I. Objectives
(1) General objectives.
Improve the population's awareness of the prevention of mother-to-child transmission of HIV, prevent women of childbearing age from contracting HIV, minimize HIV infection in children through mother-to-child transmission, reduce the impact of HIV on women and children, and improve the quality of life and health of women and children.
(ii) Specific objectives.
1. To establish and improve the management and service model for the prevention of mother-to-child transmission of AIDS that is suitable for China's national conditions.
2. The coverage rate of training for personnel undertaking services for the prevention of mother-to-child transmission of AIDS reaches more than 90%.
3. The knowledge rate of prevention of mother-to-child transmission of HIV among pregnant women has reached more than 70%.
4. The counseling rate for prevention of mother-to-child transmission of HIV among the maternal and premarital health care population has reached more than 85% respectively.
5. The HIV antibody testing rate of the maternal and premarital health care population has reached more than 80% respectively.
6. The application rate of anti-HIV drugs for HIV-infected pregnant women and babies born to them has reached more than 90% respectively.
7. The artificial feeding rate of infants born to HIV-infected pregnant women has reached more than 85%.
8. The rates of HIV antibody testing for children born to HIV-infected pregnant women at 12 months of age and 18 months of age reach more than 80% respectively.
9. The rate of children infected with HIV through mother-to-child transmission was reduced by 50%.
II. Strategies and Measures
(1) Government-led, multi-sectoral collaboration, and extensive social mobilization.
Prevention of mother-to-child transmission of HIV is an important part of the comprehensive prevention and treatment of AIDS, and governments at all levels and health administrative departments should strengthen the organizational leadership of prevention of mother-to-child transmission of HIV, set up a multisectoral collaborative working mechanism, and widely mobilize the society, so as to provide policy and social support for the smooth implementation of prevention of mother-to-child transmission of HIV.
1. Strengthening leadership and organizational coordination at all levels of government
Governments at all levels and health administrative departments should incorporate the prevention of mother-to-child transmission of HIV into the comprehensive AIDS prevention and treatment work planning of each region, and formulate work objectives and implementation plans for the region. Establish a coordination mechanism for the prevention of mother-to-child transmission of AIDS, strengthen the organization and coordination, clarify the responsibilities and tasks of various departments, and increase policy and financial support to ensure the smooth implementation of the work.
2. Strengthening multi-sectoral collaboration
The health system should establish a coordination mechanism for the prevention of mother-to-child transmission of HIV within the health system, with the participation of the maternal and child departments, and the CDC, medical administration, planning and finance and other multi-sectoral departments*** to clearly define the responsibilities and division of labor. Actively collaborate with the Women's Federation, family planning, civil affairs, finance, education, **** youth league, culture, radio and television, public security and other departments, to carry out the prevention of mother-to-child transmission of AIDS publicity and education, to prevent infection of women of childbearing age, to reduce the unwanted pregnancies of infected women, to provide prevention of mother-to-child transmission of AIDS comprehensive intervention services and integrated care and support, and to promote the work of the comprehensive development.
3. Wide-ranging health education
Wide-ranging and varied health education activities have been carried out, appropriate health education materials have been developed, and knowledge of AIDS prevention has been popularized among the women's population by using a variety of media, school curricula, lectures, and consultation hotlines. In conjunction with maternal health care, premarital health care and family planning services, key guidance on the prevention of mother-to-child transmission of AIDS is provided to pregnant women, premarital health care populations, parents of children and their family members in a variety of venues, such as obstetrics and gynecology outpatient clinics, schools for pregnant women, wards, maternity wards, premarital health care outpatient clinics, community health service centers, and village health clinics.
(2) In reproductive health care services, services for the prevention of mother-to-child transmission of AIDS are carried out.
Medical care institutions and their medical personnel, in reproductive health care services, should pay attention to the possible ways of HIV infection in women and the status of infection, and closely integrate the prevention of HIV infection in women of childbearing age as well as the reduction of unwanted pregnancies in HIV-infected women with reproductive health care services.
1. Providing AIDS prevention information and services to prevent infection in women of childbearing age
In the process of reproductive health care services, in combination with premarital health care, women's disease checkups and treatment, prevention and treatment of sexually transmitted infections (STIs)/reproductive tract infections (RTIs), family planning and other medical services, women and their spouses/sexual partners who are receiving the health care services are provided with health education and counseling for the prevention of AIDS and their familiarity with the knowledge of AIDS prevention is raised. They take the initiative to provide health education and counseling on AIDS prevention for women and their spouses/partners, increase women's familiarity with AIDS prevention-related knowledge, avoid risky behaviors for AIDS infection, and enhance their awareness of protection; they conduct risky behavior assessment, and mobilize those with high-risk behaviors to undergo AIDS testing and further counseling, so as to prevent their spouses/partners from being infected, and to minimize the spread of AIDS infection among women of childbearing age.
2. Provide contraceptive counseling and guidance to reduce unwanted pregnancies
Women of childbearing age who are infected with HIV and their families should be provided with information on the risks and prevention of mother-to-child transmission of HIV, appropriate contraceptive counseling and services, health care and referral services, etc., to help them choose safe sexual behavior and formulate an appropriate family birth plan, and provide safe termination of pregnancy services for women with unintended pregnancies, so as to reduce HIV infection and transmission. It also provides safe termination of pregnancy services for women who have unwanted pregnancies, and reduces the number of unwanted pregnancies among HIV-infected women.
(3) Incorporating the prevention of mother-to-child transmission of AIDS into the routine work of maternal and child health care, and providing comprehensive services for the prevention of mother-to-child transmission of AIDS.
Taking the maternal and child health care network as a platform, a mechanism has been established for the regularization of work on the prevention of mother-to-child transmission of AIDS, and the prevention of mother-to-child transmission of AIDS has been incorporated into the process of maternal and child health care and reproductive health services, forming a comprehensive care and support system for the prevention of mother-to-child transmission of AIDS that is centered on women, children and families.
1. Provision of counseling and testing services
Medical care institutions should, while providing maternal health care, take the initiative to provide information on the prevention of mother-to-child transmission of AIDS and pre-test counseling on HIV antibodies, and advise and mobilize pregnant women and mothers to undergo AIDS testing; they should also provide information on risky behaviors of AIDS infection, and carry out risky-behavior assessments.
Providing HIV antibody testing services for pregnant women in accordance with the requirements of the National Technical Code for AIDS Testing. It emphasizes early testing during pregnancy to clarify the status of infection as soon as possible. The process of HIV testing and services for maternal health care is shown in Annex 1.
Provide post-test counseling services based on the results of HIV antibody testing. Interpretation of test results; information on prevention of HIV infection and change of risky behaviors; guidance on contraception, maternal health care, prevention of mother-to-child transmission of HIV interventions, and referral services.
2. Maternal health care for HIV-infected women
Provide HIV-infected women with routine health care and follow-up during pregnancy, delivery and the postpartum period, and strengthen services such as pregnancy health care, guidance on safer sex, nutritional support, monitoring of AIDS-related symptoms and signs, hospital delivery, guidance on feeding, postpartum contraception, psychological support, and guidance on family protection. For pregnant women who choose to terminate their pregnancies, artificial termination of pregnancy services are provided, along with effective contraceptive guidance. HIV-infected women are included in the tracking and management of the local comprehensive AIDS prevention and treatment system after delivery.
3. Application of anti-HIV drugs
Free anti-viral drugs are provided to HIV-infected pregnant women and the babies they give birth to. AIDS-related symptoms and signs are closely monitored, and CD4 cell tests are conducted in areas with conditions. Appropriate antiretroviral drug regimens are selected according to the degree of disease progression, immunization status and antiretroviral treatment of the infected mother, taking into account the needs of the mother's own health and the prevention of mother-to-child transmission (see Annex 2).
Provide counseling and guidance on the application of antiviral drugs and related monitoring to ensure that infected mothers and babies they give birth to use the drugs in a timely, complete and standardized manner. Before starting the application of antiretroviral drugs, HIV-infected pregnant women and their families should be fully informed of the importance of adhering to the standardized application of antiretroviral drugs and related information, to improve drug adherence; during the application of drugs, regular monitoring of routine maternal blood, liver, kidney function and immune status, pay close attention to drug resistance and side effects of the drug, strengthen the follow-up of the antiretroviral drugs after the application of the drug, and if necessary, to deal with or provide referrals to services. The patient's blood pressure is also high, so the patient's blood pressure is low.
4. Provide appropriate and safe midwifery services
Mobilize HIV-infected pregnant women to give birth in hospitals, provide appropriate midwifery services for the prevention of mother-to-child transmission of HIV, and try to avoid injurious operations that may increase the risk of mother-to-child transmission of HIV, so as to reduce the chances of children being infected during the delivery process.
5. Infant feeding
In the case of infants born to HIV-infected mothers, artificial feeding is advocated, breastfeeding is avoided, and mixed feeding is eliminated. The acceptability, appropriateness, affordability, sustainability and safety of artificial feeding are evaluated, and scientific guidance and follow-up of infant feeding are conducted to minimize mother-to-child transmission through feeding and to ensure normal growth and development of children.
6. Health care for children born to HIV-infected mothers
Targeted care is provided for newborns born to HIV-infected mothers, with guidance on infant feeding, routine child health care, enhanced growth and development monitoring, and prevention of malnutrition. Immunization is carried out in accordance with national requirements for planned immunization of children born to HIV-infected mothers, and care is taken to avoid contact with patients suffering from tuberculosis, measles, polio, and so on, and to avoid going to crowded places when the immunization program has not been completed.
Strengthening follow-up services for children born to HIV-infected mothers, so that they receive HIV antibody tests at 12 and 18 months of age to clarify HIV infection status. The flow of infant follow-up and testing services is shown in Annex 1. In areas where conditions are favorable, early infant diagnostic testing can be carried out at the same time so that appropriate services can be provided as early as possible.
7. Provision of care and support
Healthcare institutions, communities, other relevant institutions and organizations should, according to the characteristics and contents of their own services, provide HIV-infected pregnant women and their families with counseling, psychological support, comprehensive care and referral services, etc., so as to reduce the impact of AIDS on women, children and families, decrease discrimination, and improve the quality of life of HIV-infected women and children. The Government has also provided counseling, psychological support and referral services.
(4) Strengthening organizational management and service capacity building to ensure the smooth implementation of prevention of mother-to-child transmission of HIV.
Clearly defining the organizational division of labor, strengthening institutional construction, carrying out personnel training, standardizing laboratory testing, and improving the service capacity of health-care institutions and personnel at all levels to ensure the implementation of measures to prevent mother-to-child transmission of HIV.
1. Organization and division of labor
The Department of Maternal and Child Health and Community Health of the Ministry of Health, under the overall organization and coordination of the Office of the State Council's Working Committee for the Prevention and Control of AIDS, is responsible for the specific organization and coordination of the prevention of mother-to-child transmission of AIDS.
The Maternal and Child Health Center of the Chinese Center for Disease Control and Prevention (CDC) is responsible for providing technical guidance on the prevention of mother-to-child transmission of HIV, organizing national expert technical steering groups, formulating work plans and implementation programs, preparing training materials and conducting teacher training, supervising and inspecting the work of various regions and evaluating the work, collecting and analyzing information, organizing experience exchanges and promotions, and carrying out scientific research on the prevention of HIV transmission, and so on. It is also responsible for collecting and analyzing information, organizing experience exchange and promotion, and conducting scientific research on the prevention of mother-to-child transmission of AIDS.
Administrative departments of maternal and child health at the provincial, municipal and county levels are responsible for organizing and coordinating the prevention of mother-to-child transmission of AIDS in their respective jurisdictions, and for ensuring the implementation of all related work.
Provincial, municipal and county-level maternal and child health care institutions are responsible for the technical guidance of the prevention of mother-to-child transmission of HIV in their respective jurisdictions, and have formed expert technical steering groups to supervise and inspect the progress of the work as well as to train the personnel; and they are responsible for the collection, collation, reporting, analysis and feedback of the relevant information in their respective jurisdictions.
Medical care institutions at all levels that provide maternal health care and midwifery services are responsible for implementing technical services for the prevention of mother-to-child transmission of AIDS, participating in and accepting relevant technical guidance and training, and collecting and reporting relevant information.
2. Strengthening institutional capacity building
All health care institutions at all levels that provide maternal health care and midwifery services should provide services in accordance with the requirements for the prevention of mother-to-child transmission of HIV and the service process. They should strengthen the construction of management, technology and basic facilities for the prevention of mother-to-child transmission of HIV, and improve the comprehensive service capacity for the prevention of mother-to-child transmission of HIV.
3. Personnel training
Training in knowledge and service skills is provided to all personnel involved in PMTCT services. The training targets include local authorities in charge of maternal and child health and the prevention of mother-to-child transmission of AIDS, health administrative departments and management personnel of relevant organizations and relevant professional and technical personnel. The content of the training can be determined according to actual needs, or a nationally standardized training material can be prepared by a central-level expert technical steering group. Various forms are taken to carry out national-provincial-city (prefecture)-county (district)-township-village level-by-level training.
4. Standardizing Laboratory Testing
Healthcare institutions undertaking the prevention of mother-to-child transmission of HIV should carry out HIV antibody testing in accordance with the requirements of the National Technical Code for HIV Testing. Equipped with the necessary equipment and qualified testing personnel, establish HIV initial screening and confirmation laboratories or HIV testing sites that meet the requirements, improve the testing system, standardize the testing operation, integrate the resources of all relevant departments, division of labor and cooperation, and establish an effective and feasible testing process related to the prevention of mother-to-child transmission of HIV.
5. Preventing medical infections and occupational exposure
Healthcare institutions that are responsible for the prevention of mother-to-child transmission of HIV should follow the principle of standardized prevention, and strictly implement the relevant sterilization and isolation system, so as to avoid medical infections and occupational exposure of healthcare workers.
In accordance with the requirements of the Ministry of Health's "Guiding Principles for the Protection of Medical Personnel Against Occupational Exposure to HIV", a sound mechanism for the protection of medical personnel against occupational exposure to HIV and the handling of emergencies should be established. In the event of occupational exposure, emergency measures should be taken to notify the supervisor, contact the local disease prevention and control organization, assess and determine the level of exposure and the source of exposure, register and correctly use prophylactic medication and accept epidemiological monitoring.
Three, information management
Establishing a sound management information system for the prevention of mother-to-child transmission of HIV, improving the management of information and data and reporting system at each level. Designated specialists are responsible for strengthening the collection, reporting, review and management of information, improving the timeliness, completeness and accuracy of information reporting, and improving the analysis, utilization and feedback of information.
Prevention of mother-to-child transmission of AIDS-related information includes relevant statements and various types of registration. The reports include monthly reports on the prevention of mother-to-child transmission of HIV, registration cards on the basic information of HIV-infected pregnant women/marital examination women, registration cards on HIV-infected pregnant women and babies they have given birth to, and registration cards on the follow-up of HIV-infected pregnant women and children they have given birth to, and other series of case registration cards. The various types of registrations include premarital health clinic registrations containing records of HIV counseling and testing, pregnancy health clinic registrations, delivery registrations, and HIV-positive pregnant women's test results report cards, health care manuals, medical records, and follow-up records.
The HIV-infected pregnant women and women in the marriage examination found, in accordance with the "People's Republic of China*** and the State Law on Prevention and Control of Infectious Diseases" and the "AIDS epidemic information reporting management norms" requirements for infectious disease outbreaks report, and fill in the prevention of mother-to-child transmission of AIDS work related statements and a series of case registration card, reporting process and requirements are detailed in Annex 3.
Four, supervision and guidance and Evaluation
Establishing a system of supervision, guidance and evaluation of the prevention of mother-to-child transmission of AIDS at the national, provincial, municipal and county levels. The Ministry of Health and national-level technical guidance departments are responsible for formulating supervision and guidance programs for the prevention of mother-to-child transmission of AIDS, and conducting regular spot checks and supervision and guidance. Local health administrative departments at all levels should formulate their own supervision programs according to the annual work plan and the national supervision program, organize regular self-inspection and supervision and guidance, evaluate the work of prevention of mother-to-child transmission of AIDS in their jurisdictions, and continuously improve the quality of the work of prevention of mother-to-child transmission of AIDS.
Attachments: 1. Prevention of mother-to-child transmission of HIV service process
2. Prevention of mother-to-child transmission of HIV antiretroviral drug application program
3. Prevention of mother-to-child transmission of HIV related report reporting process and requirements
Reference: http://202.96.155.163/wsj/fs/ygzl/ doc5296.doc