2 HIV cases of under five toddlers due to Mother to Child Transmission not detected at the right time

The country detected 40 new HIV cases in the last six months from January to June 2022, of which 19 are male and 21 are female. Out of 40 newly diagnosed cases, the majority are between the ages of 25-49 years old and 20 percent of them are above fifty years old while 5 percent are between the ages of 20-24 years and another 5 percent are below 5 years.

Among the new cases, 13 are diagnosed through medical screening, 12 through contact tracing, 10 through Voluntary Counseling and Testing (VCT), and 5 through screening of pregnant mothers attending the Antenatal Care (ANC) services

Out of 40 new cases, 38 of them have contracted HIV through unsafe heterosexual practices and 2 from Mother to Child Transmission (MTCT).

Regarding the two MTCT cases, it was learned that both the mothers were found HIV negative during the first ANC visit in 2016 and 2017 respectively. However, these two pregnant mothers may have been exposed to HIV infection after the first HIV test and during the latter stage of their pregnancy (after the first ANC visit, before delivery, or during breastfeeding) and then transmitted it to their children.

These mothers went undetected during the later stages of their pregnancy checkups because back then there was no policy of mandatory two-time HIV testing for pregnant mothers. The policy of two-time HIV testing (first visit and before delivery) was introduced in 2018 to prevent such risk of mother-to-child transmission.

If the mother had been detected in time, then there are various measures to try and prevent mother to child transmission of HIV.

Over all, 835 HIV positive cases were reported from 1993 until June 2022, of which 433 were male and 402 females. From 2000 to 2013, the number of new HIV diagnosis rose from 9 to 51.

Currently, about 628 people are living with HIV (PLHIV) in the country. Out of 628 PLHIV, 608 are on antiretroviral treatment (ART) resulting in 97 percent treatment coverage among the living cases.

Despite the low prevalence of HIV in Bhutan, the need to intensify HIV Counseling and Testing is being accorded high priority by the Royal Government to bridge the current case detection gap of 35.8 percent of the estimated 1300 HIV cases in the country.

The health minister Dasho Dechen Wangmo said, case detection gap has been reduced from 47.6 percent in 2019 to 35 percent in June 2022 resulting in overall reduction by 11.8 percent in last four years but it is not enough to meet the national and global target to end the AIDS epidemic by 2030. Therefore, in addition to the existing facility based and mobile HIV testing services, the health ministry has also introduced HIV Self-Testing (HIVST) in six high-risk districts to ensure enhanced access to HIV testing services for early diagnosis and treatment.  

Also urged all expecting parents to take additional responsibility for the prevention of mother-to-child transmission of HIV to ensure that every child has a right to be born free from HIV.

On the coverage and accessibility of HIV testing services in Bhutan, the Officiating Director for the Department of Public Health, Rixin Jamtsho, said, the health ministry has expanded its HIV testing program like never before and it is available in all the health care facilities across the country, standalone community testing center called health information and service center (HISC) in six major urban areas, namely, Thimphu, Phuentsholing, Gelephu, Samdrup Jongkhar, Lobesa and Trongsa including the private diagnostic centers.

He said, it is important to know that timely testing is the only means to know your HIV status to initiate early treatment and that good adherence to the treatment is indispensable for achieving an effective treatment outcome. He explains that unlike in the past, now there are scientifically proven effective HIV medicines that can reduce the viral load in the body and improve the immune system of the PLHIV.

Meanwhile, the health ministry will continue to strive hard to bridge the current case detection gap to achieve sustainable development goals to end the AIDS epidemic by 2030.

Four key strategies will be implemented to enhance the case diagnosis.

These are  phase-wise scaling up of the HIV self-testing and counselling services across the country, implementing the contact tracing and partner notification services, provider-initiated HIV counselling and testing services to be streamlined and strengthened across the health facilities to enable healthcare providers to provide HIV testing to any persons attending health care facilities as a standard component of medical care, strengthen the routine surveillance systems in the hospitals across the country to meet the requirement of the elimination of Mother to Child Transmission of HIV, Syphilis and Hepatitis B by 2025.

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