Every child deserves the best start to a healthy life, free from preventable diseases and infections. To this end, the WHO, UNICEF and UNAIDS have launched the Regional Roadmap for the Triple Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Syphilis and Hepatitis B in the Asia and Pacific Region (2024–2030). This resource offers guidance to strengthen national strategies and operational plans to end these three diseases among children in the five years left to meet the 2030 Sustainable Development Goal target.
The roadmap assesses how 21 focus countries across Asia Pacific have progressed in eliminating mother-to-child transmission of HIV, syphilis and hepatitis B since 2018. To achieve this, there should be access to antenatal screening of all women and their partners for the three diseases, prompt treatment, safe delivery and infant feeding options as well as appropriate infant preventative treatments (prophylaxis) and vaccines.
Thailand, Malaysia, Sri Lanka and the Maldives have already achieved dual elimination of HIV and syphilis mother-to-child transmission and are now preparing for hepatitis B validation. Bhutan, Cambodia, China and Mongolia, are also making solid progress and are either close to being, or on-track. However, while other countries have demonstrated commitment, they still face significant challenges and require additional support from global and regional health stakeholders to accelerate progress.
UNAIDS estimates that prevention of mother-to-child transmission services have averted nearly 72,000 new HIV infections among children in the region since 2015. Yet in 2023, approximately 10,000 children were newly infected.
“Around 30 children contract HIV every day in this region,” said Eamonn Murphy, UNAIDS Regional Director for Asia Pacific and Eastern Europe Central Asia. “No child should begin life with a disease we can prevent, and no family should miss out on the information, services and support to give their children an HIV-free start.”
The roadmap points to the need for increased syphilis and hepatitis B monitoring as well as for hepatitis B strategies to be integrated into programmes and policies to prevent mother-to-child transmission.
The roadmap outlines seven strategic priorities to guide national action. These include policy leadership, universal service access, integration with reproductive and child health systems, community engagement and strengthened monitoring. It also provides operational guidance to support countries at various stages of implementation, from initial planning to validation and sustainability. Strengthened social protection mechanisms and implementation of human rights protections are also required.
Regional success in achieving elimination will rely on the collaborative efforts of all key stakeholders and the involvement of communities, affected individuals and women. Only then can we truly build a generation in which all children and their families are protected and thriving.
Focus on Pakistan
Despite a lack of national consensus on universal vs. targeted testing, the health department of Khyber Pakhtunkhwa (KP) province has integrated HIV testing, while Punjab province has integrated both HIV and syphilis testing into routine antenatal care. Regarding hepatitis, Pakistan has adopted a universal hepatitis B and hepatitis C virus screening policy for pregnant women. The 2020 ‘Essential Package of Health Services’, endorsed by federal and national health ministries, includes provider-initiated counselling and testing for HIV, hepatitis B and STIs (including syphilis) in districts with high disease burden.
In Pakistan there are independent HIV, hepatitis and mother, newborn, child and adolescent health (MNCAH) programmes, each contributing to EMTCT service delivery to varying degrees. However, a critical barrier undermining the country’s progress towards triple EMTCT is the absence of joint forums and coordination mechanisms to unite these programmes’ efforts. Consequently, there is duplication of services, missed opportunities and a waste of resources resulting in slow progress to attain the EMTCT goal. To stay on track for triple EMTCT, Pakistan needs to establish a national coordination body which develops tailored national and sub-national triple EMTCT policies and a strategy to integrate EMTCT services through MNCH platforms.