The Progress of the National Programme on Prevention of Mother-to-child Transmission of HIV, syphilis and HBV in China

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1 The Progress of the National Programme on Prevention of Mother-to-child Transmission of HIV, syphilis and HBV in China Song Li, PhD Department of Women and Children Health National Health and Family Planning Commission of the People s Republic of China 1

2 HIV Epidemic in China By the end of 2011, 780,000 people were estimated to live with HIV/AIDS (PLHIV) Of those PLHIV in China, 28.6% were female 2014 newly reported HIV-infected cases Heterosexual: 66.4 % MTCT: 1% Sources: 2012 China AIDS response progress report Xinjiang Tibet Gansu Qinghai Inner Mongolia Beijing Liaonin g Hebei Tianjin Ningxia Shanxi Shandon g Shaanxi Henan Jiangsu Sichuan Hubei Anhui Shangh Chongqi Jiangxi Zhejian ai ng Hunan Guizho g Fujian Yunnan u Guangx Taiwan Guangdon i g Hong Kong province Macao Hainan Heilongjia ng Jilin

3 The distribution of HIV-positive PW in China (2014)

4 Maternal and Children Care in China Situation in China (2014)* Population 1.36 billion CBR MMR 21.7/100,000 LBs IMR 8.9/1,000LBs ANC ( 1 visit) coverage 95.6% Hospital delivery rate 99.6% CDC MCH General hospitals Data sources: * Chinese Health Statistical Digest, 2014

5 National Strategies on PMTCT of HIV, Syphilis and HBV Policy Four Free and One Care: ipmtct is an essential and important part of comprehensive HIV/AIDS prevention and control Combine ipmtct program with routine MCH services is highlighted in National Programe Action Plan for Women and Children ( ) Basic strategies Government commitment, strong leadership and multi-sector collaboration Promote universal access to ipmtct comprehensive services for all pregnant women, their children and families Social mobilization, health promotion and extensive society participation Strengthen health system, promote the integration of health resources and reinforce the maternal and child health system Build the capacities, improve the quality and the delivery of ipmtct services

6 Expanded to Cover the Entire Country Integrated PMTCT of HIV, syphilis and HBV 1 pilot county 85 counties 333 counties 1156 counties Cover all pregnant women and children pilot sites 271 counties 453 counties 1638 counties

7 Budget for PMTCT by Central Government Increased significantly (10,000 RMB)

8 HIV,Syphilis and HBV test at ANC PW with HIV PW with Syphilis Mother: ARVs, CD4+ count and VL Hospital delivery Children: ARVs, Formula feeding, Follow-up, EID, HIV testing Mother: Treatment Children: Prophylaxis treatment, Follow-up and Diagnosis PW wit hhbv Children: Ensure the HBV-exposed infant receives HBIG and 1st dose HBV vaccine within 24 hours of birth All services listed are free for HIV/syphilis/HBV positive pregnant women and their children

9 Integrate PMTCT services into Routine MCH services T &C ARV Safe delivery Infant feeding Care of Newborn Infant care Pre-married care Pre- pregnancy care ANC Care for delivery Postnatal care Contraception counseling

10 Improve the quality of ipmtct Services Building capacity of EID testing Develop training package on ipmtct Monitoring and evaluation Develop technical guideline on ipmtct

11 Integrate ipmtct Information Management System Continue to improve ipmtct information management and data utilization Development of integrated data reporting, management and statistical analysis system

12 Developing technical guideline and health education materials

13 Pregnant Women Received HIV, Syphilis and HBV Testing Increased Yearly ( ) 未接受检测 接受检测 HIV HIV HIV HIV HIV HIV HIV 梅毒乙肝 HIV 梅毒乙肝 HIV 梅毒乙肝 HIV 梅毒乙肝

14 Rate of Pregnant Women Received HIV, Syphilis and HBV above 98% National Wide 年 2006 年 2007 年 年 2009 年 2010 年 2011 年 2012 年 2013 年 2014 年孕产妇 PW received HIV 抗体检测率 HIV testing (%) 孕产妇梅毒检测率 PW received 孕产妇乙肝表面抗原检测率 PW received HBV testing syphilis testing

15 The percentage of HIV-positive Pregnant and Their Infants Received ARVs for PMTCT ( ) 100,0 90,0 80,0 91,7 82,6 70,0 60,0 50,0 40,0 孕产妇用药 Pregnant Women 儿童用药 Infants 30,0 20,0 10,0 0,

16 The Rate of HIV MTCT was 6.1% in 2014 (%) 35,0 30,0 未校正的母婴传播率 No adjust rate (%) 校正后的母婴传播率 adjusted rate (%) 25,0 20,0 15,0 10,0 6,7 6,1 5,0 0,0 未干预 ,0 No PMTCT

17 The Percentage of Syphilis-infected Pregnant Women Receive Treatment 100,00% 90,00% 80,00% 70,00% 60,00% 50,00% 40,00% 30,00% 20,00% 10,00% 0,00% 62,1% 68,1% 56,2% 48,0%

18 HBIG intervention 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 94,4% 97,7% 86,2%

19 Challenges and the way forwards

20 According to the Cascade analysis: Regional Disparity Setting priorities for specific provinces based on challenges of each province with high-burden of HIV and syphilis. e.g. The province from South-east of China Focus on migrants so as to improve follow-up of pregnant women and children The province from North-west of China Focus on early detection, quality of services and infant and young child nutrition

21 CHALLENGES (2)-Quality of services 35,0 30,0 25,0 20,0 15,0 10,0 5,0 0,0 No PMTCT 未干预 The way forward: Early testing and diagnosis Standard treatment 6,7 6,1 High quality follow-up EID?

22 CHALLENGES (3) Capacity building among grassroots To aim to the weak point Migrant group: T&C OF HIV, Diagnosis of congenital Syphilis and follow up To develop standard training materials and more high quality trainings for county and township level staffs Improve the capacity of ipmtct staffs in different levels and different areas

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