Abstract—To strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The aim of the this study was to find out the IDSP disease pattern and load on a tertiary hospital. It was cross-sectional study carried out in hospitals attached to SMS medical College, Jaipur (Rajasthan) India. Weekly report of IDSP in 'P' Form was collected from SMS Medical College, Hospitals. Data related to IDSP diseases were gathered from these reports. These reports were analysed in percentage and proportion. It was observed in this study that among IDSP diseases most common was fever of unknown origin accounting total 93 (23.97%) cases followed by Acute Diarrheal including Ac. Gastroenteritis, Acute Respiratory Infection (ARI) Influenza like illness (ILI), Pneumonia, Malaria, Viral hepatitis etc. Distribution of various IDSP diseases were with significant variation in pediatric and adult population. Among pediatric population ADD was most common whereas in adult population ARIs were most common. Even after launching of more than a decade, a sizable burden of IDSP diseases is there at tertiary level hospital, who could be treated at peripheral health institutes like Sub centre and Primary health centre. So there is a strong need for IDSP disease and its toll free no awareness.
Abstract—To strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The aim of the this study was to find out the IDSP disease pattern and load on a tertiary hospital. It was cross-sectional study carried out in hospitals attached to SMS medical College, Jaipur (Rajasthan) India. Weekly report of IDSP in 'P' Form was collected from SMS Medical College, Hospitals. Data related to IDSP diseases were gathered from these reports. These reports were analysed in percentage and proportion. It was observed in this study that among IDSP diseases most common was fever of unknown origin accounting total 93 (23.97%) cases followed by Acute Diarrheal including Ac. Gastroenteritis, Acute Respiratory Infection (ARI) Influenza like illness (ILI), Pneumonia, Malaria, Viral hepatitis etc. Distribution of various IDSP diseases were with significant variation in pediatric and adult population. Among pediatric population ADD was most common whereas in adult population ARIs were most common. Even after launching of more than a decade, a sizable burden of IDSP diseases is there at tertiary level hospital, who could be treated at peripheral health institutes like Sub centre and Primary health centre. So there is a strong need for IDSP disease and its toll free no awareness.
Primary health care reform in 1 care for 1 malaysiaEyesWideOpen2008
The government denies that 1Care has been confirmed and accepted, yet it promotes its 1Care reforms internationally!
This is from the International Journal of Public Health Research Special Issue 2011, pp (50-56)
Standards for TB care in India, RNTCP challenges: India, Maharashtra & Mumbai...Amol Patil
This presentation contains TB statistics- Global, India, Maharashtra and Mumbai till 2015.
Details of TB control strategies will be covered in Subsequent parts.
Complementary and alternative medicine in European countries— legislative fra...LucyPi1
Abstract Complementary and alternative medicine (CAM) is a set of different diagnostic and therapeutic procedures, as well as the use of natural products for the treatment of patients, derived from previously known traditional methods and enriched with modern scientific knowledge. The present article reviews the available data regarding the use of CAM and the legislation behind it in European countries. The use of CAM is recorded in Europe as a whole and varies between 10–70% of the population of individual European countries. At least 300,000 registered CAM providers have been identified in the European Union (EU), of which slightly more than half includes non-medical practitioners. The most practiced discipline is acupuncture, followed by homeopathy. CAM regulation and legislation in Europe is not precisely defined and is constantly striving to find a common approach. Since legal frameworks for CAM are not defined, each European country has its own regulations and legislation. In order to define universal legislation for CAM, the EU created the CAMbrella project, a project of the EU designed to find a unique system that would include the treatment of CAM in Europe. According to the data from CAMbrella, from 39 countries in the EU, 17 have general CAM legislations. The status of CAM in Europe is characterized by enormous heterogeneity in all aspects, including terminology, methods, prevalence and ultimately, legal status, regulations and legislation.
Call for action :expanding Cancer care in india Earnest and Young report Healthcare consultant
The context of cancer care in India is characterized by high incidence, late detection, lack of access to quality affordable care to majority of the populace and hence high mortality. It is agonising to observe high percentage of late detection owing to issues of access, affordability and awareness given that both the cost and success of treatment is favourably skewed towards earlier detection in a significant manner, leave alone the anguish of the family that has to negotiate with the reality of losing their loved one knowing that it is a travesty, not tragedy, of destiny. Further, it is of great concern to observe increasing deterioration of the key risk factors that contribute to the sickness, viz. use of alcohol/tobacco, obesity, environmental pollution etc. It is imperative for the stakeholders of Indian healthcare to address this growing menace before it becomes a national catastrophe.
Primary health care reform in 1 care for 1 malaysiaEyesWideOpen2008
The government denies that 1Care has been confirmed and accepted, yet it promotes its 1Care reforms internationally!
This is from the International Journal of Public Health Research Special Issue 2011, pp (50-56)
Standards for TB care in India, RNTCP challenges: India, Maharashtra & Mumbai...Amol Patil
This presentation contains TB statistics- Global, India, Maharashtra and Mumbai till 2015.
Details of TB control strategies will be covered in Subsequent parts.
Complementary and alternative medicine in European countries— legislative fra...LucyPi1
Abstract Complementary and alternative medicine (CAM) is a set of different diagnostic and therapeutic procedures, as well as the use of natural products for the treatment of patients, derived from previously known traditional methods and enriched with modern scientific knowledge. The present article reviews the available data regarding the use of CAM and the legislation behind it in European countries. The use of CAM is recorded in Europe as a whole and varies between 10–70% of the population of individual European countries. At least 300,000 registered CAM providers have been identified in the European Union (EU), of which slightly more than half includes non-medical practitioners. The most practiced discipline is acupuncture, followed by homeopathy. CAM regulation and legislation in Europe is not precisely defined and is constantly striving to find a common approach. Since legal frameworks for CAM are not defined, each European country has its own regulations and legislation. In order to define universal legislation for CAM, the EU created the CAMbrella project, a project of the EU designed to find a unique system that would include the treatment of CAM in Europe. According to the data from CAMbrella, from 39 countries in the EU, 17 have general CAM legislations. The status of CAM in Europe is characterized by enormous heterogeneity in all aspects, including terminology, methods, prevalence and ultimately, legal status, regulations and legislation.
Call for action :expanding Cancer care in india Earnest and Young report Healthcare consultant
The context of cancer care in India is characterized by high incidence, late detection, lack of access to quality affordable care to majority of the populace and hence high mortality. It is agonising to observe high percentage of late detection owing to issues of access, affordability and awareness given that both the cost and success of treatment is favourably skewed towards earlier detection in a significant manner, leave alone the anguish of the family that has to negotiate with the reality of losing their loved one knowing that it is a travesty, not tragedy, of destiny. Further, it is of great concern to observe increasing deterioration of the key risk factors that contribute to the sickness, viz. use of alcohol/tobacco, obesity, environmental pollution etc. It is imperative for the stakeholders of Indian healthcare to address this growing menace before it becomes a national catastrophe.
Dr. Laura Guay, the Foundation’s Vice President of Research, also conducted a journalist training today sponsored by the National Press Foundation, teaching reporters about some of the most misunderstood issues concerning HIV and children
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.
The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of PLHIV.
Washington Global Health Alliance Discovery Series
Catherine Wilfert, MD [
December 1, 2008
'Global Prevention of Mother to Child Transmission of HIV-1'
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Review key HIV data from IAS 2019 on the updated NTD risk in women receiving ART at conception, PrEP, first-line and switch options, and early-phase investigational strategies.
การดูแลท่านผู้สูงอายุในประเทศไทยคงมีหน่วยงานหลายหน่วยงานที่ดูแลอยู่ อย่่างไรก็ดี ก็จะต้องออกแบบระบบสำหรับ health and well-being อย่างถ้วนหน้า โดย Leave no one behind โดยบูรณาการไปข้างหน้าให้ดีและยั่งยืน เหมาะสมกับบริบทของประเทศไทย
โรคเรื้อรังเกี่ยวกับระบบทางเดินหายใจ นับว่าเป็นปัญหาสาธารณสุขที่กระทบต่อคุณภาพชีวิตประชาชนมากเป็นอันดับต้นๆ การพัฒนาระบบการดูแลที่เรียกว่า chronic care model นับว่าจะช่วยทั้ง health and well being คนไข้ ครอบครัว และช่วยทางด้าน equity efficiency ระบบบริการสาธารณสุขด้วย
การจัดการกับเรื่องราวให้มีการพัฒนาอย่างยั่งยืน sustainable development goal ให้เกิด health and well being ตาม SDG 3 สำหรับสังคมผู้สูงอายุนั้น ต้องการการร่วมมือบูรณาการและผลักดันอย่างยิ่ง ทั้งนโยบายประชากร นโยบายทางการเงิน การจัดสวัสดิการ การจัดการสุขภาพ การจัดการสิ่งแวดล้อมและความปลอดภัย
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
1. Morbidity and Mortality Weekly Report
562 MMWR / June 10, 2016 / Vol. 65 / No. 22 US Department of Health and Human Services/Centers for Disease Control and Prevention
Thailandexperiencedageneralizedhumanimmunodeficiency
virus (HIV) epidemic during the 1990s. HIV prevalence among
pregnant women was 2.0% and the mother-to-child transmis-
sion (MTCT) rate was >20% (1–3). In June 2016, Thailand
became the first country in Asia to validate the elimination of
MTCT by meeting World Health Organization (WHO) tar-
gets. Because Thailand’s experience implementing a successful
prevention of MTCT program might be instructive for other
countries, Thailand’s prevention of MTCT interventions,
outcomes, factors that contributed to success, and challenges
that remain were reviewed. Thailand’s national prevention of
MTCT program has evolved with prevention science from
national implementation of short course zidovudine (AZT) in
2000 to lifelong highly active antiretroviral therapy regardless
of CD4 count (WHO option B+) in 2014 (1). By 2015, HIV
prevalence among pregnant women had decreased to 0.6% and
the MTCT rate to 1.9% (the elimination of MTCT target is
<2% for nonbreastfeeding populations) (4). A strong public
health infrastructure, committed political leadership, govern-
ment funding, engagement of multiple partners, and a robust
monitoring system allowed Thailand to achieve this important
public health milestone.
Early prevention of MTCT response
The first case of HIV in a pregnant woman in Thailand
was reported in 1988 and increasing HIV prevalence among
pregnant women and other populations was recognized in the
early 1990s (3,5). In 1996, after the ACTG 076 trial* (6),
the Thailand Ministry of Public Health (MOPH) and Siriraj
Hospital, in collaboration with CDCThailand/Southeast Asia
Regional Office, launched a trial of short-course oral AZT, a
regimen feasible for use inThailand (2).The trial demonstrated
a 50% reduction in MTCT.
In 1996, Her Royal Highness Princess Soamsawali donated
funds to the Thai Red Cross Society to make antiretrovirals for
prevention of MTCT available to hospitals around the country.
During 1997–1999, the MOPH implemented pilot prevention
of MTCT projects in northeastern (7) and northern Thailand
(5) to provide HIV testing for pregnant women and AZT for
prevention of MTCT, and to implement a pilot prevention of
MTCT monitoring system. In 2000, the Department of Health
(DOH) MOPH announced the first national prevention of
MTCT policy and issued guidelines for all government hospitals
tointegratepreventionofMTCTactivitiesintoroutinematernal
and child health services, including HIV testing for all pregnant
women, antiretroviral therapy for prevention of MTCT, and
infant formula for infants born to HIV-positive mothers. The
prevention of MTCT program covers all public and private
health care facilities.TheThai government funds prevention of
MTCT services for Thais under the universal health coverage
policy. During 2007–2014, non-Thai HIV-positive pregnant
women could access prevention of MTCT services through a
Global Fund project; these services can currently be accessed
through hospital social welfare funds, the Princess Soamsawali
prevention of MTCT fund, government-sponsored migrant
health insurance, or other special projects (1) (Figure 1).
Antiretroviral regimens for Thailand’s national prevention
of MTCT program have evolved with prevention science.
In 2000, HIV-positive pregnant women were offered AZT
starting at 34 weeks gestation and their infants received AZT
for 4 weeks. A single-dose of nevirapine (WHO option A)
was added in 2004; next, in 2010, highly active antiretroviral
therapy (WHO option B) was provided during pregnancy
and continued based on CD4 count; and finally, in 2014,
highly active antiretroviral therapy for life regardless of CD4
count (WHO option B+) became the standard. HIV testing
of couples was implemented in 2010 (1).
Infant HIV testing guidelines have also evolved. During
2000–2006, HIV diagnosis in infants aged 12 months and
18 months was accomplished using antibody tests; diagnoses
in some infants aged >2 months were made using DNA poly-
merase chain reaction (PCR) testing as part of research studies
or other projects. In 2007, HIV DNA PCR testing was imple-
mented for infants aged 1–2 months and 2–4 months using
national HIV/AIDS funds. In 2014, the national prevention
of MTCT guidelines were modified to classify infants based on
their risk for acquiring HIV. Infants with standard risk receive
AZT for 4 weeks, and HIV DNA PCR testing is performed at
age 1 month and 2–4 months. Infants with high risk (mater-
nal plasma HIV viral load >50 copies/mL or infants born to
mothers taking highly active antiretroviral therapy for <4 weeks
before delivery) receive AZT, lamivudine, and nevirapine for
*ACTG 076 was a Phase III, randomized, double-blind, placebo-controlled
clinical trial designed to evaluate whether zidovudine administered orally
(initiated at 14–34 weeks gestation) and intravenously during labor to HIV-
infected pregnant women and orally to their infants could reduce the rate of
transmission from mother to infant.
Elimination of Mother-to-Child Transmission of HIV — Thailand
Rangsima Lolekha, MD1; Sarawut Boonsuk, MD2; Tanarak Plipat, MD, PhD3 ; Michael Martin, MD1; Chaweewan Tonputsa, MA2;
Niramon Punsuwan, MS3; Thananda Naiwatanakul, MSC1; Kulkanya Chokephaibulkit, MD4; Hansa Thaisri, MSC5; Praphan Phanuphak, MD, PhD6;
Suchada Chaivooth, MD7; Sumet Ongwandee, MD3; Benjamas Baipluthong, MPH1; Wachira Pengjuntr, MD2; Sopon Mekton, MD8
2. Morbidity and Mortality Weekly Report
MMWR / June 10, 2016 / Vol. 65 / No. 22 563US Department of Health and Human Services/Centers for Disease Control and Prevention
6 weeks, and HIV DNA PCR testing is performed at ages 1,
2, and 4 months. All children born to HIV-positive mothers
have confirmatory HIV antibody testing at age 18 months (1).
Stigma and discrimination against women living with HIV
continues to prevent some women from accessing antenatal
clinic services (1). Women living with HIV in Thailand and
civil society organizations have worked with the MOPH to
develop and implement a training curriculum for hospital
personnel that aims to reduce stigma and discrimination (1).
National prevention of MTCT monitoring system
In 2000, the DOH MOPH, with assistance from CDC,
launched the Perinatal HIV Intervention Monitoring System
(PHIMS) to monitor prevention of MTCT services (8). PHIMS
collects monthly summaries from hospitals, including HIV test-
ing of pregnant women and their partners, and antiretroviral
coverage for prevention of MTCT. PHIMS has been integrated
in routine hospital reporting activities, and in 2015, PHIMS
covered 837 (92%) governmental hospitals in Thailand (77%
of total deliveries including Thais and non-Thais).
Thailand has high levels of health care coverage: 98.3% of
pregnant women had at least one antenatal clinic visit in 2015
(elimination of MTCT target >95%) (4). The percentage of
pregnant women tested for HIV has increased from 61.9%
among women in the 1998 prevention of MTCT pilot proj-
ects (7) to 92.9% in 2001(8) after the national prevention of
MTCT policy was announced, and to 99.6% in 2015 (elimi-
nation of MTCT target >95%) (1). The use of antiretrovirals
for prevention of MTCT increased from 64.6% in 1998 (7)
to 71.4% in 2001 (8), and to 95.6% in 2015 (elimination of
MTCT target >90%) (1) (Table).
FIGURE 1. Timeline of the prevention of mother-to-child transmission (MTCT) of HIV policy — Thailand, 1993–2015
AZT (initiate at
28 weeks gestation),
NVP (1 dose), and
HAART for women
with eligible criteria
AZT (initiate at
28 weeks
gestation)
and NVP (1 dose)
Early infant
diagnosis
Prevention of
MTCT regimen in
infants
Prevention of
MTCT regimen in
pregnant
women
Prevention of
MTCT via
breast milk
Voluntary HIV
counseling and
testing
Perinatal HIV intervention monitoring system (77 provinces)
Perinatal HIV outcome monitoring system(four provinces in 2001; 14 provinces in 2004)
National AIDS Program
Voluntary HIV counseling and testing/Provider initiated testing and counseling
Couples HIV testing and counseling
Free infant formula from government (for 12 months) Free infant formula from government (for 18 months)
AZT for 4 weeks or
AZT/3TC for 4–6 weeks and
NVP for 2–4 weeks
(after birth)
HAART for all pregnant women
as soon as possible and
continue for life
AZT for 4 weeks (after birth)
AZT for 4 weeks or
AZT/3TC/NVP for 6 weeks
(after birth)
HIV antibody (at 12–18 months)
DNA PCR (two times, National AIDS funds) DNA PCR based on risk for
MTCT
1993 2000 2004 2007 2010 2014
DNA PCR (research and projects)
National
prevention of
MTCT
monitoring and
evaluation
system
HAART for all pregnant
women (initiate at
14 weeks gestation) and
continue for women with
eligible criteria
Short course
AZT (initiate at
34 weeks
gestation)
Abbreviations: 3TC = lamivudine; AIDS = acquired immunodeficiency syndrome; AZT = zidovudine; HAART = highly active antiretroviral therapy; HIV = human
immunodeficiency virus; NVP = nevirapine; PCR = polymerase chain reaction.
3. Morbidity and Mortality Weekly Report
564 MMWR / June 10, 2016 / Vol. 65 / No. 22 US Department of Health and Human Services/Centers for Disease Control and Prevention
The MOPH Bureau of Epidemiology, with support from
CDC, launched the Perinatal HIV Outcome Monitoring
System in 2001 (9). Providers in 64 public hospitals in four
of the country’s 77 provinces submitted data, including the
number of infants born to HIV-positive mothers, the number
of HIV-infected infants, and the MTCT rate, to the Perinatal
HIV Outcome Monitoring System, which expanded to 191
facilities in 14 provinces during 2004–2007. In 2008,Thailand
established the National AIDS Program to monitor national
HIV treatment and care services. MTCT rates were calcu-
lated based on infant HIV DNA PCR test results reported in
the National AIDS Program. Adjusted MTCT rates during
2001–2012 were calculated to include HIV-exposed infants
who were not tested for HIV or whose HIV test results were
not reported (9,10). During 2013–2015, adjusted MTCT rates
were calculated using SPECTRUM version 5.4 (1).
With the implementation of HIV prevention policies and
increased coverage of effective prevention tools (e.g., HIV
testing and antiretrovirals for prevention of MTCT) and
strong prevention of MTCT monitoring systems, the MTCT
rate decreased from 24.2% in 1994 (2) to 10.2% in 2003
with the introduction of short-course AZT, to 4.5% with the
implementation of WHO option A, and to 1.9% in 2015 after
the implementation of WHO option B+ (Figure 2).
Discussion
Thailand has achieved WHO targets for the elimination
of MTCT, and is the first country with a generalized HIV
epidemic to reach this milestone. The prevalence of HIV
among pregnant women has decreased substantially during
the past two decades. A combination of factors has made this
possible. The Thai government responded to the increasing
prevalence of HIV among pregnant women by working with
domestic and international medical experts and researchers to
assess available data, initiate studies where needed, build the
capacity of health care workers, launch national HIV education
and 100% condom use campaigns, implement pilot preven-
tion of MTCT activities, gather evidence to develop national
policy, and expand activities nationwide. The government
also engaged with civil society, persons living with HIV, and
nongovernmental organizations to consider appropriate and
feasible prevention interventions. A well-developed national
health and laboratory system, the integration of prevention
of MTCT into routine maternal child health care, and gov-
ernment funding of prevention of MTCT services have been
TABLE. Coverage of prevention of mother-to-child transmission (MTCT) of HIV services using Perinatal HIV Intervention Monitoring System
(PHIMS) data for Thai and non-Thai populations — Thailand, July 1998–June 1999, 2001, 2005, 2011, and 2015
Indicator (definition)
Reporting time frame
July 1998–
June 1999*
No. (%)
(n = 774,349†)
2001§
No. (%)
(n = 766,107†)
2005¶
No. (%)
(n = 822,593†)
2011**
No. (%)
(n = 796,091†)
2015††
No. (%)
(n = 736,352†)
Coverage of reporting governmental hospitals 7 (—)§§ 793/853¶¶ (93.0) 804/893¶¶ (90.0) 487/868¶¶ (56.1)*** 837/914¶¶ (91.6)
Deliveries covered by PHIMS††† 75,308 (9.7) 653,576 (85.3) 692,133 (84.1) 364,455 (45.8) 566,403 (76.9)
Pregnant women receiving antenatal care§§§ 74,511 (98.9) 631,344 (96.6) 678,565 (98.0) 356,532 (97.8) 556,773 (98.3)
Coverage of pregnant women tested for HIV§§§ 46,648 (61.9) 607,336 (92.9) 688,955 (99.5) 363,848 (99.8) 564,125 (99.6)
Pregnant women testing HIV positive 410 (0.88) 7,659 (1.26) 6,231 (0.90) 2,333 (0.64) 3,399 (0.60)
HIV-positive pregnant women receiving ART for
prevention of MTCT§§§
265 (64.6) 5,466 (71.4) 5,584 (89.6) 2,191 (93.9) 3,249 (95.6)
Live infants born to HIV-positive pregnant women — 7,492 (97.8) 6,037 (96.9) 2,274 (97.5) 3,385 (99.6)
HIV-exposed infants who received ART for PMTCT — 6,718 (89.7) 5,961 (98.7) 2,238 (98.4) 3,368 (99.5)
Partners tested for HIV — — — — 239,473 (42.3)
Partners testing HIV positive — — — — 1,003 (0.4)
Abbreviations: ART = antiretroviral therapy; HIV = human immunodeficiency virus.
* Data from pilot project in region 7 (NortheasternThailand). Kanshana S,Thewanda D,Teeraratkul A, et al. Implementing short-course zidovudine to reduce mother-
infant HIV transmission in a large pilot program in Thailand. AIDS. 2000 Jul 28;14(11):1617–23.
† Total number of deliveries in Thailand. Data from Ministry of Interior.
§ First year data from PHIMS report; 1 year after the national prevention of MTCT policy launched in 2000. 2001 represents October 2000–September 2001 based
on Thailand governmental reporting practice; a similar time-frame was used for 2005, 2011, and 2015.
¶ PHIMS data 1 year after WHO option A Prevention of MTCT Policy implemented in Thailand in 2004.
** PHIMS data 1 year after WHO option B Prevention of MTCT Policy implemented in Thailand in 2010.
†† PHIMS data 1 year after WHO option B+ Policy implemented in Thailand in 2014.
§§ Seven provinces in Region 7 (Northeastern Thailand).
¶¶ Number of hospitals reporting/number of hospitals covered by PHIMS.
*** Coverage of PHIMS report was low because of the transition of the PHIMS system from a local network-based system to a web-based system.
††† Number of women reported in PHIMS (% of total deliveries).
§§§ WHO targets for elimination of MTCT of HIV: antenatal care coverage (at least one visit) ≥95%; HIV testing coverage of pregnant women ≥95%; ART coverage of
HIV-positive pregnant women ≥90%.
4. Morbidity and Mortality Weekly Report
MMWR / June 10, 2016 / Vol. 65 / No. 22 565US Department of Health and Human Services/Centers for Disease Control and Prevention
important in attaining high coverage and consistent prevention
of MTCT services nationwide.Thailand has a robust national
prevention of MTCT monitoring and evaluation system that
promotes data use for program improvement at national and
subnational levels. As a result, the expanding epidemic of HIV
among women was stemmed and MTCT reduced, and fewer
infants are born HIV-positive in Thailand.
The findings in this report are subject to at least three limi-
tations. First, nationwide surveillance data about HIV testing
coverage and the MTCT rate in the 1980s and 1990s are lack-
ing. Second, assessments of HIV testing and the MTCT rate
did not cover 23% of deliveries in 2015. Finally, the DOH
sent a prevention of MTCT coverage questionnaire during
2013–2015 to 170 hospitals that are not part of the PHIMS
reporting system, including 140 private hospitals, 19 non-
MOPH government hospitals, and 11 university hospitals;
although only 39% responded, coverage of antenatal clinics,
HIV testing, and antiretrovirals for prevention of MTCT met
elimination of MTCT targets in the hospitals that responded.
Thailand’s national AIDS strategy aims to reduce the MTCT
rate to <1% by 2030. Preliminary data from an active case
management network launched in Thailand in August 2014
FIGURE 2. Rate of mother-to-child transmission (MTCT) of HIV* and timeline for introduction of MTCT prevention regimens† — Thailand
2001–2015§
0
2
4
6
8
10
12
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
MTCTofHIVrate(%)
PHOMS sentinel provincial data, 2001–2007 (four
provinces in 2001; 14 provinces in 2004)
National AIDS Program data
2008–2015, all provinces
Short-course AZT
implemented
WHO option A
WHO option B
WHO option B+
100
Year
Adjusted MTCT rate
MTCT rate by DNA PCR
Abbreviations: AIDS = acquired immunodeficiency syndrome; AZT = zidovudine; HIV = human immunodeficiency virus; PCR = polymerase chain reaction;
PHOMS = Perinatal HIV Outcome Monitoring System, WHO = World Health Organization.
* The adjusted MTCT rates during 2001–2012 were calculated to include HIV-exposed infants who were not tested for HIV or whose HIV test results were not reported
(http://dx.doi.org/10.1097/QAD.0b013e328010e02d; http://dx.doi.org/10.7448/IAS.19.1.20511). The adjusted MTCT rates during 2013–2015 were calculated using
SPECTRUM version 5.4 (a software tool developed by the Joint United Nations Programme on HIV/AIDS and partners to assist countries in monitoring their HIV
epidemic and provide outputs such as the number of pregnant women and infants infected with HIV). The MTCT rate was calculated based on national infant HIV
DNA PCR test results.
† In2000,HIV-positivepregnantwomenwereofferedAZTstartingat34weeksgestationandtheirinfantsreceivedAZTfor4weeks.Asingle-doseofnevirapine(WHOoptionA)
wasaddedin2004;next,in2010highlyactiveantiretroviraltherapy(WHOoptionB)wasprovidedduringpregnancyandcontinuedbasedonCD4count;andfinally,highly
active antiretroviral therapy for life regardless of CD4 count (WHO option B+) became the standard in 2014.
§ 2001–2007: method of calculation for estimates of MTCT rate described at http://dx.doi.org/10.1097/QAD.0b013e328010e02d; 2008–2012: global AIDS response
report 2008–2012; 2013–2015: SPECTRUM version 5.4.
5. Morbidity and Mortality Weekly Report
566 MMWR / June 10, 2016 / Vol. 65 / No. 22 US Department of Health and Human Services/Centers for Disease Control and Prevention
suggested that approximately 80% of new perinatal HIV cases
occurred among women who begin antenatal clinic services
late, have poor antiretroviral therapy adherence, or test HIV-
negative at the first antenatal clinic visit but acquire HIV later
(before or after delivery) (1). In response, Thailand’s National
HIV Treatment and Prevention Guideline 2016 will recom-
mend raltegravir, an integrase inhibitor with rapid antiviral
activity, for HIV-positive pregnant women who receive care
after 32 weeks of pregnancy, and emphasize HIV testing of
couples beginning during visits to antenatal clinics and con-
tinuing through the postpartum period. Data suggest that to
reach a MTCT rate <1%, Thailand will need to strengthen
ownership of prevention of MTCT at subnational and com-
munity levels, enhance prevention of MTCT monitoring and
data use, ensure that HIV-positive migrants have access to
HIV services; and sustain the active case management system.
Acknowledgments
Siriporn Kanchana, MD,NipunpornVoramongkol,MD,Pornsinee
Amornwichet, Nareeluck Kullerk, Thailand Department of Health;
technical specialists from 12 regional health promotion centers; Robert
James Simonds, MD, Achara Teeraratkul, MD, CDC; Busarawan
Sriwanthana, PhD, DMSc, Nittaya Phanuphak, MD, PhD,Thai Red
Cross AIDS Research Center; Sorakij Bhakeecheep, MD, National
Health Security Office, Thailand; Tanawan Samleerat, PhD, Chiang
Mai University; staff members of the Active Case Management
NetworkWorkingGroup;staffmembersoftheThailandSPECTRUM
Working Group; Division of Global HIV/AIDS and TB, CDC;
Division of HIV/AIDS Prevention, CDC; PEPFAR; health care
workers, program managers, volunteers, persons living with HIV,
leaders both in the health facilities and the communities.
1CDC Thailand/Southeast Asia Regional Office, Nonthaburi, Thailand;
2Department of Health, Ministry of Public Health, Nonthaburi, Thailand;
3Department of Disease Control, Ministry of Public Health, Nonthaburi,
Thailand; 4Department of Pediatrics, Siriraj Hospital, Mahidol University,
Bangkok,Thailand;5Department of Medical Sciences, Ministry of Public Health,
Nonthaburi, Thailand; 6Thai Red Cross AIDS Research Center, Bangkok,
Thailand; 7TheThailand National Health Security Office, Nonthaburi,Thailand;
8Thailand Ministry of Public Health, Nonthaburi, Thailand.
Corresponding author: Rangsima Lolekha, hpu8@cdc.gov, 66-2-580-0669.
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Summary
What is already known about this topic?
Thailand experienced a generalized human immunodeficiency
virus (HIV) epidemic in the 1990s. HIV prevalence among
women in antenatal clinics was 2%, and mother-to-child
transmission (MTCT) rate of HIV was >20%.
What is added by this report?
Thailand has achieved World Health Organization targets for the
elimination of MTCT. With implementation of programs for 100%
condom use and HIV prevention, HIV prevalence among
pregnant women decreased from 2% in the mid-1990s to 0.6% in
2015. The MTCT rate decreased from >20% to 1.9% because of
the effective use of antiretroviral regimens to prevent MTCT,
including the adoption of WHO option B+ (lifelong highly active
antiretroviral therapy regardless of CD4 count) in 2014, and the
high coverage of antenatal care and prevention of MTCT services
in Thailand. Factors that contributed to these achievements
include the commitment and leadership of the Thai government,
a strong public health infrastructure, a self-reliant national
budget, the engagement of nongovernmental and civil society
partners, and a robust prevention of MTCT monitoring program.
What are the implications for public health?
Thailand has achieved World Health Organization elimination of
MTCT targets and can serve as a model for other countries.