Preventing Mother-to-Child Transmission of HIV in Vietnam:

An Assessment of Progress and Future Directions

by Chinh T. Le,a Thanh Tung Vu,b Minh Chau Luu,b Thi Nhan Do,b Thu-Ha Dinh,c and Mary L. Kambc
a
This study was conducted while the author was contracted by the Global AIDS Program (GAP), Vietnam Office, Centers for
Disease Control and Prevention (CDC), Hanoi, Vietnam. Current affiliation: Benton County Department of Public Health,
OR 97333, USA
b
Ministry of Health, LIFE-GAP Office, Socialist Republic of Vietnam
c
GAP Vietnam Office, CDC, Hanoi, and currently with the Division of Sexually Transmitted Disease Prevention, CDC,
Atlanta, GA 30333, USA

Summary
Preliminary to the development a new program supporting perinatal HIV prevention, this assessment
was conducted to evaluate Vietnam’s national prevention of mother-to-child HIV transmission
(PMTCT) program by estimating HIV prevalence among prenatal women and analyzing the healthcare
system capacity to deliver services. In 2002–03, a technical team reviewed existing national and local
surveillance and program data and conducted on-site interviews and observations at maternal-child
health (MCH) programs in the seven provinces with highest HIV rates. The team found that despite
high (85%) prenatal service utilization and widespread availability of HIV testing and dissemination of
prevention protocols, few HIV-infected mothers were identified in time to allow effective perinatal HIV
prevention. Program deficits clustered around the general areas of provider misunderstanding of
occupational HIV risk and MTCT, impractical PMTCT policies, and practices hampering effective use
of prevention and treatment protocols. Existing problems were significant but modifiable, and will
require implementation of practical and appropriate guidelines, enhanced clinical and laboratory
capacity, and continued program management and monitoring.

Key words: Prevention of mother-to-child transmission of HIV, Vietnam, perinatal HIV testing and
prophylaxis.

Acknowledgements
This article was funded by U.S. Centers for Disease
Control, Global AIDS Program. The authors thank
the clinical and public health staff at the provinces
visited and government officials who participated in
the interviews and provided documents and reports.
We thank Mr Patrick Chong for his assistance in the
evaluation, and Drs Nathan Shaffer and Mitchell
Wolfe, Mr Richard Noegel and Ms Jennifer Mark
for their review of the manuscript and helpful
suggestions.
Correspondence: Mary L. Kamb, Centers for Disease
Control and Prevention (CDC), Division of STD
Prevention, 1600 Clifton Rd., N.E. Mailstop E-02,
Atlanta, GA 30333, USA. Tel.: þ404-639-8632;
Fax: þ404-639-8609. E-mail: <mkamb@cdc.gov>.


The findings and conclusions in this paper and those of the
authors do not necessarily represent the views of the Centers
for Disease Control and Prevention.
Introduction
In 2005, 2.3 million children under 15 years of age
were infected with HIV worldwide, most perinatally
[1]. Global attention around perinatal HIV has
focused predominantly on sub-Saharan Africa,
where the epidemic is most severe. However, Asian
nations with low community HIV prevalence but
large populations contribute high numbers of global
infections [2, 3]. In Vietnam, by 2003 more than
245 000 persons were estimated to have been HIV
infected, including 2500 children infected perinatally
[4]. Initially driven by injection drug use (60–70% of
reported HIV cases) and sex trade, HIV was increas-
ingly observed to affect other population groups [5].
Accordingly, Vietnam’s national AIDS strategy
recognized not only the importance of interventions
for persons most vulnerable to HIV but also
promoted a program on preventing mother-to-child
transmission of HIV (PMTCT) integrated into the
existing maternal-child health (MCH) program [5–6].
Despite a large population (82 million) of whom
75% live in rural areas, Vietnam’s public health

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TABLE 1
Mother-child health (MCH) performance indicators,
Vietnam, 1997–2000
% of pregnancies that received no prenatal care:
National average: 28.3% (rural ¼ 31%,
urban ¼ 12.7%)
% of pregnancies that received three or more prenatal
visits:
National average: 34.5% (rural ¼ 29.2%,
urban ¼ 66.6%)
% of women who gave birth at home:
National average: 38.3% (rural ¼ 43%,
urban ¼ 8%)
% of pregnant women with anemia: 30%
Fetal and stillbirth deaths: 7 per 1000
pregnancies
Infant mortality 36.7 per 1000
(age 1–12 months): live births
% of newborns with 7.3%
birth weight <2500 gm:
Maternal mortality rate: 95 per 100 000
births
system is well developed and extensive, reaching rural
and urban areas in every province. Basic primary
health care services are delivered at the commune
level, and an estimated 92% of villages have a health
center [6–8]. By 1982, 85% of pregnant women had at
least one antenatal visit; and by 2000, 56% of
communes were served by a physician, 88% by an
assistant or midwife, and 77% of communes had a
trained health worker delivering basic preventive
interventions [6–9]. Most (96%) deliveries were
attended, at least by traditional birth assistants if not
midwives [8]. However, essential supplies were often
limited: In 2000, only 80% of commune health centers
had access to electricity, 50% to an infant scale, 41%
to a gynecological exam light, 15% to piped water,
and 12% to a telephone [6–8]. The infrastructure and
human capacity were superior at the district and
provincial levels, although quality varied [7]. National
performance indicators for 1997–2001 (Table 1)
indicated that MCH care in Vietnam lagged behind
wealthier Thailand and Malaysia, but functioned
more effectively than other resource-limited countries
in Southeast Asia and elsewhere [6–8].
The World Health Organization (WHO) has
recommended that national PMTCT programs
include three concurrent strategies: (1) prevention
of primary HIV infection among childbearing
women; (2) prevention of unwanted pregnancy
among HIV-infected women; and (3) interventions
preventing HIV transmission from infected mothers
to infants [1, 4]. The first two strategies are typically
achieved through behavioral change and contra-
ception approaches, while the third involves deliver-
ing services for HIV-infected women and their
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C. T. LE ET AL.
infants and is the focus of most PMTCT programs.
As part of a needs assessment of PMTCT services,
Vietnam Ministry of Health (MOH), with support
from the U.S. Centers for Disease Control and
Prevention, sought to estimate the extent of perinatal
HIV infections and to evaluate the country’s capacity
to deliver PMTCT-specific services within the exist-
ing MCH system. This was the first assessment of its
kind in Vietnam, and serves as a baseline to evaluate
the subsequent, enhanced national PMTCT program
under the MOH.
Methods
In 2002–03 a team of pediatric and public health
researchers reviewed existing HIV-related reports
from MOH including national HIV Sentinel
Surveillance (HIV SS) data (1994–2002), MCH
statistics (1997–2002), and official documents and
policies [4–7, 10–17]. Team members visited public
health offices and the main obstetrical hospitals
(n ¼ 8) in the seven cities or provinces (Fig. 1) with
highest HIV case rates. At each site, the team
interviewed health officials, laboratory technicians,
counselors and obstetric and pediatric practitioners
about local HIV trends, access and use of PMTCT
services, their own analysis of local issues (e.g., staff
training, capacities, attitudes on HIV and PMTCT),
and HIV testing strategies used, whether routine (i.e.,
‘‘opt out’’ testing for all patients unless they explicitly
refused), voluntary opt-in (i.e., testing those who
explicitly accepted), universal mandatory (i.e., testing
for all patients and not involving consent), or
selective (i.e., targeted testing based on perceived
patient risk). The investigators also directly observed
procedures at facilities. The eight provincial hospitals
visited served about a third of the total deliveries in
each province; another third took place in district or
commune health centers, and the remaining third
occurred at home (Table 1).
Team members also met with officials from the
national institutions, local non-governmental orga-
nizations, and international agencies who currently
or had participated in PMTCT projects in Vietnam
(UNAIDS, WHO, and UNCEF) [18]. Relevant data
were compiled, including current policies, practices
and program effectiveness indicators (e.g., rates of
prenatal HIV testing and counseling; HIV screening
at delivery; dose and frequency of HIV antiretroviral
(ARV) prophylaxis for infected women and their
infants, and follow-up care). Descriptive observa-
tions were reported if providing valuable information
about access and quality of local PMTCT services.
Results
In order to evaluate the nation’s MCH system
capacity to provide effective PMTCT interventions,
the assessment findings focused on two areas:
(1) HIV case identification and completeness of
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 C. T. LE ET AL.

TABLE 2
HIV prevalence among pregnant women screened
during antenatal visits as part of National HIV
Sentinel Surveillance, Vietnam, 1994–2002

Year No. No. HIV()/ Prevalence

provincesa No. screened (range)

1994 10 2/12 542 0.02 (0–0.13)

1995 10 9/13 586 0.07 (0–0.38)
1996 12 8/21 500 0.04 (0–0.19)
1997 20 22/18 119 0.12 (0–1.22)
1998 20 13/15 655 0.08 (0–0.96)
1999 20 13/16 172 0.08 (0–0.38)
2000 20 31/15 853 0.20 (0–1.00)
2001 31 80/22 310 0.36 (0–1.92)
2002 31 72/21 486 0.30 (0–1.00)
a
Number of Vietnam’s 61 provinces or urban areas
participating in National HIV Sentinel Surveillance
activities during that year.

among women receiving antenatal services increased

FIG. 1. Map of Vietnam, showing the provinces and
cities where PMTCT programs were assessed in 2002:
Ho Chi Minh City (population 8.5 million and
largest urban area), Ha Noi (capital city; 3.5 million),
Hai Phong city (1.5 million), Quang Ninh province
(1.1 million), An Giang province (2.1 million), Can
Tho province (2.5 million), and Kien Giang province
(1.6 million).
reporting of HIV infection among pregnant women,
and (2) adequacy of the existing program at
preventing perinatal HIV transmission. At the time
of the assessment, highly active ARV therapy
(HAART) was not yet available in Vietnam, and
thus although referrals for clinical evaluation and
follow-up were addressed, provision of HIV therapy
was not evaluated.
Case identification and reporting of perinatal HIV
Established in 1994, Vietnam’s HIV SS collects
seroprevalence data for subpopulations of varying
HIV risk, one such group being antenatal women.
By 2001, 31 of all 61 provinces participated in
HIV SS activities. Nationwide, HIV prevalence
from 0.02% (range, 0–0.13%) in 1994 to 0.30%
(range, 0–1.0%) in 2002, with some provinces
reporting near 1% prevalence (Table 2). Antenatal
HIV SS prevalence ranged from 0.38 to 0.88% in the
seven provinces covered in the evaluation. With an
estimated of 1.5–2 million births per year, national
prevalence data suggested up to 6000 infants may
have been exposed to HIV at birth in 2002, although
this estimate would be skewed high if participating
provinces had higher HIV prevalence than non-
participating provinces.
Six of the eight major hospitals visited conducted
universal mandatory HIV testing at time of delivery.
Seropositivity rates at those facilities ranging from
0.34 to 1.1% in 2002 (Table 3), generally consistent
with provincial HIV SS estimates, suggesting identi-
fication of most HIV cases among pregnant women
delivering at these facilities. The other two of the
hospitals used alternative testing strategies during
prenatal visits: An Giang employed a selective
strategy, and Can Tho routinely offered voluntary
opt-in testing using a voluntary counseling and
testing (VCT) approach. At these two sites, compar-
ison of antenatal infection estimates by provincial
HIV SS estimates and by facilities suggested that
their testing strategies may have missed many
infected mothers.
Interviewed healthcare workers reported that
although shortages of testing commodities sometimes
occurred, HIV testing services were generally avail-
able at all antenatal and delivery sites (confirmed by
site visits). Typically, HIV Enzyme Immunoassay
(EIA) tests were performed locally, with positive
results forwarded to specific regional laboratories
licensed for confirmatory tests. Test costs varied
among the sites, and were typically charged to the

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TABLE 3
HIV positivity ratesa among pregnant women delivering at eight major hospitals, Vietnam, 2000–2002

Location (time period) Testing # women HIV

strategyb tested positive (%)

Quang Ninh General Hospital

(Jan–Dec 2000) Selective 642 2.3
(Jan–Dec 2001) Universal mandatory 2080 1.2
(Jan–mid-Oct 2002) Universal mandatory 2090 1.1
Hai Phong Obstetrics and Gynecology Hospital
(Jan–Dec 2000) Universal mandatory 8750 0.18
(Jan–Dec 2001) Universal mandatory 8543 0.32
(Jan–Sept 2002) Universal mandatory 9531 0.34
Ho Chi Minh City (two largest obstetrical hospitals)
Hung Vuong (Jan–Dec 2000) Universal mandatory 23 568 0.35
Hung Vuong (Jan–Dec 2001) Universal mandatory 22 109 0.68
Hung Vuong (Jan–Aug 2002) Universal mandatory 13 690 1.06
Tu Du (Jan–Dec 2000) Universal mandatory 37 530 0.31
Tu Du (Jan–Dec 2001) Universal mandatory 35 390 0.43
Tu Du (Jan–Sept 2002) Universal mandatory 28 842 0.51
Ha Noi, Maternity C Hospital
(Jan–Dec 2002) Universal mandatory 10 171 0.43
Kien Giang, Rach Gia General Hospital
(Jan–Dec 2001) Universal mandatory 4431 0.45
(Jan–Oct 2002) Universal mandatory 3637 0.60
An Giang General Hospital
(Jan 2000–Oct 2002) Selective NAc NAc
Can Tho Provincial Hospital
(Jan 2002–Oct 2002) Voluntary opt-in 4679 0.1
a
HIV-positive test at either a prenatal visit or delivery.
b
See text for definition of testing strategies. Hospitals that conducted ‘‘universal mandatory’’ testing obtained HIV test at the
time of labor and delivery.
c
Data not available on total number tested. Thirty-three HIV-positive pregnant women were identified at this site by selective
testing.

patients. Cost and patients’ refusal were cited by
providers as the main reasons for low prenatal testing
rate, although patients generally paid out-of-pocket
for mandatory testing done at delivery. Of note, any
HIV testing was primarily done to ‘‘protect health
workers’’ rather than for perinatal HIV prevention,
and mothers screening positive were commonly
isolated along with their infants away from other
patients. In fact, in most hospitals, women were not
informed of positive test results by hospital staff as
this responsibility fell to local health departments
where confirmatory test results were performed.
MOH statistics indicated that from 1996 to 1999,
of the expected several thousand cases, a total of
217 pregnant women nationwide were reported as
HIV-infected. For the years 2000 and 2001, there
were, respectively, 108 and 182 HIV-positive mothers
reported to the MOH nationwide [5, 6]. Yet for the
same 2-year period, local data indicated 605 HIV-
positive women had delivered at the 6 hospitals
visited that provided universal testing at delivery,
indicating substantial underreporting of identified
cases to the national HIV program.
PMTCT program
Review of policies and protocols indicated the HIV
national program focused primarily on delivering
basic information-education-communication (IEC)
messages [11], which reached 80% of the population,
reportedly [7]. MOH had developed handbooks and
protocols for counseling, prevention [11–15], and
clinical protocols based on those of other countries
[16] (e.g., use of CD4 cell counts, viral load mea-
surements, and antimicrobial and ARV agents
unavailable in most of Vietnam). One of the goals
of the national AIDS program was to implement an
effective PMTCT program using VCT, and zidovu-
dine and nevirapine prophylaxis [12, 13]. The team
found widespread dissemination of protocols but
observed that the understanding of these varied
among patients and even among health providers.
Monitoring implementation of the national

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TABLE 4
Prenatal HIV testing and ARV administration to positive mothers and infants at eight major hospitals,
Vietnam, 2000–2002
Facility/Location (time period) No. mothers given ARVs/No.
HIV mothers delivering
Quang Ninh Provincial Hospital
(Jan–Dec 2000)
(Jan 2001–Oct 2002)
Hai Phong City Maternity Hospital
(Jan 2000–Oct 2002)
Ho Chi Minh City, Hung Vuong Maternity Hospital
(Jan 2000–Oct 2002)
Ho Chi Minh City, Tu Du Maternity Hospital
(Jan 2000–Oct 2002)
Ha Noi, Maternity Hospital C
(Jan–Oct 2002)
Kien Giang, Rach Gia Provincial Hospital
(2001–2002)
An Giang General Hospital
(Jan 2000–Oct 2002)
Can Tho Provincial Hospital
(Jan 2002–Oct 2002)
Total
a
NA: data not available.
b
Excludes denominator data from Ha Noi as numerator data were not available.
c
Per national guidelines.
guidelines was limited because accountability pro-
cesses for the provincial and national systems were
not clearly documented [18].
National goals were ambitious given available
resources. The national budget for PMTCT activities
ranged from 120 to 810 million VN Dong (USD
8000–54 000) annually. During 2000, the budget was
500 million VN Dong, (USD 34 000), mainly spent
on IEC activities [9]. Although international donors
provided support to some aspects of the national
AIDS program, few were involved in PMTCT
projects. An ‘‘Action Plan’’ developed in 2000 by
MOH, with international support, outlined a com-
prehensive PMTCT program but did not define
resources to support it [17]. Under this collaborative
international effort, only two PMTCT projects were
conducted: UNAIDS donated a limited supply
of ARV drugs, and UNICEF assisted in a survey
among pregnant women, community leaders,
and health providers on PMTCT knowledge and
attitudes [7].
Our survey revealed that for HIV positive mothers,
provision of prenatal or intrapartum ARV prophy-
laxis was sporadic despite its recommendation in
protocols available at all facilities visited (Table 4).
During 2000–02, at the 8 hospitals visited, 253
(28.3%) of 895 pregnant women identified as
HIV-positive and 37 (4.1%) infants born to these
mothers received any ARV drugs. The on-site visits
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No. infants given
ARVc/No. HIV mothers
8/8 8/8 (100%)
34/42 (81.0%) 1/42 (2.4%)
32/58 (55.2%) 13/58 (22.4%)
53/241 (22.0%) 10/241 (4.1%)
89/425 (20.9%) 5/425 (1.2%)
37/44 (84.1%) NAa/44
0/39 0/39
0/33 0/33
0/5 0/5
253/895 (28.3%) 37/851 (4.3%)b
identified several barriers to effective prophylaxis:
Zidovudine was unavailable for infants in oral
syrup form. Supplies of nevirapine were often limited
and hard to access quickly. But most importantly,
per MOH policy, provision of ARV prophylaxis
required a positive HIV test be confirmed by desig-
nated laboratories (35 were available by 2002,
nationwide) and confirmatory test results generally
took at least a week (and sometimes several weeks) to
return. Consequently, very few women identified as
HIV-positive during late pregnancy (and none during
labor and delivery) were eligible for therapy. Thus,
even where ARV prophylactic drugs were available,
they were often not provided.
Postpartum, HIV-positive mothers were advised
not to breastfeed their infants [13], who were given
formula feeding, but only for the duration of hospital
stay. Formula was unaffordable for most families,
considering its cost of the equivalent of USD 20 per
month in 2002, and the average monthly income
of USD 35 [9, 10]. Furthermore, most mother–child
pairs screening HIV positive did not receive
follow-up care for a variety of reasons: about 20%
of families gave an incorrect address, possibly for
fear of discrimination; many returned to distant
districts or communes where few health workers were
trained in HIV care; some HIV-positive mothers
abandoned their newborns infants, who then
remained in isolation wards without specific
229

treatment due to lack of capacity for follow-up
testing or available ARVs in infant formulations.
As a result, actual data on mother-to-child HIV
transmission were neither available at any sites
visited nor nationwide. Provincial public health
officials readily acknowledged deficiencies in the
system in several areas [9, 10, 17].
Discussion
This assessment of the HIV perinatal situation and
PMTCT efforts in Vietnam found that by 2003: (1)
perinatal HIV infection was increasing with several
provinces nearing 1% antenatal prevalence; (2) HIV
testing was widely available, but testing strategies
primarily identified infections at delivery rather than
during pregnancy; (3) if identified, HIV-positive
women generally did not receive effective prophylaxis
as laboratory capacity and protocols did not allow
provision of test results quickly enough for interven-
tion; and (4) most women identified as HIV-positive
and their infants did not receive the clinical and
supportive follow up needed to ensure adequate care.
Almost all of these issues were related to systems-
level problems amenable to modification.
In Vietnam and elsewhere, failure of PMTCT has
been viewed as fundamentally caused by lack of ARV
drugs needed for effective intervention. However,
provision of ARVs without effective testing strate-
gies, public health system capacity or operational
support for delivering practical interventions could
waste resources. Four areas were identified, with
recommendations made to address to ensure a more
effective PMTCT program:
1. Educating health care providers about HIV and
PMTCT. Training and education programs for
providers about HIV transmission and preven-
tion, including ways to (i) reduce discrimination,
(ii) prevent occupational exposure through use of
universal precautions and post-exposure prophy-
laxis, and (iii) prevent mother-to-child transmis-
sion of HIV through prompt case identification
and timely prophylactic interventions were iden-
tified as priority areas to address.
2. Adopting affordable, routine prenatal HIV screen-
ing approaches. For greatest PMTCT impact, HIV
screening strategies would ideally occur during
prenatal care (rather than at delivery) and would
use voluntary, routine (opt-out) testing and
counseling as a strategy [19]. Such antenatal
screening could start with higher prevalence
areas and be phased in elsewhere based on local
or regional epidemiology. Practical approaches
(e.g., group counseling, video-based models) that
explicitly describe the benefits of testing for
pregnant women and infants are available in
other parts of the world, and could be adapted to
Vietnamese culture and healthcare systems.
230
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C. T. LE ET AL.
Testing accounted for the largest cost of any
PMTCT program, and could be consider too
costly in this low prevalence epidemic. However,
pregnant women in Vietnam were already paying
for a HIV test within the existing system of
universal mandatory screening at delivery, but
were not receiving personal benefits. The observed
situation suggested that test costs could be
supported by individual payments when afford-
able, and subsidized by the government for
families living at or below poverty levels.
3. Optimizing preventive treatment and follow-up.
A strategy based on confirmation of any initial
positive test is important in a low prevalence
epidemic, but lack of prompt confirmation
impaired timely PMTCT. Use of rapid testing
assays in perinatal settings [19–21] would allow
identification of HIV infections on-site, and
rapid initiation of ARV prophylaxis. Routine
provision of test results with counseling, along
with provision of effective prophylaxis and sup-
port for follow-up HIV care is needed to inform
women of their HIV status, ensure they receive
appropriate care, and importantly to help edu-
cate them on how to minimize risk for HIV
transmission to their infants and sex partners.
Additionally, positive women and infants should
be offered care (and if appropriate, treatment) to
ensure their own health. This would require
ensuring adequate supplies of appropriate pro-
phylactic drugs and infant formula supplementa-
tion at central and birthing centers, developing
appropriate delivery protocols and referral sys-
tems, and effective communication with women
and between hospitals and local commune
health centers to reduce stigma around HIV and
ensure continuity of care. Safe infant-feeding
options are an area of urgent need for develop-
ing world settings, and counseling on the variety
of possible options and their potential conse-
quences should be discussed and options chosen
fully supported [22–24]. These options include
formula feeding when affordable, practice of
exclusive breastfeeding for at least 6 months, or
provision of HAART during the breastfeeding
period.
4. Ongoing program monitoring. The use of standar-
dized reporting forms in patient case manage-
ment and drug delivery, with consistent
monitoring of key indicators such as rates and
timing of prenatal testing, HIV positivity, ade-
quate and timely prophylaxis, post-partum
follow-up and perinatal transmission were recom-
mended as important for measuring program
quality and effectiveness.
This assessment had some limitations. National
HIV SS covered only half of provinces and
Journal of Tropical Pediatrics Vol. 54, No. 4
 C. T. LE ET AL.
principally represented pregnant women who recei-
ved prenatal care in urban or provincial centers.
Our on-site assessment was conducted in hospitals
serving urban centers where HIV prevalence may
have been higher than elsewhere. Also, our evalua-
tion relied on information provided by local con-
sultants with no way of verifying the accuracy of
their information. No observations or data were
available for the rest of the country, where perinatal
HIV was less well recognized.
A key conclusion that emerges from our study in
Vietnam may apply elsewhere: On-site visits and
interviews of providers who actually deliver health-
care services were invaluable in correcting system and
local deficits, in developing practical protocols, and
building capacities to achieve sustainable results.
On-site assessments may also allow a better evalua-
tion of the local healthcare performance than official
national reports.
Vietnam is a resource-limited nation that has
consistently articulated implementation of a
PMTCT program to be a priority in its fight against
HIV. Despite limited economic resources, the coun-
try has a relatively strong public health infrastruc-
ture and an abundance of community workers
and social agencies dedicated to health care. With
several past successes in other health programs,
Vietnam has demonstrated effective mobilization of
limited resources and ability to attain public health
goals. Given leadership, commitment and some
improvement of the existing MCH infrastructure,
this nation should be able to successfully implement
effective PMTCT programs in high prevalence
provinces in the near future. The results of this
assessment have already led MOH and several
provincial PMTCT programs to adopt changes in
provider training, capacity, and clinical and labora-
tory protocols that should improve delivery of
essential MCH and HIV services. We hope to be
able to report on these demonstration projects in the
near future.
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