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close this bookUNAIDS Technical Update Mother-to-Child Transmission of HIV - Update 1.2 (UNAIDS, 2001, 9 p.)
View the documentIssues for Policy decision options
View the documentPotential operational packages for countries of East Asia and Pacific
View the documentConclusion: Crosscutting issues for scaling up
View the documentAcronyms
View the documentBibliography

Potential operational packages for countries of East Asia and Pacific

Countries of the East Asia and Pacific Region can be grouped in function of the particular context including health system development and resources available. Within each group, different packages can be developed in function of the prevalence and incidence of HIV in specific areas.


Group A (Thailand, Malaysia)

Group B: Myanmar, Cambodia/PNG

Group C: Vietnam, China, Philippines/Indonesia

High prevalence areas

Full package
PMTCT:
VCT-ARV-IFC +
PREVENT and
SUPPORT

Improve access
MCH + trigger response to HIV + test full package PMTCT

Test full package PMTCT+ Improve quality MCH

Low prevalence/high incidence areas

VCT-ARV-IFC + PREVENT

Improve access to MCHPREVENT package
Exclusive BF

Improve quality MCHPREVENT package
Exclusive BF

Low prevalence/low incidence areas

VCT-ARV-IFC

Exclusive BF

Exclusive BF

Some countries already identified the key packages to be implemented in their own context. The tentative packages for Vietnam, Myanmar and Cambodia are presented below as national managers developed them.

1 Vietnam

The Vietnam approach proposes to implement several different packages into the UNICEF country program within existing health care services. Four main packages are proposed. The most comprehensive is to be implemented in three provinces (Quang Ninh, An Giang, Kien Giang) and two cities (HCMC, Haiphong)


Package 1

Package 2

Package 3

Package 4



Community Based Monitoring Project

Safe Motherhood & Community Based Monitoring

Pilot three districts and two cities


Everywhere

14 districts

18 districts

3 districts &2 cities

Phase alpha


Condom promotion

- Life skills
- Condom promotion

- Life skills
- Condom promotion
- STIs

Phase 1: Inform


STI management

- RH Counselling
- STI management

- HIV testing & counselling in women’s health services
- STI management
- Syphilis screening and treatment

Phase 2:
Prophylaxis


-Safe delivery practices-Universal precautions

- Safe delivery practices
- Universal precautions

- ARV treatment
- Safe delivery practices
- Universal precautions

Phase 3: Care

Exclusive breastfeeding up to 4 months

Exclusive breastfeeding up to 4 months

Exclusive Breastfeeding up to 4 months

Infant feeding & counselling

Phase omega




- PCP prophylaxis
- TB diagnosis and treatment
- Social support
- Home based care
- Acceptance raising

Opportunity




- Existing Counselling capacity in HCMC and Hanoi

Additional
Benefit

Reinforcement of exclusive breastfeeding

Reinforcement of exclusive breastfeeding

Integration of condoms and life skills within safe motherhood

Development of a Vietnamese approach for counselling within reproductive health services

2 Cambodia

Four different groups of health facilities providing antenatal and obstetric services were identified in which activities to prevent Mother To Child Transmission of HIV could be implemented. A specific package of activities was developed for each of these groups. (see tables 1 and 2 below). The groups were the following: MCH Hospitals which are to represent quality standards in public services: the National MCH center and the Calmette hospital

· Hospitals to represent standards of care in the private sector (not for profit and for profit)

· A pilot district (including hospital and satellite health centers) in which the full package of improved reproductive health and enhanced response to HIV (including prevention in high risk groups and care) is to be offered and a model tested for future extension on a national scale.

· All the other health centers/antenatal clinics throughout the countries in which a minimum package to respond to HIV among the population of reproductive age is to be offered


All health centers

One pilot district including hospital and satellites health centers

Public Hospital


Private Hospital

Site chosen


Battambang

National MCH,

Calmette


Phase Alpha: reducing HIV+ pregnancies

100% condom policy in commercial sex places
Life Skills
STIs treatment
Family Planning

100% condom policy in commercial sex places
Life Skills
STIs treatment
Family Planning

Counseling in Treatment of STIs Information

Family Planning


Phase 1: Inform in ANC

Anaemia prophylaxis
Treatment of STIs in pregnant women

Treatment of STIs
Counseling inTreatment of STIs
Information VCCT
Improved ANC
Syphilis
Partner’s information
Partner’s testing

VCCT
Improved ANC
STIs
SyphilisPartner’s information
Partner’s testing


Idem

Phase 2: Prophylactic treatment

UP
SOP
BCC

ARV
UP
SOP
BCC

HIV+ mothers:
ARVUPSOPBCC

HIV - and unknown status
UP
SOP
BCC

Idem public

Phase 3: Care of children and mothers

Exclusive Breastfeeding up to 6 months
Complementary feeding as off 6 months IMCI

Infant feeding counseling IMCI

HIV+ mothers: Infant feeding counseling for HIV+ mothers: BMS or EBF, early cessation and complementary food IMCI

HIV - and unknown status mothers
Infant feeding counseling for EBF 6 months and complementary food IMCI

Idem public

Phase w


Communication for Acceptance raising
Home based Care
PCPP
TB

Home based Care
PCPP
TB



3 Myanmar

In Myanmar activities of prevention of Mother To Child Transmission of HIV are proposed to be mainstreamed in the existing IMMCI program and in the HIV/AIDS project areas. In addition several pilot districts (districts with high HIV prevalence) are to implement the full package of prevention including ARV.

Myammar

IMMCI

HIV AIDS project areas

Pilot 3 districts

Phase Alpha: Prevent


Life Skills
Condom Promotion
STIs

Life Skills: in out-of school
Condom promotion
STIs
FP

Phase 1: Inform

Quality ANCSTIs


VCT
STIs

Phase 2: Prophylaxis

Safe delivery
UP


ARV
Safe delivery
UP

Phase 3: Care

Exclusive BF 6m
IMCI

Exclusive BF 6m

Infant feeding counseling

Phase Omega: Support



TB
Spiritual support
Acceptance raising