Elimination of mother–to–child transmission of HIV and

congenital syphilis

1

Early stages in the Syphilis Control Program

o Dermatologists at dispensaries.

o Not integrated into basic health services

o Insufficient coverage by these services

o Non-existent epidemiological control actions

2

o Focus on identifying cases

o Epidemiological research and analysis

o Via community health centers

3

1970: Mother and Child Care Program

•At least 10 prenatal controls

•Including STI/ HIV/ AIDS counseling

•Serology and HIV testing to pregnant

women and their partners

•99.9% of births at health institutions

4

Antenatal Care

o Periodic

o With a Team approach

o Comprehensive

o Community involved

Source: EDO Information System and Birth Information System, National Medical Records and

Health Statistics Bureau.

Cases of syphilis in women and congenital syphilisCuba: 1980-2014

Around 1.5 million syphilis serologies per year; more than 300 000 to pregnant women

0,12

0,04

0,030,04

0,06

5

• Ministry of Public Health• Ministry of Education• Ministry of Higher Education• Ministry of Tourism• Ministry of Justice• Ministry of Culture• Ministry of Domestic Trade• Ministry of Construction• NGO´s and other associations: FMC,

PVV, CSJ, AHS, other according to local conditions.

• Ministry of Defense

• Ministry of Labor and Social Security• Cuban Radio and Television Institute • Youth organizations• Ministry of Interior

1983: Group coordinating multisectorial response to HIV/AIDS epidemic.

6

• Serological screening of population groups

• Epidemiological survey of cases

• Partner Notification

• Ensuring medical care for those affected

• Education of the population

1986: Program for prevention and control of

HIV/AIDS

Identification of priorities

8

Network of scientific centers at the serviceof Public Health

Ensured research, development of human resources and introduction of technology for a comprehensive response to HIV / AIDS epidemic

1986: Development of human and material capabilities

Educational component

Basic strategies

Training

Communication: personal, group and the media

Counseling

Condoms

Intersectoral and community work

More than 13,000 voluntary promoters

9

Cumulative statistics, Cuba: 1986- 2014

Source: HIV / AIDS´ computerized registry, MINSAP

Total HIV cases 21 922

Total deaths 3 652 (16,7%)

Persons living with HIV 18 270 (83,3%)

10

Cuba 2014: HIV prevalence (%) in population raging 15 - 49 years

2 provinces above the national prevalence

7 provinces prevalence between 0.18 and 0.21%

11

HIV cases by sex and sexual orientation among men.

Cuba: 1986-2014

Source: HIV / AIDS´ computerized registry, MINSAP

N= 21,922

N= 17,739

Prevention of mother- to- child HIV transmission

HIV serology testing in all three trimesters of

pregnancy

Screening of sexual partners

Combined anti-retroviral therapy

Cesarean delivery

Preventive treatment to newborns

The rate of mother- to -child HIV transmission has been

equal to or lower than 2% in the last three years.

12

Impact indicator 2012 2013 2014

Mother-to-child transmission rate 1.85 1.74 2.0

Organization of care for people with HIV

Secondary Health Careo Network of hospitalso Centers of

comprehensive careo Regional Centers

Tertiary Health Care: o “Pedro Kouri” Tropical Medicine

Instituteo Institutes for other specialties.

Primary health careo Family Doctor and Nurse Office

o Polyclinic - specialists trained in STI / HIV / AIDSo Counseling serviceso STD / HIV / AIDS consultations and other services at

polyclinics

13

Follow-up studies of people with HIV

Capitán Roberto Fleites Polyclinic

Mario Gutiérrez Polyclinic

Juan Bruno Zayas Hospital

Camilo Cienfuegos Hospital

Manuel Fajardo Hospital

CPHEM,Havana

Luis Pasteur Polyclinic

Tropical Medicine Institute

Mayabeque

San José de la Lajas

9 flow cytometry laboratories

5 viral load laboratories

14

PROVINCES

Antiretroviral treatment in Cuba: 2001-2015

8.102

9.661

13.075

12.026

4.6494.018

3.123

2.581

299 8721.2921.727 2.098

5.692

6734

0

1500

3000

4500

6000

7500

9000

10500

12000

13500

15000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Source: Computerized registry of HIV / AIDS, MINSAP2015 until 21/06/2015 15

Steps in the validation process

• Official request to participate in the validation exercise

• Establishment of the country team /preparation of country report

• Establishment of external validation team

• Review of the Regional Validation Committee report

• Pre-validation visit

• Validation visit and field work

• Report by the regional validation team

• Examination of the final report by the World Committee

• Completion of the validation process

16

17

18

Cuba´s efforts to eliminate syphilis and HIV / AIDS are highlighted

Havana, March 27th , 2015, (AIN)