Increasing Number of Pregnant Women Newly Diagnosed with HIV in the Philippines 12 July 2016

Modes of HIV Transmission in the Philippines Sharing of infected needles among people who inject drugs (PWID), mostly males Male-to-Male sex or Males who have sex w/ both males & females Male-to-Female sex Mother to baby MSM have female sex partners Male PWID have female sex partners

Increasing Number of Females Diagnosed with HIV 2,574 newly diagnosed HIV+ females from Jan 1984 to May 2016 Regions: NCR, 7, 3, 4A, 11, 1 Majority are housewives or don’t have a job (except in Region 3) 26% are OFWs Only 497 (20%) PLHIV females are currently taking ART Source: HIV/AIDS & ART Registry of the Philippines (HARP), Epidemiology Bureau, Department of Health

Downstream (males to females to babies) Infections PWID Female Partners of AIDS Epidemic Model, Cebu Province Annual Proportion of New HIV Infections, 2001-2022 91 infants infected from HIV+ mothers 2014: 5 HIV+ infants 2015: 17 infants Jan to May 2016: 7 infants Modes of HIV transmission: 2,349 or 91% sexual transmission 90 or 3% sharing needles 15 or <1% from blood transfusion 1 through accidental needle prick 77 or 3% unknown transmission 42 or 2% female infants were infected from maternal transmission Source: HIV/AIDS & ART Registry of the Philippines (HARP), Epidemiology Bureau, Department of Health

Pregnant Women Newly Diagnosed with HIV Year New Pregnant HIV+ 2011 2 2012 11 2013 15 2014 18 2015 40 Jan – May 2016 29 Source: HIV/AIDS & ART Registry of the Philippines (HARP), Epidemiology Bureau, Department of Health

Issues identified HIV Testing Access to ART HIV testing results takes 2-3 weeks in NCR. Cebu City already using rHIVda (1 day results) Access to ART Less than half are on ART. Service Delivery Networks for HIV+ pregnant women not fully established in NCR. RITM & SLH are the common referral hospitals (but these do not have MCH services). Delivery and Early Infant Diagnosis Don’t know where these pregnant women give birth. Babies are not diagnosed.

Current Activities to Address Issues Surveillance Epi Bureau implementing heightened surveillance for Maternal to Child Transmission of HIV HIV Program Universal offering of HIV testing among pregnant women in health centers in Cebu city and NCR since 2013. Cebu, Manila, QC & Marikina with existing SDN HIV Testing - rHIVda being used for pregnant women in Cebu Other areas send to SACCL for Western Blot diagnosis Access to ART - ART given for free at Treatment Hubs and Satellite Treatment Hubs (QC, Marikina, Manila, Mandaluyong, Pasig, and Cebu) Delivery and Early Infant Diagnosis - Free PCR testing for babies

Recommendations Expand and improve SDN in NCR Capacitate Satellite Treatment Hubs to provide ARV to pregnant women DOH Regional Offices (NCR, Region 7, Region 4A, Region 3) requested to organize regular PMTCT review Refresher course on inter-personal counseling HIV Testing - Expand rHIVda for pregnant women in NCR - SACCL to prioritize Western Blot diagnosis of pregnant women in other areas Delivery and Early Infant Diagnosis - Identify least one hospital per city or inter-local health zone to deliver MCH services for HIV+ pregnant women (ie. ANC, delivery, early infant diagnosis, infant ARV prophylaxis)