Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis

The Caribbean has set ambitious targets for the elimination of vertical transmission of HIV and congenital syphilis. The strong commitment of the region and the historically high antenatal coverage in the Caribbean provide a solid basis and opportunity for accelerated expansion of services for these targets to be reached. In addition the Caribbean has a history of leadership and success in public health mobilization. The region has been a pioneer in the elimination of measles and polio, and was the first region to embrace the target of elimination of mother-to -child transmission of HIV and syphilis. Through targeted and harmonized action the Caribbean has the potential to become the first region in the developing world to achieve this target. Indeed UNAIDS in KS3, acknowledged that one of the key accomplishments in the region was in the area of prevention of mother–to-child transmission of HIV to such an extent, that the possibility of eliminating new infections among children has become a real possibility.

Approach and Action Plan
With support from PAHO and UNICEF, the PANCAP partners leading this initiative, the Caribbean developed a Conceptual Framework for implementation of the Elimination Initiative. The conceptual Framework has four critical lines of action:
1.    Enhancing capacity of maternal and child health (MCH) and newborn services for the early detection, care and treatment for HIV and syphilis in pregnant women, their partners and children
2.    Strengthening surveillance of HIV and syphilis in MCH services and health information systems
3.    Integrating HIV/STI interventions with sexual/reproductive health and other relevant services
4.    Health systems strengthening

Current status and achievements
The Elimination Initiative was officially launched in the Caribbean in 2009. Between the launch and the end of 2010 the region made the following progress in implementation of the EI, in collaboration with PAHO and UNICEF:
1.    Establishment of a Technical Working Group (TWG) consisting of key technical and programmatic experts. The TWG has been critical in moving the process forward in the region. The TWG meets regularly in face-to-face and virtual meetings.
2.    Development and dissemination of a Concept Document
3.    Development and dissemination of a regional monitoring strategy
4.    Development of integrated clinical guidelines
5.    Development of a communication strategy and dissemination of advocacy materials, including posters and leaflets
6.    Launch and presentation of the EI at various high level events and meetings
7.    Organization of a high level consensus and monitoring meeting, with participation of the Chief Medical Officers (CMOs) of the region, the TWG and other relevant partners.
The broad-based partnership generated around the Elimination Initiative has received global recognition, and in November 2010 the Caribbean received an award for a South-South Cooperation Solution by the Solution Forum on Global Health, hosted by UNDP, ILO and WHO.
 
In addition several tools which have been developed to assist countries in their efforts were reviewed at a special meeting of Regional Chief Medical Officers which was held in March 2012.  They include the following:

1.    Case Based Surveillance Guide: This guide provides a strategic approach for regional and country level surveillance in support of the Elimination Initiative including guidance and recommendations on data flows, tools and strategies at national level and data collection elements at facilities.
2.    Laboratory Guide for the Elimination Initiative: To provide optimal care in the context of the Elimination Initiative, access to quality assured laboratory support is essential for timely diagnosis of HIV and syphilis in women, men, children and infants as well as for the monitoring clients receiving antiretrovirals. The Laboratory Guide provides recommendations for National Laboratories and National Programmes to implement and expand point of care (POC) HIV and syphilis testing in Maternal, Neo-natal and Child Health (CMNCH), Sexual and Reproductive health (SRH) and other primary health care services. In addition, it includes recommendations for immunological and virological monitoring
3.    Field Guide: The field guide which is still a draft document is not intended to replace the technical documents which have been developed but will be a complimentary tool providing policymakers, programme directors, health care providers, civil society and other partners with practical guidance for planning, implementation and monitoring of the Elimination Initiative. It identifies opportunities for health systems strengthening along the 6 WHO building blocks, enhancing linkages and referrals especially to MNCH and SRH to increase access to the Elimination Initiative interventions. The field guide provides guidance on policy development, operational planning, communication strategy and strategic information for monitoring and evaluating national progress.
4.    Validation Tool: Many Caribbean countries may have already met or are making progress to the achievement of the Elimination Initiative targets. To confirm this achievement a systematic review of critical data from a national perspective is required. This document provides guidance on the conduct of the validation exercise in countries to confirm / or identify gaps in the achievement of the Elimination Initiative targets focusing on review of surveillance system and other sources of strategic information and programmatic components essential for the achievement of elimination.
Gaps
Despite these achievements there are still gaps which are currently being addressed on several fronts.  These include a shortage of health care personnel at all levels, weak surveillance systems, vertical systems of care delivery and limited laboratory capacity
For more information and updates on the Elimination Initiative visit:
www.unaidscaribbean.org
www.paho.org