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R.R.
Frerichs Posting
Those focusing on ways to limit mother-to-child transmission of HIV
will welcome the current Weekly Epidemiological Record (WER) of the World
Health Organization (vol. 73, no. 41, 313-320, October 9, 1998) which provides
useful recommendations for persons working in high HIV prevalence countries
in Asia.
The authors describe the 51% reduction that occurred in Thailand with
a short course of twice-daily oral zidovudine (AZT) used from 36 weeks'
gestation until delivery.
They further point out that adherence to the short AZT course was very
good in Thailand, offered in medical settings with counseling and access
to free infant formula.
Besides infants, the article comments about identifying discordant parents
(i.e., one positive and the other negative) and the importance of offering
advice to both about ways to avoid additional HIV transmission. Finally,
the WHO publication notes that simple and rapid same-day tests are becoming
available, reported to be both acceptable and accurate. Such tests will
be more fully described in the October 16th WER (i.e., vol. 72, no. 42).
More experimentation with HIV testing and delivery of AZT therapy is
needed in those Asian countries where women often deliver at home, either
with the assistance of family members or midwives. The WER article attempts
to address these problem, but offers no examples of creative solutions
that work in areas where resources are often limited. Given the financial
and organizational difficulties that face public health officials in many
countries of the region, it is important for those in the field to share
their successful experiences, relating the cost of the undertaking to the
effectiveness of identifying HIV infected women, getting them to take AZT,
discussing the results with husbands, and finally to the impact of preventing
infection in the offspring.
Are the guidelines offered by WHO practical in high HIV prevalence countries
such as India, Myanmar and Cambodia? Are more simple guidelines needed
that require less organization, labor and ultimately money, given the many
other health problems that must be confronted?
What strategies are being developed by on-governmental organizations
as they reach out to save children of HIV infected women from viral transmission?
Will rapid tests be appealing, allowing women to avoiding multiple trips
to learn of their HIV status? Are concerns over detection and disclosure
so great that HIV testing is avoiding, at the expense of infant lives?
SEA-AIDS provides an excellent forum for sharing practical results,
or at least letting others know of on-going struggles by field investigators.
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