Progress towards the elimination of vertical transmission of HIV, syphilis and hepatitis B in 21 high-burden countries.

INTRODUCTION

Elimination of mother-to-child transmission (EMTCT) of HIV, syphilis and hepatitis B by 2030 is a global goal endorsed by countries. To achieve EMTCT, countries need to meet targets for programme and impact indicators.

METHODS

We examined progress and gaps in service delivery across the three infections among 21 countries with a high burden of HIV, syphilis and/or hepatitis B. We summarized national coverage of interventions to prevent vertical transmission of HIV, hepatitis B and syphilis. Service coverage indicators were extracted from public data sources for the most recent available years (2014-2024).

RESULTS

Antenatal care (ANC) coverage (at least one visit) ranged from 62% to 99%; 14 countries (67%) had coverage ≥90%. Twelve countries (57%) had ANC HIV testing coverage above 90%; 13 countries (62%) reported antiretroviral treatment coverage ≥90%. Eight countries (38%) reported ANC syphilis testing coverage ≥90%; ten countries (48%) reported ≥90% treatment coverage among pregnant women diagnosed with syphilis. All 21 countries have introduced three infant doses of hepatitis B vaccine (HepB3), and six countries have introduced the hepatitis B birth dose vaccine (HepB-BD) in their national immunization schedule. Among the six countries that provide HepB-BD, only four reported coverage with timely HepB-BD given within 24 hours of birth (range 52-70%). Seven (33%) countries have achieved HepB3 coverage ≥ 90%.

DISCUSSION: Antenatal service delivery for prevention of mother-to-child transmission of syphilis and hepatitis B lags behind that of HIV. Despite the availability of ANC platforms for the delivery of HIV, syphilis and hepatitis B services, many countries face new and ongoing implementation and funding challenges in reaching global targets for EMTCT of these infections.

CONCLUSIONS

Integrating HIV, syphilis and hepatitis B prevention of vertical transmission services into ANC and maintaining support for EMTCT efforts is critical to close these gaps.