|Prevention of Mother-to-Child Transmission of HIV: Thai Red Cross Zidovudine Donation Programme (UNAIDS, 2001, 39 p.)|
AN OPTION FOR MOTHERS-TO-BE
With assistance from the Thai Ministry of Public Health, all hospitals throughout Thailand were informed of this programme. In addition, the mass media have provided the public with information on this programme through newspapers, pamphlets, magazines, and radio and television broadcasts. All these tasks on public notification have been succeeded with the help of the Thai Red Cross public relation and fundraising committees.
The health care provider who takes care of an HIV-infected pregnant woman can request zidovudine directly from the Thai Red Cross. It is suggested that the health care provider should discuss the following issues, which appear as a checklist on the drug request form, with the woman and her spouse prior to requesting the medication:
* The risks of HIV transmission from her to her unborn child and the choices of intervention
* The benefit of zidovudine in the prevention of HIV transmission
* The adverse side effects of zidovudine
* The mode of taking the medication and the womans willingness to receive and take this donated medication
* The risk of HIV transmission through breast feeding and the familys access to formula feeding
* The way to determine the childs HIV status and the couples willingness to bring their child for testing and for medical follow-up.
* The couples intention to raise the child
* The decision on a surrogate guardian for the child once the couple can no longer take care of the child in the future
* Appropriate family planning after the current pregnancy
An HIV-infected pregnant woman is discussing her options with a counsellor.
The health care provider should inquire about the family income and occupation so that the donated medication is appropriately offered only to those who truly cannot afford it. The physician should emphasize to the couple of the risk for HIV transmission through breast-feeding. The Thai Red Cross advocates that breast-feeding by HIV-infected women be discouraged. Alternative feeding should be thoroughly discussed with the couple. More than one counselling session may be required. At all times, the health care provider must assure the couple that their discussion will be based on the element of confidentiality and that the couples decision will be respected.
A MISSION TO SAVE THE CHILDS LIFE
After all the discussions have taken place and the woman has accepted to take zidovudine, the health care provider fills out the drug request form. The information needed in this form includes the family demography, family income and occupation, the history of pregnancy, the counselling checklist as above, the hospital address to which the medication should be delivered and the health care providers name and signature. This form ensures that all the important information has been discussed with the patient and provided to the Thai Red Cross. However, no patients names are recorded on this form. The drug request form is then sent to the Thai Red Cross preferably by facsimile. The process of approval usually takes no more than one week. Once the request is approved, the health care provider will be notified. Zidovudine is usually delivered within two weeks after notification. The first shipment will be sufficient for one patient to use for 3 months. Subsequent follow-up forms are to be filled out so that the medication can be delivered continuously to complete the whole course of the prophylactic regimen.
The zidovudine regimen used in this programme is as follows:
1. During pregnancy, a woman starts taking zidovudine any time between 14 and 34 weeks gestation. The daily dose is 200 milligrams of zidovudine (2 pills) in the morning and 300 milligrams (3 pills) in the evening until the woman goes into labour.
2. During labour, a woman takes 300 milligram of zidovudine (3 pills) by mouth every 3 hours until the infant is born.
3. After birth, the infant takes zidovudine syrup at the dose of 2 milligrams per kilogram body weight every 6 hours until the infant is 6 weeks old.
This regimen is somewhat different from the ACTG 076 regimen. In the ACTG 076 regimen, a woman would receive 100 milligrams of zidovudine five times daily during pregnancy. In this programme, the dosing of zidovudine is less frequent for better compliance. In addition, zidovudine was given intravenously (given into a vein) during labour in the ACTG 076 study. However, giving medication intravenously can be quite complicated, especially in some community hospitals in rural Thailand. Therefore, it was decided to give the medication by mouth at every 3 hours instead. It was found that the zidovudine level in the body remains quite comparable regardless of whether the medication is administered orally or intravenously.
NEW LIFE FOR THE CHILD
The Thai Red Cross provides HIV testing free of charge for all infants who receive zidovudine from the programme. Upon the parents permission, blood samples are obtained by a heel stick or finger stick technique. We recommend that blood samples be obtained at birth, at 6 weeks and at 6 months of age. Small drops of blood are placed on the provided filter paper and allow to air-dry. The samples are then mailed with the corresponding form to the Thai Red Cross in the envelope provided.
At the Thai Red Cross Laboratory, the dried blood spot samples are analysed for HIV. The technique used is called the polymerase chain reaction assay. In brief, the HIV gene is amplified if it is present in the dried blood spot. The gene is subsequently detected using a standard laboratory technique. This method has proved sensitive and specific for the diagnosis of HIV infection in infants. Once the result is available, the health care provider will be notified so that the parent will be informed of the childs HIV infection status. The Thai Red Cross encourages that all children born to HIV-infected mothers be tested for HIV antibody at least once at or after the age of 15-18 months to confirm the childs infection status. This recommendation is included in the last form as a reminder.
The Red Cross Red Ribbon Sale and the exhibition of the zidovudine donation programme
A campaign activity at King Rama V Square to raise public awareness and support on the anniversary of the zidovudine donation program
All zidovudine used in this programme comes from public donations. The donation campaign is under the direct responsibility of the public relation and fundraising committees of the Thai Red Cross. These committees consist of volunteers from various walks of life - from chief executive officers to entertainers and from royal family members to government officers. The donations are obtained through four different ways as follows:
1. Direct donation
This is the major source of the programmes fund. The Thai Red Cross accepts donation year-round from individuals, groups or organizations. The mass media regularly publicize the need for donations. One can donate in person at the Red Cross offices, by sending a cheque or a money order, or by transferring funds to the programmes bank account. There are no limits on the amount of donation. In addition, the donation is tax-deductible.
2. Donation through the Thai Red Cross annual activities
With the effort of the public relation and fundraising committees, the Thai Red Cross has many activities for the general public each year. The main activities or events for example are the Annual Thai Red Cross Fair, the World AIDS Day activities, the National Mothers Day cerebration, and the Princess Soamsawalis birthday cerebration. On these special occasions, other than the donation campaign, there are countless educational activities related to HIV/AIDS prevention and care. This helps contribute to a better understanding of HIV/AIDS within the Thai society.
3. Donation through the Red Cross Red Ribbon Sale
Every year on 26 February, in recognition of the day this programme was founded, the Thai Red Cross holds the Red Cross Red Ribbon Sale throughout Thailand. This event, which is dedicated to those who suffer from AIDS, seeks to raise public awareness of this disease. Parts of the profit are directed to the zidovudine donation programme.
4. Donation through miscellaneous activities
The public relation and fundraising committees have worked with several non-government organizations and the private sectors to establish a variety of fundraising activities. These include charity concerts, dinners, fashion shows, golf tournaments, gallery exhibitions, and the sale of special cassettes or compact discs, and so on.