Ilya Abellanosa Tac-an

City Health Department

Cebu City
2
nd
largest city with fastest
growing economy in the Phil.
Total Population: 956,172
80 barangays
84 BHCs divided
geographically into 5 health
areas: North, South, East
West, Central
6 satellite laboratories
0
40
80
120
160
200
240
280
320
360
Asymptomatics
AIDS
Asymptomatics 3 1 1 1 3 1 4 3 4 3 2 1 2 1 3 2 2 5 7 10 176 141 183 360 257
AIDS 0 1 0 2 1 1 1 2 4 2 2 3 1 0 4 2 3 2 1 3 1 1 3 5 2 2
89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14*
Number
Year
**Age Range = 15-79 yrs.
39% = 15-24 years old
HIV/AIDS Cases in Cebu City by Year
Cebu City HIV/AIDS Registry 1989- August 2014 N= 1225
Low and Slow
Prevalence
Hidden and
Growing
Fast and Furious
Mode of
Transmission
1989-
2007
N=74*
2008
N=10
2009
N=11
2010
N=177
2011
N=144
2012
N=188
2013
N=362
2014*)
N=259
TOTAL
N=1225*
Sexual
Contact
50
(91%)
9
(90%)
4
(36%)
16
(9%)
31
(22%)
44
(23%)
86
(24%)
70
(27%)
310
(26%)
Heterosexual
Male
Female
20
20
0
1
0
1
1
0
5
5
2
6
0
8
0
3
28
44
Homosexual/
Bisexual
10 8 3 15 21 36 78 67 238
Injecting Drug
Use
5
(9%)
1
(10%)
7
(54%)
161
(91%)
113
(78%)
144
(77%)
276
(76%)
189
(73%)
896
(74%)
Male
Female
4
1
1
0
1
6
135
26
105
8
126
18
272
4
180
9
824
72
HIV/AIDS Cases by Mode of Transmission
Cebu City HIV/AIDS Registry 1989 to August 2014 N = 1225
No data = 19
**Up to August 2014
A concentrated epidemic of HIV
among
- injecting drug users (2013) - 48%
- men having sex with men (2013) - 7.7%
- free-lance sex workers (2011) - 5.4%
**transgender - 4.0%
Sexual partners of PWID are at higher
risk
Current Situation
More women practicing risky behavior
shared injectable drugs
had unprotected penetrative sex
More women with (+) HIV Ab test results
2009 7
2010 26
2011 13
2012 - 24
2013 12
2014 - 12
More HIV (+) women getting pregnant
Current Situation
Without intervention, the HIV transmission risk
from an HIV infected mother to her child is
5-10% during pregnancy
10-15% during labour and delivery
5-20% during breast-feeding
15-25% overall without breastfeeding
20-35% overall with BF up to 6 months
30-45% overall with BF up to 18-24 months
Possible Consequences
2012: Cebu City a Category A city
HIV antibody testing is offered
to all pregnant women attending
prenatal clinics
2010: free VCT at the Social
Hygiene Clinic
5 PWID FLSWpregnant
women diagnosed with HIV
Late 2010: VCT piloted in the 5 Area
Health Centers to pregnant
women with (+) risk
assessments. All with (-)
results
PMTCT Background
2011: PICT in the 5 Area Health
Centers and 1 Lying-In Clinic
2012: PICT offerred in all 81
Barangay Health Centers
(Opt Out)
Blood Collection done in 6
satellite laboratories and at
SHC
Background
SHC/Laboratory
HIV Counseling and Testing
Anti-Retroviral Therapy
Refer/follow-up pregnant women
VSMMC-HACT
ART and Management of
Opportunistic infections
Obstetric care for pregnant
PLHIV
PCR for baby at 6 weeks
CebuPlus Assocn.
Psychosocial support
Temporary Shelter
Financial Support
Follow-up
Barangay Health Centers - Antenatal Clinic
HIV Education
PICT blood collection
2011
N = 2740
2012
N=4474
2013
(5750)
2014*
(3688)
(+) % (+) % (+) % (+) %
HIV 1 0.04 7 0.16 8 0.14 3 0.08
Syphilis 7 0.26 10 0.22 12 0.21 6 0.16
Hep B 19 0.69 163 3.6 139 2.9
No
reagent
Provider Initiated Counseling and
Testing among Pregnant Women
**Up to Sept. 2014
HIV Cases among Pregnant Women
2010 2011
N=2740
2012
N=4523
2013
N=5750
2014*
N=3688
HIV (+)
Cases
6 2 11 8 3
Injecting
drug user
5 1 5 1 0
Partner of
IDU
5 7 3
Non-drug
related
1 1 1
Remarks SHC: 6 BHC: 1
SHC: 1
BHC: 7
SHC: 4
BHC: 8 BHC: 3
30 HIV+ pregnant women from 2010-Sept 2014
- PWID : 12
- Wife/Sex partner PWID : 15
- Not drug related : 3
Outcome: A. Mother
Current Situation
Before Delivery After Delivery
Aborted 5
Lost to ff. up 4
Live Birth 21
ART
Continue ART
Stopped ART
ART
Refused 2
On ART 19
Died: 3
Outcome: B. Baby:
Delivered alive: 21 - all given ART prophylaxis
PCR
1
st
PCR non-reactive : 11
Pending results : 3
2
nd
PCR non-reactive : 2
HIV Ab test non=reactive : 2
Not tested : 3
Current Situation
PMTCT Services in the Health
Center
Prevention/Reduction of risky practices
STI/HIV 101 during Pre-Marital Counseling,
Mothers Classes, 1
st
antenatal check-up
Pre-test Counseling *
STI Diagnosis and Treatment *
Prevention of pregnancy
Family Planning Counseling
Provision of Contraceptives
* In the 5 Area Health Centers and 1 lying in clinic
PMTCT Services in the Health
Center
Provider Initiated Counseling and Testing
during antenatal clinic*
Referral to Social hygiene Clinic for Post Test
Counseling and further referral of clients to
Cebu Plus for psycho-social support and
VSMMC for ARV treatment and obstetric care
Postnatal care for the mother and the
newborn
Issues and
Concerns
Action Taken
Delay in antenatal
check-up
BHC:
Masterlisting of pregnant
women in the barangay
Health teaching and
counseling.
Delay submission to
HIV testing
Refusal of mother to
deliver at VSMMC
Non-adherence to ART
after delivery
VSMMC/CCHD follow
up clients
Issues and
Concerns
Action Taken
Drug Issues among
PWID
ROMP: Motivational
Counseling
CCHD Referral to NA and
Voluntary
Rehabilitation
Mother who could not
take care of their
babies
CPAI- Referral to Asilo dela
Milagrosa for
adoption of baby
Increase number of HIV counseling and testing
sites
Increase number of trained personnel on HIV
counseling and testing in barangay health centers
Facilitate release of confirmatory test
Improve post natal care and follow-up
Improve referral system
Continue multi-sectoral partnership
Recommendations
UNICEF
DOH : NASPCP and MCH
Regional Health 7
BHC personnel
VSMMC
CebuPlus Association