Prevention and management of mother-to-

child transmission of HIV

Guangzhou Women and Children’s Medical Center (GWCMC)

Hu Fang hufang0351083@126.com
 1 Basic information

2 Main measures

Contents
3 Clinical treatment regimens

4 Results and effects

Basic information
 Elimination of mother-to-child transmission （EMTCT）
of HIV, syphilis and HBV
Guangzhou is WHO
one of the 4 cities EMTCT
that passed the certification
Full Guangdong
implementation EMTCT
of EMTCT in certification
EMTCT Guangdong 2025
prevention of started in Province
mother-to-child Guangdong
Province as a 8 July, 2022
transmission
(PMTCT) of pilot project
HIV, syphilis
and HBV 1 January, 2021

30 July, 2018

before 2018
 Basic information of Guangzhou

Ø Districts：11

Ø Area：7434.4 km2 CongHua

Ø Permanent residents：18, 810, 600 HuaDu

ZengCheng
BaiYun

TianHe

PanYu
HuangPu
YueXiu LiWan
HaiZhu
NanSha
 “Four-in-one” HIV/AIDS management service system

ü Counseling and testing

ü Epidemiological investigation ü Care and social support
and monitoring ü Mobilize to detect and
treat

ü Counseling and testing

ü Infectious disease ü Counseling and testing
report ü Infectious disease report
ü Treat
 Epidemiological features of HIV in Guangzhou

Ø 2021, proportion of cumulative surviving cases is 7.5/10, 000

Ø 1681 new cases of HIV reported in 2021, of these, 10.1% were females
Ø From 2019 to 2021, HIV prevalence of pregnant women ranged from 2.44/10, 000 to 3.18/10, 000.
There are 100~150 pregnant women with HIV infection every year.
Main measures
 Strengthen organizational management and
optimize service process

Health administrative organization：

ü project implementation plan
ü administrative measures for funds
ü work leading group
ü Expert base for technical guidance
 Strengthen organizational management and
optimize service process
Financial institutions：over 90,000,000 RMB (2019—2021)
(1) provide free HIV, syphilis and HBV testing for all pregnant women
(2) HIV, syphilis or HBV infected pregnant women and their children can receive free
intervention services.
3
Strengthen organizational management and
optimize service process
 Strengthen organizational management and
optimize service process
All pregnant women
receive free testing.

All infected pregnant

women and their children
receive free intervention.
 Optimize service process during COVID-19 pandemic

ü update designated hospitals：Guangzhou

8th people’s hospital— 1-2hospital(s) each CongHua

district HuaDu
ZengCheng
ü Equip each designated hospital with HIV BaiYun
TianHe
antiviral drugs
ü The government purchased the services of YueXiu

LiWan PanYu
one company for HIV confirmatory test, HuangPu
HaiZhu
HIV-RNA and CD4.
NanSha
 3 Improve laboratory construction and expand testing coverage
Network of HIV screening and confirmation

confirmatory screening
laboratory：8 laboratory：139

Screening Center detection point：

Laboratory：11 234

STD laboratory：
38

l The number of laboratories and testing

quantities rank first in Guangdong province.
l All hospitals have the ability to screen HIV,
syphilis and hepatitis B.
 Manage the critical links
ü For pregnant women who are hospitalized at delivery and whose HIV infection
status is not clear, start the HIV rapid detection process and get the results within
30 minutes.
ü Develop sexual partner testing process for HIV-infected pregnant women, and
mobilize their sexual partners to conduct HIV antibody testing.
ü Establish files to facilitate follow-up
ü Set up designated medical institutions to manage patients in a closed loop.
Regular training and supervision to ensure that hospitals
provide standardized services
 Verify information by multiple departments and
analyze project progress regularly
ü Exchange and check the information of infected pregnant women and
children among multiple departments
ü Analyze the project progress every two months and report to Guangzhou
Municipal Health Commission
 Multi-sectoral participation to protect the rights
and interests of infected persons
Health, civil administration, public security, justice, education, women's and
children's working committees, social organizations and other departments
jointly participate

Several departments jointly Use multiple platforms such as schools,

issued a series of documents to Establish Strengthening communities and hospitals to jointly
protect the rights and interests mechanisms action carry out various activities.
of women and children.

Living security for women and Social humanistic Social organizations carry out
children in need assistance concern various forms of humanistic care
activities.
 Create a patient-centered, stigma-free care environment

ü conduct qualitative and quantitative surveys to understand discriminations,

prejudices and stereotypes of staff against HIV infected pregnant women and
their offsprings in Guangzhou medical institutions.
ü issue anti-discrimination documents of medical institutions
ü organize anti-discrimination training
Clinical treatment regimens
 Treatment of HIV infected pregnant women
ü As long as pregnant women are diagnosed with HIV, start ART .
1) TDF+3TC+LPV/r
2) TDF+3TC+EFV
3) AZT+3TC+LPV/r
ü For pregnant women who have received ART before pregnancy, adjust drugs
according to the value of HIV RNA.
ü For pregnant women who started ART after 28 weeks of pregnancy, adopt
TDF+3TC/Entracabine+Integrase inhibitor

TDF, Tenofovir; 3TC, Lamivudine; LPV/r, Lopinavir/ritonavir; EFV, efavirenz; AZT, Zidovudine
 Testing and monitoring of HIV infected pregnant women

ü Before ART： HIV RNA, CD4+T, routine blood test,

urinalysis, liver and kidney function, biochemical detection
ü During ART：HIV RNA, CD4+T, drug resistance test
ü During the 3rd trimester： HIV RNA
 Safe midwifery

ü When pregnant women regularly take medicines during pregnancy and

have no clinical symptoms of AIDS, or the viral load in the third trimester
is less than 1000 copies/ml, or have been in labor, cesarean section is not
recommended, especially emergency cesarean section.
ü Try to avoid invasive obstetric operations, such as fetal scalp monitoring,
amniotic fluid rupture, etc
 Drugs for newborns born to HIV infected pregnant women

If one of the following conditions is met, children are at high risk of

HIV exposure：
ü HIV viral load of pregnant women in the 3rd trimester is over 50 copies/mL；
ü No HIV RNA was detected in the third trimester of pregnancy, and ART
during pregnancy was less than 12 weeks.
ü positive HIV antibody screening test at or after labor
Drugs for newborns born to HIV infected pregnant women
high risk of HIV exposure：use triple antiviral drugs as early as possible after
birth until 6 weeks
ü Within 2 weeks after birth：AZT+3TC+NVP
ü 2-6 weeks after birth：AZT+3TC+LPV/r
 Drugs for newborns born to HIV infected pregnant women

general risk of HIV exposure：use NVP or AZT as early as possible after

birth until 4 weeks

Recommended dose of nevirapine (NVP) Recommended dose of Zidovudine (AZT)

 Management of children born to HIV infected mothers

ü Scientific feeding：promote artificial feeding, avoid breast feeding, and

eliminate mixed feeding
ü Vaccination：Inactivated vaccine can be used instead of live attenuated
vaccine before children can be excluded from HIV infection. No BCG！
ü Identify HIV infection：detect HIV RNA at 48 hours, 6 weeks and 3
months after birth respectively. HIV antibody screening shall be conducted
for those with negative early diagnosis at the age of 12 and 18 months.
Results and effects
 Achieve the goal of eliminating MTCT
90 87 2.00

1.7
70
1.60
65

58
60
52
1.20
47 48

0.80
30

0.40

0 0 0 0 0 0 0 0.00
2015 2016 2017 2018 2019 2020 2021

Number of children exposed to HIV in utero MTCT rate of HIV (%)

 Scientific research achievements
ü Between 2017 and 2021, our team published more than 20 papers on this project.
ü Relevant results were exchanged with domestic and foreign experts in the form of
speeches at the conference.
 Thank you！

Guangzhou Women and Children’s Medical Center (GWCMC)

Hu Fang hufang0351083@126.com