|Prevention of Mother-to-Child Transmission of HIV: Thai Red Cross Zidovudine Donation Programme (UNAIDS, 2001, 39 p.)|
THE ROLES OF THE ROYAL FAMILY
As its patron, Her Royal Highness Princess Soamsawali has taken an active role in guiding and overseeing the zidovudine donation programme. Her Royal Highness has devoted her time to participate in numerous events related to this programme, has chaired the programmes annual meeting, and has regularly donated funds and infant formula for the programme. One main event is the Spiritual Candle Light Ceremony on the World AIDS Day, when Her Royal Highness specifically meets with patients, volunteers and those who work in the field of HIV. On Her Royal Highnesss birthday, there are abundant activities related to HIV/AIDS throughout the country. As the result of her dedication, Her Royal Highness has been acknowledged, both by Thai and by the international community, including UNAIDS and UNICEF, as the foremost figure in HIV prevention and education in Thailand.
Her Royal Highness Princess Soamsawali is not the only royal family member involved with the Thai Red Cross. Her Royal Highness Princess Maha Chakri Sirindhorn is the patron of the Thai Red Cross Society. Although Her Royal Highness may not have an active role in the zidovudine donation programme, Her Royal Highness oversees all activities of the Thai Red Cross Society, including those related to HIV/AIDS, and has provided valuable inputs for the operation of the Thai Red Cross AIDS Research Centre. In addition, parts of this programmes fund have come directly from Her Royal Highnesss donations.
MINISTRY OF PUBLIC HEALTH
The Thai Ministry of Public Health, particularly the Division of AIDS, has played an important role by providing information on the programme to all hospitals throughout the country. The Ministry has helped streamline the process by which hospitals participate in the programme, and it continues to monitor and evaluate each hospitals participation. Such intervention has helped tremendously in the smooth operation of the programme at these hospitals. In addition, the Ministry has contributed zidovudine to be used in the programme.
One reason that explains the success of this programme is its community-to-community nature. The donation from the community eventually returns back to the community. Being Buddhists, Thai people strongly believe that it is religiously important to support charities. Preventing one child from this deadly disease is considered by Thai as one of the most favorable and charitable attainments. Therefore, the programme is very well received and fits very well in Thailand.
MONITORING AND EVALUATION
From February 1996 to August 1999, there had been almost 2,900 HIV-infected pregnant women receiving free zidovudine from this programme (see graph). They were from 81 hospitals in 40 provinces throughout Thailand. The analysis of the transmission rate was performed by the Thai Red Cross in August 1999. The analysis was limited to a subgroup of 719 mother-infant pairs among whom dried blood spot HIV tests were available on infants at or after 4 weeks of age. The mothers started zidovudine during pregnancy at 14-34 weeks gestation and continued till delivery, and the infants received zidovudine for 6 weeks after birth. The transmission rate in this group was 5.9 per cent, which is agreeable with the rates reported from developed countries where zidovudine ATCG 076 regimen was implemented. Therefore, the scientific strength of this programme exists as it is now proven that zidovudine remains effective in reducing mother-to-child transmission of HIV outside the setting of clinical research in the less-developed region of the world. Our analysis also confirmed that zidovudine is effective in the population with predominant HIV subtype E infection. Of note, HIV subtype E is the most common subtype in Thailand whereas subtype B is the most common subtype in the western world. The ACTG 076 study was performed in the United States and France where HIV subtype B is predominant.
Cumulative Number of HIV-Infected Pregnant Women Receiving Zidovudine from Thai Red Cross Zidovudine Donation Program (1996-1999)
This programme has demonstrated that the community can work effectively together to overcome the obstacle of the high cost of zidovudine. Donation of medication has proved feasible and can be used as one of the strategic tools to prevent mother-to-child transmission of HIV in less-developed countries.