The Bhutanese Leading the way.
Since the diagnosis of the first mother-to-child transmission (MTCT) case, a total of 187 pregnant mothers were detected with HIV from 2002 until 2022. Out of which, 127 babies are found to be negative while 42 are HIV positive (39 MTCT cases are infected without prevention of mother-to-child transmission (PMTCT) intervention and 3 with PMTCT intervention) and the remaining 11 were still under the confirmation of their HIV status after completion of 18 months, while 4 of children have died. Figures show that in the last five years (2018-2022), there was one MTCT case reported in 2020.
However, since the start of PMTCT interventions in Bhutan, a total of 139 pregnant mothers were diagnosed with HIV through the routine Antenatal Care (ANC) check-up.
The first case of MTCT was reported in Bhutan in 2002. However, the retrospective study shows that one of the earliest MTCT could have taken place back in 1997, as one child was already eight years old when detected with 3 HIV infections in 2004. Thirteen children are recorded with HIV infection from their mothers as of February 2006. This constitutes nearly 9 percent out of the total detected cases of 160.
The routine program data from the Care, Support and Treatment (CST) of NACP located in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) shows an average number of 0.2 MTCT cases and 8.8 PMTCT cases (ANC HIV Positive Mothers) in the last five years (2018-2022).
An official from the Department of Public Health, Ministry of Health said that the PMTCT services started in 2002 and until 2017, pregnant mothers had to go through a one-time HIV testing policy during ANC visits in the hospital. 2018 onwards, the health ministry has initiated two-time HIV testing, but globally it is recommended one-time HIV testing during the entire pregnancy.
During the ANC visit, mothers are provided with PMTCT services where they are screened for HIV, Hepatitis B and Congenital Syphilis.
The majority of the HIV cases of mother to child are those cases who are infected a long time, back where the mothers have not availed the PMCT services. A few reasons might be that the mothers have delivered their babies at home or might not have visited the hospital and tested for HIV.
For instance, the majority of the mothers have come for PMTCT services during their second pregnancy, and that is when they are diagnosed as HIV positive. The health workers do the risk assessment and also do the contact tracing, as per the health protocol.
The most significant source of HIV infection is in children below the age of 10 years. Transmission can occur during pregnancy, delivery, after delivery and through breast milk. However, with the initiation of PMTCT services, the health workers have been able to prevent mother-to-child HIV cases so far.
The official said as compared to many other infectious diseases, timely diagnosis for HIV testing is very important because HIV remains in the body for a very long period, without any signs and symptoms. So, if an infected individual is not diagnosed on time, then the individual might spread to others by that time. Therefore, testing is very important.
The benefits of timely testing and treatment are that the mothers can get the care and support, reduce the HIV viral load in the body, improve the body’s immune system, and prevent further transmission.
Therefore, all pregnant mothers should avail themselves of HIV testing services twice from their nearest health centers, and know their HIV status. The first test is done during the first visit to the ANC, and then the second test is during the last trimester.
Meanwhile, Bhutan has completed the pre-validation assessment to see Bhutan’s readiness for regional validation for the triple elimination.
In Bhutan, the prevention of MTCT of HIV was started in 2006 with the aim of zero vertical transmission. The National HIV/AIDS and STIs Control Program has initiated the PMTCT services by integrating them into the mother and child services in all the hospitals using rapid testing kits for the triple elimination target. Since then, the number of HIV cases among newborn babies has reduced drastically despite the HIV-positive cases being diagnosed among pregnant mothers over the period.
However, there is one HIV-positive case among infants in 2018 transmitted through breast milk, and it was found that the mother was exposed to HIV infection during her late postnatal period.
According to the available evidence from the national program, it has been the last four years (2016-2019) without any HIV-positive newborn babies, despite 11 positive pregnant mothers being diagnosed in the same year. These cases are mostly diagnosed at the hospitals using rapid test kits, and then confirmed at the national reference lab at Royal Center for Disease Control in Thimphu.
As per the existing HIV management treatment guidelines, in 2016 newborn babies are provided with free formula milk to ensure that a positive mother does not breastmilk her baby. The current treatment regimen followed in Bhutan for the PMTCT is option B+ as per 2015 WHO recommendations.
