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Integration of HIV, Hep B and Syphilis Screening and Prevention of Vertical Transmission in Yunnan China. Haoyu Qian (Programs Coordinator, ADARC &YAI) July 23 rd , 2010. Background. Rural Health Network in Yunnan Yunnan: Rural, Mountainous, Multi-ethnic

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Integration of HIV, Hep B and Syphilis Screening and Prevention of Vertical Transmission in Yunnan China

Haoyu Qian

(Programs Coordinator, ADARC &YAI)

July 23rd, 2010


Background
Background Prevention of Vertical Transmission in Yunnan China

  • Rural Health Network in Yunnan

    • Yunnan: Rural, Mountainous, Multi-ethnic

    • Health network: County, Township, Village

  • HIV PMTCT foundation

    • Yunnan most severely affected by HIV in China

    • National HIV PMTCT program started in 2005

  • Rationale for integration of HIV, HBV and Syphilis

    • High HBV prevalence rate and increase syphilis and congenital syphilis in China

    • Effective methods exist to prevent vertical transmission for all 3 diseases


Program setting
Program Setting Prevention of Vertical Transmission in Yunnan China

  • Program Objective:

    • Explore the feasibility of integrating HIV, HBV, and syphilis screening and PMTCT services

  • Sites

    • ANC clinics and L&D wards at 12 county level MCH and comprehensive hospitals in 6 counties

  • Target Population:

    • All pregnant women receiving ANC and L&D services at the 12 health facilities

  • Program Duration:

    • From January to September 2009


Program intervention
Program Intervention Prevention of Vertical Transmission in Yunnan China

  • Counseling and testing of all pregnant women for HIV, HBV and Syphilis

  • Intervention for Positives

    • HIV: Choice of HAART or scAZT for positive women

    • HBV: HBIG shot to exposed infants after birth in addition to first of 3 HBV vaccine

    • Syphilis: Benzathine penicillin treatment for positive women, prophylactic penicillin for babies if mother received treatment late in pregnancy

  • Extending Service

    • Testing of partners of positive women, provide treatment for syphilis, and making referrals for HIV and HBV


Coverage and time of testing
Coverage and Time of Testing Prevention of Vertical Transmission in Yunnan China

  • Coverage in Catchment Area

    • Covering 84% of women delivering in the 6 counties

  • Time of testing during pregnancy

    • 87% of HIV counseling and testing and 82% of HBV and syphilis testing occurs during ANC.

    • 13% of HIV and 18% of HBV and syphilis screening occurs during labor and delivery


Point prevalence
Point Prevalence Prevention of Vertical Transmission in Yunnan China


Intervention for positive women
Intervention for Positive Women Prevention of Vertical Transmission in Yunnan China

  • HIV Positive Women:

    • 97% of the women received ARV prophylaxis, Out of which 65% received HAART prophylaxis

  • HBsAg Positive Women:

    • 96% of the exposed babies received HBIG shot at the same time as first HBV vaccination.

  • Syphilis Positive Women:

    • 94% of the women completed penicillin treatment before birth


Extending service to partners
Extending Service to Partners Prevention of Vertical Transmission in Yunnan China

  • Service to partners of positive women

    • HIV*: 88% received counseling and testing, out of which 50% were serodiscordant

    • HBV: 64% received counseling, out of which 85% received testing. Out of these partner who tested negative, 35% followed through with catch up vaccination at local CDC

    • Syphilis: 85% received counseling and testing, all positive partners received treatment at MCH

*HIV data for 2009 the whole year


Lessons learned
Lessons Learned Prevention of Vertical Transmission in Yunnan China

  • Synergies

    • Packaging of 3 tests instead of just one

    • PMTCT integration into MCH services

  • Capacity Building

    • Training of health care workers

    • Strengthen network linkages

  • Reduction of Stigma against HIV

    • 3 tests as standard part of ANC services makes HIV stand out less.


Future steps
Future Steps Prevention of Vertical Transmission in Yunnan China

  • Expansion of Integrated Model in Yunnan

    • Expansion program for HIV, HBV and syphilis screening and PMTCT will cover 26 counties in Yunnan with support from Zeshan Foundation

  • China MOH making plans to adapt integrated counseling and testing

    • Offering program experience, provide technical advocacy to MOH


Acknowledgement
Acknowledgement Prevention of Vertical Transmission in Yunnan China

  • Zeshan Foundation

  • Yunnan AIDS Initiative

  • Aaron Diamond AIDS Research Center

  • Elizabeth Glaser Pediatric AIDS Foundation

  • Healthcare providers from program sites in Luxi (潞西), Longchuan (陇川), Linxiang (临翔), Cangyuan (沧源), Tengchong (腾冲), and Lancang (澜沧) counties

  • Women and babies in these same counties.


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