WHO has updated its Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus. This third version of global guidance incorporates EMTCT of HBV towards validation of ‘triple elimination’ and provides standardized processes and criteria to both validate EMTCT of HIV, syphilis and HBV, and to recognize high burden countries that have made significant progress on the path to elimination (PTE).
The similarity of the critical interventions necessary to prevent transmission adds to the feasibility and benefit of an integrated approach to EMTCT of all three infections as triple elimination. Building on an integrated maternal and child health platform, WHO has moved to operationalize universal health coverage in the context of integrated communicable disease prevention.
The guidance strongly emphasizes country-led accountability, rigorous analysis, intensive programme assessment and multilevel collaboration, including the involvement of communities of women living with HIV or HBV, or affected by syphilis. A harmonized approach to triple elimination is encouraged within a public health, rights-based and person-centred approach but depending on readiness, countries may choose to pursue validation of single, dual or triple EMTCT.
Since the efforts to establish criteria for validation began in 2007, two editions of the document have been published, and as of November 2021, 15 countries and territories have been validated for EMTCT of HIV and syphilis and one country has been certified on the silver tier in the path to elimination. The two previous editions for this guidance document supported the standardization and formal approach to EMTCT validation, including criteria, indicators and targets to be achieved. The third version was developed by WHO and the Global Validation Advisory Committee. It is intended for use by national, regional and global validation committees as they prepare or review national and regional submissions for validation of EMTCT of HIV, syphilis and HBV.
Mother-to-child transmission, or vertical transmission, is a significant contributor to the HIV pandemic, accounting for 9% of new infections globally in 2017 (1). “With renewed focus to end the epidemics of HIV, viral hepatitis and sexually transmitted infections, we are convinced that setting the bar high for validation will result in the best results for all and, in particular, for women and children at risk for HIV, syphilis and HBV,” said Dr Meg Doherty, Director of WHO’s Department of Global HIV, Hepatitis and STI Programmes.
1. Ending AIDS: progress towards the 90–90–90 targets. Global AIDS update 2017. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2017