China

1. Experiences on Pediatric HIV and Congenital Syphilis Care and Treatment Interventions China Dr. Wang Ailing National Centre for Women and Children’s Health, China CDC Aug. 2011

2. BACKGROUND Nationwide fundamental data in China (2010) CBR 12.13 ‰ MMR 29.7/100,000 IMR 13.1‰ ANC coverage 94.1% Hospital delivery rate 97.8% Rate of HIV screening among PW 74.4% Rate of syphilis screening among PW 57.6% Data source: Chinese Health Statistical Digest, 2011 Chinese MCH annual report, 2011

3. Develop and issue the National Strategy Plan for Syphilis Prevention and Control (2011-2020) by MOH in 2010 • By 2015: • Reported 1st and 2nd stage syphilis cases increasing rate is below 5% , reported congenital syphilis is less than 30/100,000 alive birth • By 2020: • …reported congenital syphilis is less than 15/100,000 alive birth, which basically meet the Goal of ECS

4. Current policies and practices-objectives • Five-Year Action Plan to Control HIV/AIDS (2011-2015) • National action Plan for PMTCT of HIV/Syphilis/HBV ( 2010) Objectives – PMTCT of HIV(by 2015) • The percentage of screening for HIV among PW be up to 80% • The percentage of screening for syphilis among PW be up to 70% • The percentage of taking ARVs of HIV-infected PW and their infants be up to 90% • The percentage of treatment of PW with syphilis be up to 80% • The rate of reported pediatric HIV infected through MTCT be controlled under 8% • Reported congenital syphilis is less than 30/100,000 alive birth

5. Current policies and practices-strategies • Expand coverage of PMTCT service • All counties of Henan, Guangxi, Sichuan, Yunnan, Guizhou, Xinjiang • 72% counties of Guangdong 1156 counties 453 counties

6. HIV、syphilis、 HBV HIV Linkages of PMTCT of HIV, syphilis and HBV Integration of PMTCT into current MCH and RH services

7. Current policies and practices--primary prevention among women • Primary prevention among women and infants • Provide health education and counseling toward the clients from clinics of gynecology, family planning, pre-married health care and other people related reproductive health services • couple visits, testing and counseling are encouraged • Establish referral mechanisms between MNCH and RH services

8. Current policies and practices ---for prevention of unintended pregnancies among women living with HIV • Prevention of unwanted pregnancies among HIV-positive women • Contraception counseling • Family planning • Women with syphilis: suggest treatment firstly • Developing“the Services Guideline on Primary Prevention Among Women and Prevention of Unintended Pregnancies among women living with HIV” • Will be finished at the end of this year

9. Current policies and practices---- for prevention of mother-to-child transmission of HIV and syphilis(1) • pregnant women with HIV or syphilis • the services extended to integrate prevention of Mother-to-child transmission of HIV, syphilis and HBV • ART/ARV (mentioned above) • For syphilis infected PW and their children, provide standard therapy or prophylaxis treatment for both • Follow-up services

10. Implications of the revised 2010 WHO guidelines and plans • Updated the country PMTCT guideline: • ARV prophylaxis will begin from 14th week of pregnancy . • Option B was be selected in China PMTCT guideline. • Provide EID for HIV explored babies when 6 weeks and 3 months. • Other potential linkages: • Pregnant women: CD4 and VL tests and Blood Routine tests, liver and kidney function tests and other tests related to ARVs using, OIs prophylaxis, Hospital delivery subsidies, follow-up services • HIV explored babies: EID test and HIV antibody test, Infants formula, follow-up services, OIs prophylaxis

11. Current policies and practices---- for prevention of mother-to-child transmission of HIV and syphilis(2) • Infants feeding • Advocate formula-feeding. • Exclusive breastfeeding is recommended for HIV-infected mothers in case of some special areas or families. • Emphasize direction from health providers • Infant feeding • nutrition counselling • grown development evaluation

12. MAJOR CHALLENGES (1) • The coverage of PMTCT service • How to find HIV-infected pregnant women as many as possible? • How to reach the women who are in rural, remote areas and are ethnic minorities

13. MAJOR CHALLENGES (2) • How to efficiently implement? Multi-sectoral collaboration • Internal: MCH, Disease Prevention and Control, hospitals at different levels • External: family planning, Women’s federation, Civil Affair Sector……

14. MAJOR CHALLENGES (3) • Lack of capacity of service • Human resource constraints and weak capacity to provide quality services • experts and specialists at national and provincial levels • service providers at local level • Intervention, treatment, EID and follow-up • Information, Monitoring and Evaluation

15. Plans • Continue to increase the coverage of PMTCT service • Improving the capacity and quality of services • Training the updated guideline, especially the new counties and local levels • Improve the quality of services • Technical guidleine • Technical guideline on prevention of mother-to-child transmission of HIV(version 3) • Technical guideline on elimination congenital syphilis • Strengthen M&E

16. Thanks！