government of Thailand’s commitment to
radically improve overall health conditions has played
a crucial part in the elimination of mother-to-child
transmission of HIV and syphilis. Universal health care
began in 2001 and was made free in 2007. The public
health system reaches even the most remote areas.
Government health-care spending in Thailand now
totals $360 per person or 6·5% of gross domestic
product.1 Nearly 99·9% of Thai citizens are covered
under government-supported health insurance
www.thelancet.com Vol 387 June 18, 2016
schemes. In 2013, government-funded insurance
schemes were extended to non-Thai residents,
including undocumented migrant workers; in 2015,
1·45 million migrants had health insurance due to
this policy.2
Michel Sidibé, *Poonam Khetrapal Singh
Joint United Nations Programme on HIV/AIDS (UNAIDS),
CH-1211, Geneva 27, Switzerland (MS); and WHO Regional Office
for South-East Asia, New Delhi, India (PKS)
serdo@who.int
MS is Executive Director of UNAIDS. PKS is Regional Director of WHO Regional
Office for South-East Asia.
© 2016. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights
reserved.
1
2
3
4
5
6
7
8
9
10
Ministry of Public Health, Royal Government of Thailand. Validation of
elimination of mother-to-child transmission of HIV and syphilis,
Thailand 2013–2015 report. Bangkok: Royal Government of Thailand,
2016.
Regional Validation Committee. Elimination of mother-to-child
transmission of HIV and congenital syphilis, Thailand validation.
New Delhi: WHO Regional Office for South-East Asia, 2016.
WHO. Thailand is first country in Asia to eliminate mother-to-child
transmission of HIV and syphilis. June 7, 2016. http://www.searo.who.int/
mediacentre/releases/2016/1627/en/ (accessed June 8, 2016).
WHO. WHO validates countries’ elimination of mother-to-child
transmission of HIV and syphilis. June 8, 2016. http://www.who.int/
mediacentre/news/statements/2016/mother-child-hiv-syphilis/en/
(accessed June 8, 2016).
Brown T. Understanding HIV prevalence differentials in southeast Asia.
Bangkok: East-West Center/Thai Red Cross Society Collaboration on HIV
Analysis, Modeling and Policy, 2003.
Kandrana S, Simonds R. National program for preventing mother-child HIV
transmission in Thailand: successful implementation and lessons learned.
AIDS 2002; 16: 953–59.
HIV and AIDS Data Hub for Asia-Pacific. Thailand country review.
Bangkok: HIV and AIDS Data Hub for Asia-Pacific, 2012.
Inter-Agency Task Team for Prevention and Treatment of HIV Infection in
Pregnant Women, Mother and Children. Global Plan. http://emtct-iatt.org/
global-plan/ (accessed June 7, 2016).
National AIDS Prevention and Alleviation Committee, Royal Government
of Thailand. UNGASS country progress report: Thailand. Bangkok:
Royal Government of Thailand, 2010.
UNAIDS. UNAIDS announces lower price tag on investments needed to
fast-track ending the AIDS epidemic. April 1, 2016. http://www.unaids.org/
sites/default/files/20160401_PR_resource_needs_en.pdf (accessed June 5,
2016).
2489