The Feasibility Study on Introducing Three-Antiretroviral Combinations as Standard Regimens for Prevention of Mother to Child HIV Transmission in Thailand

Abstract

A program for prevention of mother-to-child HIV transmission (PMTCT) has been introduced in Thailand since 2000. In current national guidelines, combination of zidovudine (AZT) and singledose nevirapine (sd-NVP) is provided to HIV-infected pregnant women who have CD4 > 200 cell/ mm3, while a three-antiretroviral regimen comprising AZT+3TC+NVP is offered to those with CD4 < 200 cell/mm3. In developed countries, all HIV infected pregnant women are eligible for three- ARV regimens as these prophylaxis protocols are more effective than two-drug combinations. However, the administration of the three-drug regimens is relatively more complex compared to AZT+sd- NVP. This study was aimed at assessing the feasibility of introducing the three-drug combination as a national standard regimen for PMTCT. The new PMTCT protocol was developed by consultation with Thai experts, and subsequently implemented, during 1 April - 30 September 2009 in all hospitals under the Ministry of Public Health (MOPH) in 4 provinces: Nakhon Sawan, Sa Kaeo, Si Sa Ket and Satun. Qualitative data was collected from focus group discussion and in depth interview with health officers, health professions and pregnant women. Data record form was employed to collect quantitative data from patients. Ninety-two HIV-infected pregnant women sought care at study hospitals voluntarily participated in this operational research. It was found that adherence to the three-ARV regimen was high, and only 3 pregnant women had to switch the drug regimen to others due to side effects. Furthermore, pregnant women were willing to take three-ARV regimens, since the drugs could prevent HIV transmission to their children. From the focus group discussion with health personnel, replacing the current standard regimen with the three-drug combinations was feasible because it did not increase the workload of health providers significantly and not complicate the treatment process. Nevertheless, three main points of concern - policy implication from central to practitioner, essential materials, and reimbursement system - have to be assessed before launching a program.