Thidarat Jupimai, MSc, PhDc
Nominated From: University of Hawai’i
Research Site: Thailand
Research Area: HIV/AIDS; AART; Maternal and Child Health
Primary Mentor: Dr. Vivek Nerurkar
Challenges in initiating early antiretroviral therapy and maintain adherence among HIV1 infected infants, Thailand
In Thailand, the prevalence of HIV infection in pregnant women is 0.6%, the PMTCT transmission rate is 2.3% There are approximately 4,900 infants born to HIV positive mothers and approximately 100 infants are perinatally infected with HIV. Thai Ministry of Public Health adopted Global campaign “Getting to Zero” lanced by UNAIDS aiming for eliminating new HIV infections among children. The Ministry of Public Health (MoPH) in collaboration with Thailand MOPHUS CDC Collaboration, and HIVNAT The Thai Red Cross AIDS Research Centre established the Active Case Management Network for Early Antiretroviral Treatment in HIV-infected Infants Aiming to HIV Cure (ACC) program in April 2014. The program aims to identify HIV1 positive infants and promptly initiate ART.
As of 2013, 3.2 million children of age less than 15 years of age are living with HIV globally. Among the 2.1 million people newly infected are 240,000 children younger than 15 years old. However only 24% of children living with HIV were receiving Antiretroviral treatment (ART).With the Prevention of Mother-To-Child Transmission (PMTCT) cascade and early infant diagnosis, more infants and children can be identified and initiate treatment.
Providing Antiretrovirals (ARV) to young infants is a challenging task, due to factors such as readiness of caregivers especially postpartum mother, complexity of ARVs for infants in terms of adjusting dose and formula issue. Therefore, both health care providers and caregivers must be well prepared and overcome several obstacles to deliver lifesaving ARV to infants. According to ACC program; only 70% of HIV-infected infants identified through Thai national early infant diagnosis program had initiated ART with median (IQR) age at ART initiation of 88 (74138) days.
As per the Global target to reduce morbidity and mortality from AIDS, early initiation of ARV in infants is very important, since about half of HIV-infected infants is a rapid progress or that will developed HIV-related symptoms/AIDS within 2 years of life. The study is aimed to address the attitudes and challenges for initiating ART for HIV-infected infants and also adherence to treatment among caregivers and health care providers. We are interested in exploring the reasons why those individual cases did not initiate ART as well as those patients who early initiated ART, how difficulties to maintain in good adherence since adherence are the most important for patients to achieve viral suppression.
Genital shedding of HIV after scheduled treatment interruption.
Pharmacokinetics and 48 week efficacy of low-dose lopinavir/ritonavir in HIV-infected children.
Long-term efficacy and safety of first-line therapy with once-daily saquinavir/ritonavir.