Four countries eliminate mother-to-child transmission of HIV or syphilis

Issue: July 2016

WHO recently announced that Armenia has eliminated mother-to-child transmission of HIV, the Republic of Moldova has eliminated mother-to-child transmission of syphilis, and Thailand and Belarus have eliminated mother-to-child transmission of both infections.

“It is immensely encouraging to see countries succeed in eliminating mother-to-child transmission [(MTCT)] of these two infections,” WHO Director-General Margaret Chan, MD, said in a press release. “This is a tremendous achievement — a clear signal that the world is on the way to an AIDS-free generation.”

Margaret Chan

Progress made in reducing HIV, syphilis MTCT in Europe

The reduction in new cases of HIV and congenital syphilis infections in Armenia, the Republic of Moldova and Belarus were achieved as a result of efforts ensuring early access to free services for pregnant women, testing for the women and their partners, and early diagnosis in infants, according to WHO’s Regional Office for Europe. The European region has the world’s highest percentage of pregnant women with HIV receiving ART, with up to 95% receiving the treatment. In addition, more than 70% of infants born to mothers with HIV are tested within 2 months of birth.

“After 2 decades of intensive efforts in the region, we now have validated proof that it is possible to realize the right of all children to be born HIV-free,” Marie-Pierre Poirier, regional director for UNICEF in Europe and Central Asia, said in the release. “As we move forward, it is important that children have equitable access to services that can help them thrive and develop in a supportive family environment, with their mothers alive and nurturing their well-being.”

Thailand first HIV-endemic country to eliminate MTCT

Although Cuba became the first country to end MTCT of both HIV and syphilis last year, Thailand is the first country with a large HIV epidemic to “ensure an AIDS-free generation,” according to WHO’s Regional Office for South-East Asia. The country’s ministry of health reported that 98% of all pregnant women with HIV have access to ART, reducing the rate of MTCT to less than 2%. The number of infants who contracted HIV through their mothers declined 90% from 2000 to 2015, and the amount of new infections among women of childbearing age declined 87% from 2000 to 2014.

Michel Sidibe

“Thailand has turned around its epidemic and transformed the lives of thousands of women and children affected by HIV,” Michel Sidibé, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS), said in the release. “Thailand’s progress shows how much can be achieved when science and medicine are underpinned by sustained political commitment.”

Multipronged strategy sets example

In a recent MMWR, Rangsima Lolekha, MD, of the CDC’s Thailand/Southeast Asia Regional Office, and colleagues reviewed Thailand’s MTCT prevention interventions, which may serve as a model for other countries. According to their report, the elimination of MTCT in Thailand was attributable to clinical trials conducted in the country, the capacity of health care workers, national HIV education and 100% condom use campaigns, pilot prevention activities offering HIV testing and treatment for pregnant women, and a national prevention policy requiring all government hospitals to integrate MTCT prevention activities into routine maternal and child health services. Thailand’s success also was due to government engagement with civil society, people living with HIV and nongovernmental organizations to reduce stigma and discrimination, government funding of MTCT services and surveillance and evaluation systems.

With these activities and resources, Lolekha and colleagues reported that 98.3% of pregnant women had at least one clinic visit in 2015. Between 1998 and 2015, the percentage of pregnant women tested for HIV increased from 61.9% to 99.6%, and the use of ART for MTCT prevention increased from 64.6% to 95.6%. As a result, MTCT decreased from 24.2% in 1994 to 1.9% in 2015.

Moving forward, Thailand’s national AIDS strategy aims to reduce MTCT to less than 1% by 2030. According to preliminary data from an active case management network, approximately 80% of new perinatal infections occur among women who begin antenatal services late, have poor treatment adherence or acquire HIV after they are tested at their first antenatal appointment. In light of these data, health officials are now recommending the use of raltegravir, an integrase inhibitor associated with rapid activity, after 32 weeks of pregnancy and continual HIV testing.

“Data suggest that to reach an MTCT rate less than 1%, Thailand will need to strengthen ownership of prevention of MTCT at subnational and community levels, enhance prevention of MTCT monitoring and data use, ensure that HIV-positive migrants have access to HIV services; and sustain the active case management system,” Lolekha and colleagues wrote. – by Stephanie Viguers

Reference:

Lolekha R, et al. MMWR Morb Mortal Wkly Rep. 2016;doi:10.15585/mmwr.mm6522a2.

Disclosures: Lolekha and colleagues report no relevant financial disclosures. Infectious Disease News was unable to confirm other relevant financial disclosures at the time of publication.