8 October 2018 | MANILA, Philippines – Malaysia was today certified by the World Health Organization (WHO) as having eliminated mother-to-child transmission (MTCT) of HIV and syphilis. It is the first country in the WHO Western Pacific Region to achieve this milestone.
“Thanks to Malaysia’s efforts over the past several years, parents can ensure their babies are born free of HIV and syphilis and have a healthy start to life,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific. “Elimination could not have been achieved without Malaysia’s strong commitment to ensuring access to quality and affordable health services for all women, children and families.”
Dr Shin Young-soo and WHO Director-General Dr Tedros Adhanom Ghebreyesus presented Malaysia’s Minister of Health, Dr Dzulkefly Ahmad, with a certificate of elimination during the WHO Regional Committee for the Western Pacific which opened today in Manila, Philippines.
Malaysia’s two decade-long effort pays off
Malaysia was among the early adopters globally of national prevention of mother-to-child transmission of HIV and syphilis in maternal and child health services. The country started antenatal HIV screening in 1997. Today, antenatal testing and treatment for HIV and syphilis are provided free-of-charge, and virtually all women have access to quality health services including contraception and births assisted by skilled attendants. As a result, the number of babies born with HIV or syphilis has reduced to the level compatible with global elimination criteria. The sustainability of services is ensured through full financial integration into the annual budget of the Family Health Programme.
“Achieving elimination is not the end of our struggle to ensure every Malaysian child starts life healthy and free of HIV and syphilis. It’s the beginning of a never-ending journey to provide exceptional quality of care to prevent all infections that pass from mother to child. The next target we’re aiming for is hepatitis B. It is my sincere hope that this programme, which is a source of national pride and importance, shall be further enhanced in the years to come through constant engagement with civil society and strong political support,” said Dr Dzulkefly.
Protecting future generations
Some 13 000 women who become pregnant in the WHO Western Pacific Region each year are living with HIV, and one in four does not receive antiretroviral therapy (ART). Without these medicines, there is a 15-45% chance of transmitting the virus to the baby during pregnancy, labour, delivery or breastfeeding. When both mother and baby get the medicine, the risk of HIV transmission drops to just over 1%.
“This elimination is a remarkable achievement that puts Malaysia at the forefront of the global effort to ensure that no child is born with HIV or congenital syphilis. A combination of political commitment, stronger systems for health, and timely prevention, diagnosis and treatment is the key to success” said Eamonn Murphy, UNAIDS Regional Director for Asia and the Pacific. “All countries should follow Malaysia’s example and ensure that every child has an HIV-free start to his or her life.”
Additionally, each year an estimated 45 000 pregnant women in the Region are infected with syphilis, which can result in early foetal loss and stillbirth, low-birth-weight, serious neonatal infections and death. But simple, cost-effective screening and treatment with penicillin during pregnancy can eliminate most of these complications.
“UNICEF’s vision is a world where no child dies from a preventable cause and all children reach their full potential in health and well-being,” said Karin Hulshof, UNICEF Regional Director, East Asia and the Pacific. “Early testing, early diagnosis and early treatment are key steps for attaining and sustaining elimination of MTCT. Malaysia should be congratulated for being one of the first countries to introduce national initiatives to prevent MTCT of HIV and syphilis in maternal and child health services.”
In 2017, WHO launched the Regional Framework for the Triple Elimination of Mother-to-child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific with the vision that every child should be free of these infections by 2030. It brings together the global goals of improving access to quality reproductive, maternal and child health services and ending three communicable diseases.
The framework aligns key interventions for triple elimination, such as preventing unintended pregnancy; providing quality antenatal care; early diagnosis; timely and appropriate treatment in pregnancy as well as during and after childbirth; timely hepatitis B vaccination for children, and partner testing and treatment.
Elimination of MTCT of HIV, syphilis and hepatitis B is an important milestone for ending AIDS, sexually transmitted infections and viral hepatitis as public health threats by 2030, commitments endorsed by the United Nations General Assembly and by the World Health Assembly.
Malaysia’s assessment was conducted by the Regional Validation Team—an independent body of experts convened by the WHO Regional Office for the Western Pacific, jointly with WHO Malaysia, UNICEF East Asia and Pacific Regional Office, and UNAIDS Regional Support Team for Asia and the Pacific.
Notes to editors
As treatment for prevention of mother-to-child-transmission is not 100% effective, elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.
WHO’s Global guidance on criteria and processes for validation: Elimination of mother-to-child transmission of HIV and syphilis outlines the process and indicators countries need to meet for validation:
Impact Indicators—must be met for at least 1 year:
- Fewer than 50 new paediatric HIV infections due mother-to-child transmission (MTCT) of HIV per 100 000 live births;
- HIV MTCT rate of less than 5% in breastfeeding populations, less than 2% in non-breastfeeding populations; and
- Fewer than 50 new cases of MTCT syphilis per 100 000 live births.
Process Indicators—must be met for at least 2 years:
- ≥95% of pregnant women receive at least one antenatal visit;
- ≥95% of pregnant women are tested for HIV and syphilis; and
- ≥95% of infected pregnant women receive adequate treatment.
A country that is “validated” has met the internationally-set targets at a specific point in time. They are required to maintain ongoing programmes after validation.