The global community is facing a stark reality: despite possessing the scientific knowledge and tools to prevent the vertical transmission of HIV, syphilis, and hepatitis-B, children are still being born with these preventable infections. This failure represents a significant breach of the commitment to achieving the United Nations Sustainable Development Goals (SDGs), which include targets to end AIDS, viral hepatitis, and other communicable diseases. The availability of effective interventions underscores the urgency of addressing this issue, making inaction unacceptable. A newly launched roadmap by UNICEF, WHO, and UNAIDS for the triple elimination of mother-to-child transmission of these infections in the Asia and Pacific region aims to galvanize efforts and accelerate progress towards this critical goal. This roadmap builds upon existing frameworks and global strategies, emphasizing the importance of integrated and accessible healthcare services.
The implications of vertical transmission for both mother and child are severe. HIV, syphilis, and hepatitis-B can lead to adverse pregnancy outcomes and long-term health consequences. Without intervention, the vertical transmission rate of HIV can reach up to 45%, resulting in significant morbidity and mortality among infants. Similarly, a substantial proportion of infants born to mothers with hepatitis-B can develop chronic infections if preventive measures, such as vaccination and treatment, are not implemented. Syphilis during pregnancy poses a high risk of stillbirth, premature birth, low birth weight, and infant death, as well as congenital anomalies. These stark statistics highlight the critical need for timely and effective interventions to protect the health of both mothers and their children.
With less than six years remaining to achieve the 2030 targets, governments must prioritize investments in robust policies and tailored programs. These initiatives should encompass comprehensive antenatal screening for all three infections for both pregnant women and their partners, alongside access to treatment and care services. Safe delivery and infant feeding options are crucial, as is the provision of hepatitis-B vaccination and immunoglobulins, and HIV prophylaxis for children and adolescents. Crucially, effective implementation requires close collaboration and integration within and across various health services, including reproductive, maternal, newborn, child, and adolescent health, as well as immunization and disease-specific programs. This integrated approach will enhance accessibility, improve health outcomes, optimize resource utilization, and establish sustainable mechanisms for preventing vertical transmission.
The Asia Pacific region carries a disproportionate burden, accounting for 9% of children living with HIV globally. While significant progress has been made since 2010, with a 62% decline in new HIV infections among children in the region, recent stagnation in progress raises concerns. The availability of effective treatments for decades further underscores the urgent need for accelerated action. While some countries in the region have achieved elimination of mother-to-child transmission of HIV and syphilis, disparities persist, particularly in access to hepatitis-B vaccination. High- and upper-middle-income countries have achieved near-universal coverage, while lower-middle and low-income countries lag significantly behind, jeopardizing efforts to interrupt disease transmission.
The burden of sexually transmitted infections (STIs), particularly syphilis, remains alarming in the Asia Pacific region, although data quality limitations hinder a comprehensive assessment. The high number of syphilis cases highlights another area where preventable infections are causing significant harm. The lack of readily available data on STIs necessitates strengthened surveillance and data collection efforts to accurately assess the magnitude of the problem and inform targeted interventions. The concurrent epidemics of HIV, hepatitis-B, and syphilis emphasize the need for integrated approaches to address these interconnected challenges.
The historical context of the rollout of prevention of mother-to-child transmission (PMTCT) programs reveals both successes and shortcomings. While some countries, including Thailand, Malaysia, Sri Lanka, and the Maldives, have achieved elimination of mother-to-child transmission of HIV and syphilis, challenges remain in ensuring equitable access to these life-saving interventions. Community-led initiatives have played a vital role in strengthening service delivery and advocating for people-centered care, demonstrating the power of community engagement in achieving impactful results. The experiences of these countries offer valuable lessons for other nations striving to eliminate vertical transmission. The role of community engagement in both public and private sector responses is crucial for generating demand for services related to HIV, hepatitis-B, and hepatitis-C. Empowering communities to actively participate in the response is essential for achieving equitable and sustainable progress. The ongoing efforts of community organizations and networks exemplify the crucial contributions of civil society in advancing health equity and ensuring access to quality healthcare services.
