Since 2011, progress has been made globally in eliminating mother-to-child transmission (EMTCT) of HIV, but not fast enough to reach the 2020 targets, especially the ‘Super-Fast-Track Framework to end AIDS.’ In 2019, there were approximately 150,000 new HIV infections among children under five, highlighting the need to accelerate the prevention and treatment for all pregnant and breastfeeding women living with HIV in order to eliminate new infections among children and reduce HIV-related deaths of pregnant women and new mothers.
In line with the targets of SDG3 (good health and well-being), the global community has committed to EMTCT of HIV and syphilis as a public health priority, but this requires an increased focus on integrating HIV interventions and prevention of mother-to-child transmission services within broader sexual, reproductive, maternal, newborn, child and adolescent health programmes, as well as ensuring equitable access for all women, including the most vulnerable.
In 2016, Thailand became the first country in Asia to eliminate mother-to-child transmission of HIV and syphilis. Since this success in 2016, and validation of maintenance of EMTCT in 2018 and 2021, many countries globally have been benefitting from Thailand’s vast experience, lessons learned and good practices in this area of work. More broadly, the country has become a global knowledge resource centre for systems strengthening for universal health coverage, accessible and quality maternal and child health care and data and information management system.
The elimination of mother-to-child transmission (EMTCT) of HIV and syphilis in Thailand is attributed to the meeting of science, medicine and political commitment. Through the government’s South-South and Triangular Cooperation agenda managed by the Thailand International Cooperation Agency (TICA) under the Ministry of Foreign Affairs, the government has been sharing its experience, knowledge and technical expertise with other countries globally. Since 2017, TICA has partnered with UNICEF on EMTCT. Other stakeholders brought into the partnership include the Department of Health, Department of Disease Control, UNAIDS, WHO, TUC (a Thailand Ministry of Public Health-U.S. Center for Disease Control collaboration), independent experts and civic organizations, resulting in the attainment of a comprehensive set of technical expertise, experience, inputs, insights and resources. Through Thailand’s South-South Cooperation initiatives, several countries globally have had a chance to learn from Thailand’s experience and receive support to adapt solutions to their context. These include China, India, Kazakhstan, Myanmar, Tajikistan, Ukraine and Uzbekistan.
The current collaboration agreement on EMTCT between UNICEF, TICA and the Department of Health, covering June 2020-December 2021, includes cost sharing, technical expertise and manpower for increased coordination. The cooperation is framed within SDG 3: good health and well-being, especially ending the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combatting hepatitis, waterborne diseases and other communicable diseases (target 3.3), and aims at the following:
Since the outbreak of the COVID-19 pandemic in 2020, Thailand adapted its country support to new modalities. An online workshop was organized in October 2020 with 21 participants from Lao PDR to disseminate and share knowledge, experience and lessons learned. The workshop covered several topics, including PMTCT programme and service delivery (HIV and syphilis), active case management networks for early anti-retroviral therapy initiation among HIV positive infants, EMTCT validation processes, data and information management systems, laboratory systems and information management and human rights, gender equality and community engagement. Prior in-person hospital visits were transformed into two five-minute videos displayed during the presentation (on entry of pregnant women into formal health systems at antenatal care and laboratory systems and information management for antenatal care).
Prior direct observational learning, knowledge sharing and mentorship methods had proved successful, with most of the 47 participants in the 2019 workshop expressing through an evaluation their satisfaction with the content of the sessions. A main output from the workshops was a practical application of the learning, in which participants prepared roadmaps to EMTCT validation, and revisions were incorporated into existing EMTCT plans of the respective countries.
It has been found that the more recent online methodology, used in the context of COVID-19, may be even more replicable and sustainable. During an online workshop, interaction with participants was stimulated during Q&A at the end of each session and through the Zoom chat box function. Translation was provided to participants who do not speak Thai. Evaluations were conducted twice during the workshop, at the end of the morning and afternoon sessions, which reflected the participants’ satisfaction with the online modality. This new modality of remote collaboration through SSTC can be extended as systematic programme support to achieving the global commitment to end AIDS by 2030, focusing on EMTCT.
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