Thailand eliminates mother-to-child transmission of HIV and syphilis.

2488 www.thelancet.com Vol 387 June 18, 2016 On June 7, 2016, WHO certifi ed that Thailand had eliminated mother-to-child transmission of HIV and syphilis, becoming only the second non-Organisation for Economic Co-operation and Development country after Cuba to achieve these goals. WHO also validated Belarus for eliminating mother-to-child transmission of both HIV and syphilis on June 8. This is not only a public health success story for Thailand, but also an affi rmation of how internationally agreed aspirational goals—from WHO’s Health for All by 2000 campaign and the UN’s 2001 Declaration of Commitment on HIV/AIDS to the Millennium Development Goals and the Sustainable Development Goals—can help health ministries to mobilise political will, public funds, and committed implementation. Thailand’s commitment to address mother-tochild transmission of HIV started in the 1980s, when the spread of AIDS began to accelerate. The country’s fi rst steps were to provide family education and premarital counselling, encouraging couples to be tested for HIV before having children. In 1990–91, some large hospitals started routine screening for HIV in antenatal clinics to protect health workers in the absence of eff ective interventions. The Government of Thailand’s concern about motherto-child transmission intensifi ed as the epidemic worsened. By 1995, national HIV antenatal prevalence had peaked at 2·3%, the highest ever recorded in Asia. However, at that time the high cost of antiretroviral treatment with zidovudine and technical capacity constraints prevented large-scale provision of zidovudine within the national programme. But by 1998, domestic research trials and pilot programmes undertaken by the government in collaboration with WHO, UNAIDS, the US Centers for Disease Control and Prevention, and other partners confi rmed that the use of short-course zidovudine could cut the risks of mother-to-child transmission by half. Thailand then began a countrywide programme that provided shortcourse zidovudine as a routine part of antenatal care, tripled the budget for prevention of mother-to-child transmission (PMTCT) services, and lowered costs by manufacturing generic versions of zidovudine locally. Coverage expanded rapidly, so much so that by 2001, two in three pregnant women were covered by PMTCT services. In that year, the government guaranteed universal access to PMTCT services, integrating these into the new universal health coverage scheme. Consequently, by 2009, 94% of pregnant women were counselled and tested for HIV, 94% of HIV-positive pregnant women received antiretrovirals, and an estimated 62% to more than 95% of infants born to HIV-infected women received antiretroviral prophylaxis for PMTCT. In 2015, 99·6% of infants born to HIV-positive mothers in Thailand received antiretroviral prophylaxis. In 2011, Thailand committed itself to the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping their Mothers Alive. The government’s decision to provide all pregnant women—including migrant workers, in whom substantially higher antenatal rates of HIV have been recorded—free antenatal care, delivery, and PMTCT services for HIV and syphilis pushed coverage rates higher. This concerted action culminated in Thailand’s certifi cation of elimination on June 7. WHO and UNAIDS estimate that Thailand’s eff orts on PMTCT prevented nearly 17 000 new HIV infections in infants between 2000 and 2015. In 2015, for instance, 85 infants contracted HIV rather than the 1076 who Thailand eliminates mother-to-child transmission of HIV and syphilis