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Frerichs, R.R. Guidelines for preventing mother-to-child HIV transmission.

SEA-AIDS Network, October 14, 1998.

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.