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Cuba's Health Minister at Washington National Press Club

Presentation on the validation of Cuba as the first country to eliminate mother-to-child transmission of HIV  and syphilis. Wednesday,  July 1st. National Press Club.

I wish to thank for the opportunity given us to outline the work of Cuba in the elimination of mother-to-child transmission of HIV and congenital syphilis.

At the triumph of the Revolution,  the care of sexually transmitted infections was conducted primarily by dermatologists in dispensaries for the treatment of venereal diseases and leprosy. Congenital syphilis was a major health problem then and each year a large number of cases were reported.

In 1962, the first program for the control of syphilis, conducted by the Department of Dermatology, became effective. Free care was established in dermatological offices of hospital and case reporting was improved; however, health coverage was insufficient and epidemiological control actions nonexistent.

In 1972, the program was brought under review and updated, and a different approach was taken: high priority to the finding of cases, research and epidemiological analysis, all of which was performed at community clinics, under the view that they had to be integrated into the community healthcare model.

It is then that the Mother and Child Care program is established, a program that has been subjected to continued improvement and which constitutes the platform for the prevention of maternal and congenital syphilis. Care at prenatal, delivery and postpartum levels is conducted by skilled health personnel and 99.9 percent of births take place in health institutions.

Every pregnant woman receives a minimum of 10 prenatal visits by the family doctor and attends consultations with specialists in gynecology and obstetrics. Care extends to monitoring the health of the mother, including conducting serological tests for syphilis and HIV, which comprise also the sexual partners.

Annually about 1.5 million serologic tests for syphilis are performed, of which over 300 thousand are done to pregnant women, surpassing the 99 percent coverage. Since 1980 the annual rate of congenital syphilis has remained below the elimination criterion set forth by the regional strategy in 2010. In the past four years that rate has been between 0 and 0.04 per thousand live births.

Since the beginning of the eighties, by a decision of the Government, the Operational Group to Fight AIDS was established, which designs, develops and implements policies based on response to the HIV epidemic. This task force comprises social sectors, organizations and associations of civil society, ensuring an inter-sector approach to the response. It works at national, provincial and municipal levels and it is advised by the Technical Committee on HIV / AIDS.

The Program for Prevention and Control of HIV / AIDS was developed in 1986, based on known public health programs that had been previously applied in the country for the prevention and control of other diseases. In particular, existing experiences in the control of sexually transmitted infections were used, and actions were implemented aimed at the early detection of cases, their epidemiological research, partner notification, educating the population and making available prevention, care and treatment services to those affected.

To give sustainability to the program, the network of scientific centers in the country guaranteed research, the training of human resources, and the introduction of technology, which have ensured access by the population to prevention, diagnosis, care and treatment.

The educational component has featured among its core strategies: information dissemination, raising of awareness, communication, counseling, the selling of condom and inter-sector and community approach. The actions implemented and growing participation by the population, people with HIV and other key groups have had a positive impact on indicators of behavioral change in the Cuban population.

Until December 2014 there were 21,922 people diagnosed with HIV, 3,652 had died, and 18,270 were living with HIV. Prevalence in the population 15 to 49 years of age is 0.25 percent.

Males are the most affected, representing over three quarters of those with the disease. Men who have sex with men make up 72.8 percent of all diagnosed cases and 89 percent of diagnosed males.

For the prevention of mother to child transmission of HIV, the program applied and adapted for each given moment and in line with the national context the scientifically recommended actions. Conducting HIV testing at the first prenatal visit, cesarean delivery and the suspension of breastfeeding were the only preventive measures being applied up to the late 1980s. The transmission rate then exceeded the 40 percent.

Performing quarterly HIV serology during pregnancy, screening of sexual partners, combined antiretroviral therapy and viral load measurement to monitor its effectiveness, cesarean delivery, preventive treatment of the newborn and their clinical and laboratory follow-up make up the preventive strategy that we apply. The rate of mother to child transmission of HIV has been at or below 2 percent during the last three years.

The care and treatment of people living with HIV is integrated into the network of healthcare services. It is provided by the Family doctor and nurse offices, and also involves medical specialists from the local clinic who have been trained in HIV / AIDS; with participation by the existing specialized services when individual needs arise, including referral to secondary and tertiary care institutions if necessary.

In collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria, capacities have been created to ensure access to special monitoring studies, and today we have nine flow cytometry laboratories and five viral load laboratories.

Cuba has made great efforts to ensure access to free antiretroviral treatment to those requiring it. Research, development and local production of these drugs, access to care provided by the national health system and technical cooperation received have made such results possible. Today, 13,075 Cubans receive treatment.

In response to the commitment made at the 50th Directing Council of the Pan American Health Organization in 2010, Cuba began its validation process for the elimination of mother to child transmission of HIV and congenital syphilis in November 2013, conveying it in a formal request to the Pan American Health Organization.

Once the country report was submitted, a process of exchanging began between the national team and the regional advisory validation committee, and a pre-validation visit was organized for the 4 and 5 of December, 2014. During this visit, regional experts assessed the reliability of the report, data and views were exchanged with the local team, and the validation visit was scheduled from 23 to 27 March, 2015.

The Regional Validation Committee was made up of experts in different areas and observers belonging to the World Health Organization and Pan American Health Organization, UNAIDS, UNICEF, International Community of Women Living with HIV, Centers for Disease Control of the United States, among others.

They visited in different provinces: family doctor and family nurse offices, polyclinics, hospitals and maternity homes, information processing units, laboratories, and interviewed program managers and beneficiaries of the services.

The regional advisory committee concluded its visit,  expressed its assessments, and announced the following steps, a process that concluded yesterday, June 30, with the recognition of Cuba having attained the validation regarding the elimination of these diseases.

 

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