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Session 123 Poster Abstracts
Mother-to-Child Transmission
Tuesday, 1:30 - 3:30 pm
Poster Hall


894    
Parallel MTCT-Plus Programs: Experiences and Lessons Learned from Thailand
N Phanuphak*1, S Teeratakulpisarn1, T Apornpong1, C Tasai1, W El-Sadr2, and P Phanuphak1
1Thai Red Cross AIDS Res. Ctr., Bangkok, Thailand and 2Mailman Sch. of Publ. Hlth., Columbia Univ., New York, NY, USA

Background:  A successful Thai Red Cross AIDS Research Centre (TRCARC) prevention of mother-to-child transmission program initiated in 1996 using public donation money has led to a continuation program called “Treat the Parents and Save the Orphans,” the TRC MTCT-Plus program in 2003. TRCARC was also selected as 1 of the 13 sites around the world to demonstrate the concept of Columbia University (CU)’s MTCT-Plus program. Both MTCT-Plus programs were run together while keeping as minimal differences between them as possible.

Methods:  In February 2003, we started enrolling Thai HIV-infected women and families in 4 hospitals. Both programs used the MTCT-Plus protocol modified to go along with the country’s guidelines. To prove that both programs can be run together without creating double standard of care, we compared the percentages of enrollees received basic HIV care between the 2 programs using chi-square test.

Results:  Protocol modification were:  inclusion criteria‑CU allowed no more than 50% of women be “old” (delivered July 2002 to January 2003), while TRC aimed to enroll as many “old” (any woman from previous TRC pMTCT since 1996) women as possible; co-payment with waiver‑to encourage enrollees to be self-supporting for the cost of their own CD4 test and ARV eventually, all enrollees were asked to co-pay for CD4 test and male partners were asked to co-pay for ARV; ARV follow-up‑we replaced 8 weekly follow-up visits by telephone follow-up in week 1, 3, 5, and 7 to minimize difficulties of enrollees being absent from work, which was seen to enhance adherence rather than to risk ARV side effects. Enrollment as of September 2003 at CU sites included 42 old and 54 new (currently pregnant) women, in a total of 216; whereas TRCARC included 98 old and 24 new women, in a total of 211.

 

MTCT-Plus program

CU (%)

TRCARC (%)

p

Enrollees received ARV if eligible

100

96

0.027

Enrollees received OI prophylaxis if eligible

96

94

0.678

Women and families received ARV

“New”                                                         

32.7

19.5

<0.25

“Old”

26.2

31.2

<0.5

Adults received baseline TST

54

60

0.408

HIV-exposed infants/children received PCP prophylaxis

56

25

0.104

CD4 test co-payment (fully paid)

99.5 (88.8)

100 (99.2)

0.002

Male ARV co-payment

% n

88.9

38.1

0.001

% visits

39

19.8

0.005

% actual cost

11.3

6.1

‑

 

Conclusions:  MTCT-Plus programs no matter using money from public donation or international funding agencies, can be integrated and coordinated to maximize benefit to the country’s health care system.

Keywords: MTCT-Plus; Thailand; developing country