Mother-to-child HIV transmission a continual threat to new-born

The Ministry of Health updates the HIV epidemic in the country every 6-months and this is one of the highest cases detected in the 6-monthly reports until now

Two MTCT of HIV cases were among 40 new cases of HIV detected from January to June this year

LHAKPA TSHERING

Thimphu

Despite the scaled-up prevention of mother-to-child transmission (PMTCT) of HIV (human immunodeficiency virus) program since 2006 to eliminate it by 2030 in the country, MTCT continues to escalate amongst females of reproductive age.

In the last six months from January to June 2022, two new cases of MTCT of HIV were detected among the 40 new reported HIV cases.

Both the mothers, according to the Ministry of Health (MoH), were found HIV negative during the first antenatal care (ANC) visit in 2016 and 2017, respectively.

However, they might 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.

The ministry stated these mothers went undetected during the later stages of their pregnancy checkups given that the policy of mandatory two-time HIV testing for pregnant mothers was not in place back then.

“The policy of two-time HIV testing – first visit and before delivery – was introduced in 2018 to prevent the risk of mother-to-child transmission,” it stated.

In addition, five pregnant women participating in HIV testing were diagnosed among antenatal care (ANC) mothers during this period.

Health minister Dasho Dechen Wangmo said that to achieve an AIDS-free generation, all pregnant mothers must avail the two-time HIV testing during their entire pregnancy period and avoid any risky behavior during breast-feeding to prevent mother-to-child transmission of HIV.

Lyonpo also urged all expecting parents to take additional responsibility to prevent MTCT of HIV to ensure that every child has a right to be born free from HIV.

40 new HIV cases in the last six months

The health ministry, in the last six months, detected 40 new HIV cases of which 19 are male and 21 are female, which indicated women of reproductive age suffer a high disproportionate burden of HIV compared to men.

The ministry updates the HIV epidemic in the country every 6-months and this is one of the highest cases detected in the 6-monthly reports until now.

These include 28 cases which account for 70 percent of the total cases aged between 25- to 49, eight cases or 20 percent above 50 years old, and the remaining 10 percent or two cases between the ages of 20- to 24 and below five years with five percent each.

Unprotected heterosexual practices continue to be the primary transmission of HIV with 38 infections while another two were from MTCT.

They diagnosed 13 new cases through medical screening followed by contact tracing with 12 cases, 10 through Voluntary Counseling and Testing (VCT), and five through screening of pregnant mothers attending the ANC services.

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

The cumulative number of cases reported from 1993 until June 2022 is 835 in 433 males and 402 females.

Services for early case detection and treatment

Despite the low prevalence of HIV in the country, the need to intensify HIV counseling and testing is being accorded high priority by the government to bridge the current case detection gap of 35.8 percent of the estimated 1,300 HIV cases in the country.

Health minister Dasho Dechen Wangmo said that while Bhutan struggles to find those untested and undiagnosed sexual and drug-injecting partners of people living with HIV owing to existing stigma and discrimination, the government is making significant strides in bridging the current case detection gap.

“Case detection gap has been reduced from 47.6 percent in 2019 to 35.8 percent in June 2022 resulting in an overall reduction of 11.8 percent in the last four years. However, it is not enough to meet the national and global target to end the AIDS epidemic by 2030,” she added.

Lyonpo also stated that besides the existing facility-based and mobile HIV testing services, the ministry also introduced HIV Self-Testing (HIVST) in six high-risk districts to ensure enhanced access to HIV testing services for early diagnosis and treatment.

Besides, works are underway to carry out the pre-validation assessment to check Bhutan’s readiness for the triple elimination of MTCT of HIV, syphilis, and hepatitis B by 2025.

Officiating Director for the Department of Public Health, Rixin Jamtsho, said that the ministry expanded its HIV testing program like never before and made it available in all the health care facilities across the country including the private diagnostic centers.

To enhance case diagnosis, the ministry will implement targeted index testing and partner notification services, streamline provider-initiated HIV counseling and testing services, and strengthen routine surveillance systems in the hospitals across the country.

In addition, MoH will also decentralize the HIV confirmatory test from the Royal Center for Disease Control (RCDC) to the regional referral hospitals for timely provision of the HIV confirmation results.