Haoyu Qian (Programs Coordinator, ADARC &YAI) July 23 rd , 2010

1. 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

2. 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

3. 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

4. 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

5. 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

6. Point Prevalence

7. 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

8. 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

9. 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.

10. 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

11. 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.