UNAIDS Technical Update Mother-to-Child Transmission of HIV - Update 1.2 (UNAIDS, 2001, 9 p.): Potential operational packages for countries of East Asia and Pacific

UNAIDS Technical Update Mother-to-Child Transmission of HIV - Update 1.2 (UNAIDS, 2001, 9 p.)

		Issues for Policy decision options
		Potential operational packages for countries of East Asia and Pacific
		Conclusion: Crosscutting issues for scaling up
		Acronyms
		Bibliography

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