VietNamNet Bridge – A 25-year-old mother from HCM City's Binh Thanh District was unsure about what to do when she became pregnant as she had contracted the immunodeficiency virus (HIV) from her husband, who had once been a user of recreational drugs.




Nguyen Thi Thanh Thao (not her real name) said that her mother-in-law had suggested an abortion.

To resolve the matter, Thao and her family visited the Phat Tam HIV/AIDS Prevention Division in Binh Thanh District's Ward 21 for counselling. The division is part of the HCM City AIDS Prevention Committee.

There, they met Truong Ngoc Nhu, the division's head who persuaded Thao to continue her pregnancy and take part in a programme to prevent mother-to-child transmission of HIV.

Thao was introduced to the Community Support and Counselling Centre in Binh Thanh District.

Pregnant women who have HIV and are 14 weeks pregnant are eligible for the prevention programme if their CD4 cell count, the type of white blood cell that fights infection, is more than 350. If it is less than 350, then they qualify for the anti-retroviral (ARV) treatment programme.

Thao was given medicine two times a day until the end of the first week after delivery. Thao's son also was provided medicine at delivery and until he was one month old. He was also provided formula milk and was not breast-fed.

When he was one month old, he was brought to the city's Paediatrics Hospital No. 2 for HIV tests, which were negative.

Like Thao's son, the son of 44-year-old HIV-positive mother Phan Thi Anh Tuyet (not her real name) has been free of HIV also, tests results show.

The thin mother with pale skin, who rents a room of only six square metres, takes care of her child with her husband.

Tuyet said she had never been tested for HIV until she went into labour.

Tests were positive and she received medication under the city's mother-to-child prevention programme. Her son's tests at Paediatrics Hospital No. 2 proved to be negative.

According to the World Health Organisation, in the absence of any intervention, transmission rates to the child can range from 15-45 per cent. The rate can fall below 5 per cent with effective intervention.

Truong Huu Khanh, a member of the Viet Nam Administration of HIV/AIDS Control's Division for HIV/AIDS among Children, said the city's mother-to-child transmission prevention programme was the best in the country.

Last year, the city recorded a total of 642 pregnant women infected with HIV.

Of them, 588 accessed the prevention programme during pregnancy, labour and delivery, and 80.8 per cent received early prevention during pregnancy. The rest was for labour and delivery.

The city said that 99.7 per cent of babies received prevention measures after delivery in 2013.

As a result, the city HIV transmission from mother to child or breastfeeding fall to 2.3 per cent in 2013 from 6.9 per cent in 2006.

An initial evaluation of the effectiveness of prevention treatment of HIV transmission from mother to child at the National Gyneco-Obstetrics Hospital in Ha Noi between October 2010 and June 2011 showed that the rate of transmission was 1.49 per cent.

Lifelong prevention

Dr Tran Thi Doan Trang, a specialist in the prevention programme and a member of HCM City AIDS Committee, said that the Ministry of Health had approved HCM City AIDS Prevention Committee to carry out a lifelong anti-retroviral (ARVs) treatment for all HIV-positive pregnant women, regardless of their CD4 cell count.

The lifelong treatment is known as Option B+, she said.

Previously, pregnant women with HIV received the ARV treatment when their CD4 count was under 350. If the CD4 count was more than 350 in post-pregnancy, the treatment would end.

Last November, the Option B+ pilot programme began in the provinces of An Giang, Quang Ninh, Thai Nguyen, Thanh Hoa, Lao Cai and Nghe An, she added.

The treatment was recommended by the World Health Organisation last year.

Le Truong Giang, chairman of the city's Public Health Association, said the Option B+ would help end HIV transmission from mother to child within the next two years.

Khanh said it would help protect babies from HIV transmission, and lead to elimination of new HIV infections among children.

Option B+ would also improve pregnant women's resistance to disease, and it could also prevent sexual transmission to sero-discordant partners.

"It is very important to be very safe for babies, and for it to not be costly," said Khanh.

The simplification of the daily regimen, with a single-pill fixed dose combination, would help prevent women from giving up too early, especially women in HCM City's rural areas, Khanh said.

In late 2011, the Option B+ programme was carried out throughout Malawi in Africa.

After only three months, Malawi saw very positive results, with the total number of all patients receiving antiretroviral treatment in the national programme increasing by an astounding 88 per cent.

A research report of the cost-effective analysis of Option B+ for HIV Prevention and Treatment of Mother and Children in Malawi published last March showed that the Option B+ not only prevented infant infection but also improved the 10-year survival rate in mothers more than four-fold.

This translates into savings of more than 250,000 maternal life years, compared to different prevention and treatment measures related to CD4 cell count, which have savings of 153,000 to 172,000 life-years.

The Option B+ also yields favourable incremental cost-effectiveness ratios of US$455 per life each year compared to current practices.

The research study was conducted by Malawi's Ministry of Health's HIV and AIDS Department in co-operation with local and foreign organisations and universities.