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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
  • 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
  • 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
  • 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
  • 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
intervention for positive women
Intervention for Positive Women
  • 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
  • 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
  • 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
  • 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
  • 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.