THE 6TH
NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS
Interventions to prevent mother to
child HIV transmission in HIV exposed
infants who receiving PCR test at
29 provinces, 2010- 2013
Cao Thi Thanh Thuy, MD, PhD
Clinton Health Access Initiative, Vietnam
Outline
1. Background
2. Objectives
3. Methods
4. Results & Discussions
5. Conclusions
6. Recommendations
The 6th National Scientific Conference on HIV/AIDS
Background
PMTCT and HIV infection in children in the world and Vietnam
• Around 90% of HIV infected children are from mother to child
transmission.
• As of March 20151:
– 73% (68- 79%) of pregnant women living with HIV had access
to antiretroviral medicines to prevent transmission of HIV to
their babies in 2014
– Worldwide, new HIV infections among children have declined
by 58% in 2014 (220 000 cases) since 2000 (520 000 cases)
• As of July 2014: in Vietnam, 5.779 children living with HIV2
1.UNAIDS .2014 Global statistics. 2015. 2. MOH. VAAC report. 2014
The 6th National Scientific Conference on HIV/AIDS
Background
HIV testing among pregnant women and ARV access for PMTCT
among pregnant women living with HIV: Low increasing
% of HIV-positive pregnant women who receive ARV for PMTCT
% of pregnant women who receive HIV test and know their result
Estimated rate of HIV transmission from mother to child is 12.5% in 2014
VAAC report. 2015
The 6th National Scientific Conference on HIV/AIDS
Background
PMTCT interventions create high difference
on HIV situation in children
HIV testing for pregnant women and
ART during pregnancy
Continue ART during labor and ARV
prophylaxis for baby after delivery
ART during breastfeeding and ART is
continued for life
Limited national assessment on PMTCT in Vietnam
The 6th National Scientific Conference on HIV/AIDS
Objectives
Evaluate the situation and result of prevention of HIV
transmission from mother with HIV infection to their
children (PMTCT) and some barriers related to
PMTCT interventions in 29 provinces, 2010- 2012
The 6th National Scientific Conference on HIV/AIDS
Methods
• The study was conducted from January 2010 to December
2012.
• Study subjects:
Quantitative component :
 Medical records, PMTCT cards and logbooks of HIV exposedinfants (HEIs) that were provided with PCR tests from 1/ 2010 –
12/ 2012 at HIV C&T sites in Vietnam
Qualitative component
 Participants were: Provincial HIV/AIDS Centre (PAC) leaders,
healthcare workers (HCWs) from Outpatient Clinics (OPCs) and
obstetric facilities, caregivers,
 28 in-depth interviews and 06 focus group discussions at 13
provinces.
The 6th National Scientific Conference on HIV/AIDS
Methods (cont.)
Study design:
• The study used mixed methods. Both quantitative data and
qualitative data were collected.
The sample size was calculated:
• Estimated number of HEIs needed for recruitment : 3602.
• A total of 3,665 medical records of HEIs were enrolled in this
study.
• 29 provinces in total selected in this study, including 25 randomly
selected provinces from 50 provinces where implemented EID
and 4 purposive selected provinces/cities.
The 6th National Scientific Conference on HIV/AIDS
Methods (cont.)
− Data collection was collected by using a designed forms.
− Data were analyzed with SPSS 16.0
− Qualitative data was analyzed by topics by NVIVO 8.0. We
will analyze answers of important questions regarding HIV
status, PMTCT implementation
− This research received approval from the IRB Committee in
the Hanoi Public Health School.
The 6th National Scientific Conference on HIV/AIDS
Result and discussion
The 6th National Scientific Conference on HIV/AIDS
Information related ANC care and nutrition for newborn (n=3665)
Characteristics
Frequency
Percentage (%)
Gender
Male
Female
Place of birth
1884
1781
51.4
48.6
General Hospital
679
18.5
Provincial/City Hospital
2169
59.2
District Hospital
499
14.6
Commune Health Center
68
1.9
3426
83.9
Self referral
31
6.2
Other department
223
6.1
No information
139
3.8
Vaginal Delivery
1675
45.7
C-section
988
26.9
No information
1002
27.4
Place transfer in
Obstetric/PMTCT site
Methods of delivery
Nutrition until PCR testing
Replacement Formula
2971
Breastfeeding
33
Mixed
48
th National Scientific Conference
The
6
on HIV/AIDS
No information
382
81.1
0.9
1.3
19.6
Detection of mothers’ HIV status
(n= 3665)
3.70%
6.60%
24.90%
Beforemang
pregnant
Trước
thai
During
Khi
mangpregnancy
thai
30.20%
Labor
Khi
chuyển dạ
Sau
sinh
Afterkhidelivery
34.50%
Không
có thông tin
No information
The 6th National Scientific Conference on HIV/AIDS
ARV access for PMTCT among pregnant women
living with HIV and their babies
ARV
prophylaxis
No ARV
prophylaxis
No information
15.2 % of mother did not receice any
ARV medication
9.5% infants did not receive ARV
prophylaxis
The 6th National Scientific Conference on HIV/AIDS
Result of prevention of HIV transmission from
mother with HIV infection to their children (n=3665)
PMTCT interventions
PCR +
n (%)
PCR (-)
n (%)
Tổng
ART for mother + ARV prophylaxis for infants +
Replacement Formula
ARV prophylaxis for mother during pregnancy+ ARV
prophylaxis for infants+ replacement formula
5 (0.7)
681 (99.3)
686
25 (2.4)
1003 (97.6)
1028
ARV
30 (5.5)
520 (94.5)
550
No information of ARV for mother and nutrition + ARV
prophylaxis for infants
56 (6.5)
808 (93,5)
864
ARV prophylaxis for mother + No ARV prophylaxis for
infants
No ARV for PMTCT (mother and their babies)
4 (6.6)
57 (93.4)
61
120 (45.1)
146 (54.9)
266
No information on ARV using
72 (34.3)
138 (65.7)
210
ARV prophylaxis for mother during labor+
prophylaxis for infants+ replacement formula
PMTCT assessment in Malawi 2013: PCR rate in HEIs was 4.1%, in group that mothers
and their babies received ARV prophylaxis was 10.3%, in other group that mothers
received ART was 1.4%. 90% mother with HIV infection were breastfeeding mothers.
Kim M. H.et al. PLoS One, 2013
The 6th National Scientific Conference on HIV/AIDS
PCR test result among HEIs
who receiving PCR testing (n=3665)
Rate of the PCR positive cases among HEIs who had PCR testing was 8.5%.
Estimated rate of HIV transmission from mother to child is 12.5% in 2014
The 6th National Scientific Conference on HIV/AIDS
VAAC report. 2015
Some barriers related to PMTCT interventions
1. Barriers related to mothers;
2. Barriers related to services, health care workers;
3. Barriers related to social, economic status
Mothers have not receive HIV testing and late diagnosis with HIV,
Mothers with HIV infection/ babies were not or late to access ARV for PMTCT
Children living with HIV
The 6th National Scientific Conference on HIV/AIDS
Some barriers related to PMTCT interventions
• Barriers related to mother: they did not want to HIV testing or late
diagnosis with HIV: Lack of awareness of mothers on importance of
PMTCT, self payment, ...
Pregnant women think that
PNMT they have no disease, no
risk to get HIV infection so they
did not agree to HIV test.
HCW in OBGYN , 45 years old
All pregnant women receive
counseling, but some people
refused to HIV test due to selfpayment and without cover by
health insurance
HCW in OBGYN , 43 years old
The 6th National Scientific Conference on HIV/AIDS
Some barriers related to PMTCT interventions (cont.)
• Barriers related to PMTCT services:
• Limited coverage on PMTCT services, available at high prevalence
area, project, at high level..
• Health insurance has not covered HIV test fee for pregnant women,…
In rural and distant areas, pregnant
women delivering children at home,
health commune stations or even
district healthcare centers are not
tested for HIV before childbirth.
Mother đii not know HIV status so did not
bring children until chidren get sick. This
group has a very high rate of HIV
infection. Our hospital is implementing
counselling and HIV testing for children
suspected with HIV infection
HCWs, PAC, 38 years old
My baby was 10 months old
when I found myself infected
with HIV, transmitted from my
passed-away husband.
Mother of child who
was 13 months,
th
HCWs in OPC, 51 years
old
The 6 National Scientific Conference on HIV/AIDS
Some barriers related to PMTCT interventions (cont.)
• Barriers related to PMTCT services:
– Limited human resource, limited counseling, practice for infected
mothers at obstetric care facilities.
We only wish that our staff at the
obstetric department can have more
trainings on HIV knowledge and
PMTCT. We need more awareness on
this issue to provide better
counselling.
We could not do anything for pregnant
women at labor because there were not
enough equipment and It was not easy to
confirm HIV status, so ARV prophylaxis did
not provide for pregnant women during labor.
HCW in OBGYN, 38 years old
HCW in OBGYN, 41 years old
The 6th National Scientific Conference on HIV/AIDS
Some barriers related to PMTCT interventions (cont.)
• Stigma and discrimination in family and community are still key
barriers to mothers to access PMTCT and HIV status disclose
We provided counseling on
ARV during pregnancy but she
did not agree because she
think that if her husband is
tested negative, he will kick us
out of house.
HCW in PAC 45 years old
More mothers get HIV infection before get
ting married. Mother might be worried about
family breakdown after husband knowing the
mother and maybe the child have HIV , so
women had to go to other provinces where
HIV test will not be performed.
HCW in OBGYN, 45 years old
The 6th National Scientific Conference on HIV/AIDS
Conclusion
• The rate of pregnant women who were detected HIV infection
status during labor and after delivery was high. It were limited
to receive ARV for PMTCT
• The PCR positive rate among HEIs who born to a mother
who received ART during pregnancy was very low
• Lack of awareness among HCWs on PMTCT, unavailability of
services, and stigma and discrimination are still the key
barriers of mothers accessing PMTCT
The 6th National Scientific Conference on HIV/AIDS
Recomendation
• Provide early HIV test for pregnant women and ART for
pregnant women with HIV infection for effective PMTCT
program.
• Implement effectively new guidance related to PMTCT to
increasing the accessibility HIV testing and ART for pregnant
women and bread feeding mother with HIV infection
The 6th National Scientific Conference on HIV/AIDS
Acknowledgment
• Study Team : Do Thi Nhan, Duong Hoai Minh, Nguyen Thi
Minh Thu, Le Thi Huong, Pham Van Anh, Bui Duc Duong
• Supports from patients, care givers, HCWs in OBGYN, C&T
sites
• Provincial HIV/AIDS Centres
• Vietnam Authority on HIV/AIDS Control
• Clinton Health Access Initiative, Vietnam
The 6th National Scientific Conference on HIV/AIDS
Thank you for attention!
Forward….
Cuba received formal validation from
PAHO/WHO that it has eliminated
mother-to-child transmission of HIV.
Nacer sin VIH-...
The 6th National Scientific Conference on HIV/AIDS