Abstract
BackgroundThe prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013.ObjectiveThe objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam.MethodsThis community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp).ResultsA total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%.ConclusionsA combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed.
Highlights
Over 30 years since the discovery of HIV, Asia and the Pacific has kept AIDS high on the regional agenda, rallying around global and regional commitments and goals to address and turn the tide on HIV.Building upon commitments such as the Millennium Development Goals and the United Nations (UN) General Assembly 2011 Political Declaration on HIV and AIDS, the vision of getting to zero new HIV infections, zero discrimination and zero AIDSrelated deaths introduced by UNAIDS in 2011 has resonated across the region
Some countries have achieved more than 50% coverage, notably Cambodia, Malaysia, Myanmar and Thailand
To reach the target of 50% fewer HIV infections through sexual transmission, it is crucial to focus efforts on key populations and their sexual partners, and to take a far more geographically-focused approach
Summary
Over 30 years since the discovery of HIV, Asia and the Pacific has kept AIDS high on the regional agenda, rallying around global and regional commitments and goals to address and turn the tide on HIV. Building upon commitments such as the Millennium Development Goals and the United Nations (UN) General Assembly 2011 Political Declaration on HIV and AIDS, the vision of getting to zero new HIV infections, zero discrimination and zero AIDSrelated deaths introduced by UNAIDS in 2011 has resonated across the region. Efforts and energies of countries across the region are being channelled into striving reach these ambitious targets. In 2013 some countries in the region have already met some of the targets; others report they are on schedule to reach the targets by 2015
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