Preventing mother-to-child transmission of human immunodeficiency virus (HIV) has been a success in Bhutan since the launch of a national program in 2006.
Of 83 children born from mothers with HIV, 65 children tested between 2006 and 2014 were not infected. Three died before test, and another three did not turn up for follow up. Twelve cases are yet to be tested.
According to presentation from Bhutan at the first South Asian Federation of Obstetricians and Gynecologist (SAFOG) meeting in Thimphu that ended on Sunday, the trend has been stabilizing over the years. From the 14 cases in 2011, it has dropped to eight in 2012 and 2013, seven in 2014, and six last year. It may drop further.
Over 90 percent of new HIV infection among infants and children occur through mother to child transmission. Without any intervention, the risk of transmission from the mother to the baby is 20-45 per cent.
While 91 per cent of transmission in the country is heterosexual, seven percent is attributed to PMTCT.
“With an evidence-based set of comprehensive interventions, this transmission rate can be reduced to less than two percent,” said Professor Phurb Dorji, the head of JDWNRH’s obstetrics and gynecology department.
The four-point strategy for PMTCT in line with the World Health Organization’s guideline includes antiretroviral therapy for mothers during pregnancy, planned elective caesarean, antiretroviral therapy in the neonates for post-exposure prophylaxis, and no breastfeeding.
The government provides free milk formula to babies for two years.
As per the UNAIDS estimates, Bhutan still has a detection gap of about 59 percent from the estimated 1,100 cases. Bridging this gap is crucial to meet the country’s commitments.
The PMTCT program is working for early diagnosis of children. Viral load machine and viral culture sensitivity are other needs of the health system.
Professor Phurb Dorji said, “We need to scale up by providing rapid HIV test kits to basic health units and outreach clinics and strengthen monitoring and evaluation.”
There are 24 children living with HIV/AIDS, all infected before PMTCT began program in the country in 2006. The first PMTCT case was detected in 2002.
Of the 83 infected mothers, more than 90 per cent are housewives, followed by businesswomen and civil servant at 7.2 percent and 2.4 percent respectively. Sixty-eight per cent of them are illiterate, 21 percent attended primary education, and the rest attended secondary school.
The mean age of the mothers is 25.8. More than 84 per cent of the 83 mothers were below 30 years. Most of the mothers were diagnosed during antenatal care, and about 19 were found during survey and 17 percent through contact tracing.
Of the 460 individuals with HIV, 86 have died and 20 live outside. More than 40 percent was found to be living in Thimphu and Phuentsholing.
Eighteen senior Gynecologists from India, Pakistan, Nepal, Bangladesh and Sri Lanka attended the continuing medical education meeting with 100 Bhutanese participants, including Gynecologists and health staff from all dzongkhag hospitals.The meeting focused on maternal health care.
SAFOG is a non-profit organization formed by National societies formed by Obstetricians and Gynecologists from the SAARC countries in 1996.
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