Implementing short-course zidovudine to reduce mother-infant HIV transmission in a large pilot program in Thailand

Objectives: To describe a pilot mother-infant HIV prevention program started by the Ministry of Public Health of Thailand in July 1998 and to report on the first year of its implementation. Design: Analysis of monthly summaries of data from project logbooks, simple data forms in antenatal clinics and delivery rooms, site visits and workshops, mail survey. Setting: All 89 public hospitals in seven north-eastern provinces of Thailand. Participants: Childbearing women, program officials. Interventions: Counseling and HIV testing for pregnant women, short-course antenatal zidovudine for HIV-infected pregnant women, and infant formula for their children. Main outcome measures: Proportion of women with HIV test, proportion of HIV-infected women receiving zidovudine. Results: Of 75 308 women who gave birth between July 1998 and June 1999, 74 511 (98.9%) had antenatal care, 51 492 (69.1%) in the same district and 23 019 (30.9%) outside the district where they gave birth. HIV test results were available at delivery for 46 648 (61.9%) women, 410 (0.9%) of whom rested positive. Of these HIV-infected women, 259 (63.2%) participated in the zidovudine program and 6 (1.5%) received zidovudine from other sources. The proportion of women whose HIV test results were known and proportion of HIV-infected women who received zidovudine increased significantly during the year. Conclusions: A mother-infant HIV prevention program using short-course antenatal zidovudine was quickly implemented in a large region of Thailand with moderate HIV prevalence. This successful experience is leading to national implementation of a perinatal HIV prevention program in Thailand and may prompt other developing countries to start similar programs. (C) 2000 Lippincott Williams & Wilkins.