Columbia University’s MTCT-Plus Initiative Enrolls Patients in Thailand

January 2004—The Thai Red Cross AIDS Research Centre (TRC-ARC) is serving as one of 12 pilot sites for Columbia University’s ambitious MTCT-Plus Initiative, which began enrolling patients in early 2003. Expanding upon successful perinatal transmission programs in the developing world, the initiative increases the range of services available to HIV-positive mothers and their families.

Dr. Wafaa El-Sadr, director of MTCT-Plus

MTCT-Plus patients, not only women but also their partners and children, will have ongoing access to medical services, including antiretroviral (ARV) therapy if indicated. Families will also receive nutritional support, psychosocial services, and patient education.

In its current phase, the MTCT-Plus Initiative aims to serve at least 10,000 patients in eight countries: Cote d’Ivoire, Kenya, Mozambique, Rwanda, South Africa, Thailand, Uganda, and Zambia. TRC-ARC, which is overseeing the Thai component, has selected three hospitals where families are currently being enrolled. The organization hopes to expand to more sites, including at least one in a rural area.

Thai Red Cross perinatal HIV prevention activities date back to 1996, when Her Royal Highness Princess Soamsawali sponsored a nationwide program in which HIV-positive pregnant women received free zidovudine to reduce the likelihood they would transmit the virus to their children.

The program helped keep transmission rates relatively low. However, potent ARV regimens and other components of a first-rate health care program often have not been available to HIV-positive mothers in Thailand, nor to their partners, who may also have HIV. Therefore, even when perinatal transmission does not occur, entire families remain vulnerable: mothers and fathers in danger of losing their lives to HIV-related illnesses, and children at risk of becoming orphans.

The MTCT-Plus Initiative believes that successful perinatal HIV prevention programs in developing countries can also deliver additional services and reach out to families. “Taking care of the whole family is critical to achieving the best outcomes for individuals, families and communities,” said MTCT-Plus Director Dr. Wafaa El-Sadr of Columbia’s Mailman School of Public Health, who is also a member of amfAR’s Board of Governing Directors.

Another hallmark of MTCT-Plus is its emphasis on preparing multidisciplinary care teams to respond collectively to families’ needs. The Thai teams include physicians, nurses, social workers, and HIV-positive people.

“Columbia is stressing that holistic health care is important, and we totally agree. But we wouldn’t have known how to do this on our own,” said the TRC-ARC’s Dr. Nittaya Phanuphak Pungpapong. She reported that setting up care teams has been challenging, in part because team members with different responsibilities are not accustomed to sharing information and formulating strategies together.

Nonetheless Pungpapong praised the program for “allowing us to do things the Thai way,” a flexibility that enables the program to meet local needs. For example, pregnant women in the Thai MTCT-Plus cohort will receive Thailand’s standard perinatal prevention regimen instead of that outlined in MTCT-Plus clinical guidelines.

Funding from MTCT-Plus will enable the TRC-ARC to enroll at least 750 patients in the first three years. The TRC-ARC has launched its own MTCT-Plus program under the patronage of Princess Soamsawali, which has enrolled an additional 250 patients in the first year.

Pungpapong sees the Thai MTCT-Plus program as an example of how developing-world physicians can negotiate on behalf of their patients in order to maximize limited domestic and international resources.