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Best Practices of Community Engagement Preventing Mother-To-Child Transmission of Hiv, Syphilis and Hepatitis B

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Best Practices of Community Engagement Preventing Mother-To-Child Transmission of Hiv, Syphilis and Hepatitis B BEST PRACTICES OF COMMUNITY ENGAGEMENT PREVENTING MOTHER-TO-CHILD TRANSMISSION OF HIV, SYPHILIS AND HEPATITIS B Linxiang District, China Best Practices of Community Engagement: Preventing Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B, Linxiang District, China Photo credits Cover: © Shutterstock/Lifebrary Page iv: © UNICEF China/2017/Xu Wenqing Page 1: © Shutterstock/HTeam Page 5: © UNICEF China/2017/Tao Jinhua Page 7: © UNICEF China/2017/Tao Jinhua Page 8: © UNICEF China/2017/Tao Jinhua Page 13: © UNICEF China/2017/Tao Jinhua Page 15: © UNICEF China/2017/Tao Jinhua Page 18: © UNICEF China/2017/Tao Jinhua Page 22: © UNICEF China/2017/Tao Jinhua November 2018 UNICEF East Asia and Pacific Regional Office P.O. Box 2-154 Bangkok 10200 Thailand Telephone: (662) 356-9499 Fax: (662) 280-3563 Email: [email protected] www.unicef.org/eap BEST PRACTICES OF COMMUNITY ENGAGEMENT PREVENTING MOTHER-TO-CHILD TRANSMISSION OF HIV, SYPHILIS AND HEPATITIS B Linxiang District, China ACKNOWLEDGEMENTS This best practice report was compiled with the support of several key entities. The report would not have been possible without the invaluable support of staff at the Yunnan Provincial Maternal and Child Health Care Hospital, Linxiang District Maternal and Child Health Care Hospital and Lincang City Maternal and Child Health Care Hospital. Dr. Zheng Min, Yunnan Provincial EMTCT implementation team leader, Yunnan Provincial Maternal and Child Health Hospital, Dr. Li, Director and Dr. Kang, Deputy Director of Linxiang District Bureau of Health and Family Planning Commission, Lincang City, Dr. Yang Yiqing, Director of Linxiang District Maternal and Child Health hospital and Dr. Gao Liping, Head, PMTCT Department set aside much of their precious time for individual interviews and arranged meetings with their village level focal points, women living with HIV peer support group members in Linxiang district of Lincang. We take this opportunity to sincerely thank, Dr. Jin Xi, Director, Dr. Wang Ailing and Dr. Qiao Yaping, national EMTCT implementation team leaders, Women’s Health Department, The National Centre for Women and Children’s Health, China CDC for their overall support. Special thanks to Xu Wenqing, HIV/AIDS Specialist, for overall support and assistance through each step of this documentation, Xiaona Huang, Maternal and Child Health Specialist, Yuning Yang, Health Officer, and Ron Pouwels, Chief Child Protection, UNICEF China for guidance and support. Shirley Mark Prabhu, Regional EMTCT, Adolescent Health and HIV Specialist, for facilitating and overseeing the process of documentation and finalization of this best practice, and Kritsada Jirathun, Senior Communication Associate, UNICEF East Asia and the Pacific Regional Office (EAPRO), for support on finalizing the design and layout. Finally, our thanks to Tani Ruiz, writer and Mary Ann Perkins for assistance with editing. LINXIANG DISTRICT CHINA 临翔区 ANC antenatal care ACRONYMS ART antiretroviral therapy CDC Centre for Disease Control and Prevention HIV human immunodeficiency virus MCH Maternal and Child Health MTCT mother-to-child transmission PMTCT prevention of mother-to-child transmission RMB Reminbi (Chinese Yuan) UNICEF United Nations Children’s Fund INTRODUCTION The world is facing a daunting challenge: to delivery. They are powerful partners in timely ensure that no child is born with HIV, syphilis outreach to ensure all women, including or hepatitis B. Mother-to-child transmission the most vulnerable, have access to MCH (MTCT) of these infections can be prevented information and receive ANC, including rapid when pregnant women have access to timely, tests of HIV, syphilis and hepatitis B in the high-quality antenatal care (ANC), including early stage of the first trimester of pregnancy. early diagnosis and treatment. To meet that Community health workers can help to ensure challenge, the United Nations Children’s follow-up and adherence to treatment and Fund (UNICEF) initiated pilot demonstration other interventions. Furthermore, the pilots projects in China to provide every pregnant illustrate the success of the MCH hospitals woman with testing and diagnosis in the first as the lead entity, with its administration at trimester, and to ensure all pregnant women three levels (county-township-village), and who test positive are supported to initiate and also revealed the benefit of multi-sectoral adhere to the full course of treatment. The cooperation led by the Government of China. pilots also aimed to provide the proper course of treatment to every infant exposed to HIV, From this, the pilots serve as a good example syphilis or hepatitis B. of community-based interventions for the reduction of MTCT, the practices of which The pilots demonstrate the importance of could then be scaled up throughout China including community health workers in routine and replicated in other countries in the maternal and child health (MCH) service Asia-Pacific region. Preventing Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B 1 PREVENTING MTCT IN LINXIANG DISTRICT Linxiang District in Yunnan Province, with a The Linxiang District MCH Hospital and key population of 330,000, was one of the sites health departments were wrestling with how chosen to implement a pilot programme for to establish an effective system to ensure the integrated prevention of mother-to-child PMTCT services reached all pregnant women, transmission (PMTCT) of HIV, syphilis and including those delivering at home and living hepatitis B. The pilot demonstration generated in hard-to-reach areas. knowledge and lessons learned that helped to guide the new national policy on triple testing. Fast forward to 2017. Linxiang District has won accolades for its model of integrated Located in China’s subtropical south-west, PMTCT management and has become a Linxiang District has a large population of frontrunner in China’s quest to eliminate migrants from Myanmar, and cross-border MTCT of HIV, syphilis and hepatitis B. A pilot marriages are common. Rates of HIV infection project in the district, supported by UNICEF in the Yunnan Province of Linxiang District are and other partners, demonstrated strategies, particularly high. In the past, the percentage interventions and lessons learned for of pregnant women in the district testing preventing MTCT of HIV, syphilis and positive for HIV during ANC visits was hepatitis B. The integrated PMTCT 1 per cent, around three times the level for management practices from the pilot can the province as a whole. Many more women be replicated or adapted across China and were being infected than in the past – with in other countries to eliminate MTCT within new female HIV cases almost on par with the next few years – well in advance of the male cases. 2030 regional deadline proposed by the World Health Organization (WHO).1 1 See: WHO, Regional Framework for the Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in the Asia-Pacific Region 2018-2030, available at: http://www.wpro.who.int/hiv/topics/pmtct/web_consultation_triple_EMTCT/en/ 2 Best Practices of Community Engagement The pilot programme in Linxiang District for PMTCT has delivered the following results:2 DROP IN HIV MATERNAL NEAR UNIVERSAL TRANSMISSION MORTALITY TESTING There were zero cases of Zero maternal deaths at There is 99 per cent testing LINXIANG DISTRICT MTCT of HIV in all but four of the Linxiang District MCH coverage today for pregnant the past 13 years (2004–2017). Hospital since 2016. women for HIV, syphilis and hepatitis B. PROGRESS AGAINST IMPROVED TREATMENT STIGMA AND UPTAKE DISCRIMINATION More than three quarters (78 per cent) of The PMTCT programme staff say HIV-positive pregnant women were on there is more acceptance of and less antiretroviral therapy (ART) in the first discrimination against people living with trimester in 2016 compared to just over half HIV and much greater awareness of all (55 per cent) in 2013. Nearly all (98 per cent) these diseases as a result of education women diagnosed with syphilis adhered to and advocacy. timely treatment. COMPREHENSIVE REDUCED CASES PROGRESS ON EARLY INFANT OF CONGENITAL EARLY DIAGNOSIS DIAGNOSIS SYPHILIS First trimester testing of One hundred per cent of Six cases of congenital HIV, syphilis and hepatitis B infants born to mothers syphilis were reported increased from 44 per cent in living with HIV have received per 100,000 live births 2013 to 66 per cent in 2016. antiretroviral prophylaxis (below the impact target and early infant diagnosis for eliminating MTCT since 2014. of syphilis). 2 All statistical data and information are sourced from the Linxiang District MCH Hospital, Linxiang District, Lincang City, Yunnan Province, China. Preventing Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B 3 INTEGRATION OF PMTCT INTO MCH SERVICES: THE KEY TO ELIMINATING HIV, SYPHILIS AND HEPATITIS B The success of the pilot project in Linxiang ANC visits, wherever they are provided, be it District reflected a number of key factors, at the community, township, district, county including the approach of the Government of or prefecture level. Additionally, there are China to health-care management. Since 2010, other key entry points for voluntary testing PMTCT of HIV, syphilis and hepatitis B has for HIV, syphilis and hepatitis B: at been fully integrated into routine MCH care. marriage registration, at family planning The importance of this is hard to exaggerate. centres and at hospitalization for any MCH services in China reach a vast population condition. All such testing is free of charge, through 800,000 MCH service providers. as are the medicines to treat and control These include 3,098 MCH hospitals, 34,000 those infections. community health service centres and 37,000 township hospitals. Prevention of new infections in children is a top priority for the Government, which is Virtually all pregnant women in China attend backing up its commitment to action with at least one ANC visit and deliver in a funding – both at the central and local levels. hospital, making the integration of PMTCT The total government investment in PMTCT into MCH care a fundamental – and winning jumped from US$11.8 million in 2009 to – strategy.
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