Joint statement emphasizes the elimination of vertical transmission of HIV, syphilis, and hepatitis B, suggesting effective strategies and community involvement.
PREAMBLE We, the professional associations as advocates and contributors to health and development of the people in India, have come together for promoting the elimination of vertical transmission of diseases, aligning with the theme of World Health Day 2025 “Healthy Beginnings, Hopeful Futures,” focusing on improving maternal and newborn health and survival. Achieving the triple elimination of vertical transmission of human immunodeficiency virus (HIV), Syphilis and Hepatitis B is now a global health priority. Infected infants in all three conditions are prone to higher rates of mortality and morbidity and experience lifelong consequences. Congenital syphilis continues to be the second leading cause of still birth. Early exposure via vertical transmission or during early childhood is a major factor in the overall disease burden of HBV. In the absence of preventive measures for mothers and children, the risk of vertical transmission ranges from 70% to 90% in cases of high maternal viral load. In India, the presence of a robust RMNCH + A framework and disease-specific programs (National AIDS and STD Control Programme and National Viral Hepatitis Control Programme), present opportunities for the implementation of a Triple Elimination of Mother-to-Child Transmission strategy which leverages the capabilities of the current programs and achieves the desired impact with greater efficacy and efficiency. This joint statement proclaims our collective commitment to work with the whole society including the affected community toward holistic healthy development and well-being of mother and newborn of our country; every child should be given the best chance to start a healthy life, born free of preventable infections. CONTEXT West Bengal is the first state in the country to undertake the Triple Elimination of Vertical Transmission of HIV, Syphilis, and Hepatitis B (TEVTHSH) initiative with the aim of elimination vertical transmission of HIV, syphilis, and Hepatitis B by the year 2026. Rationale of Triple Elimination of HIV Syphilis and Hepatitis B lies in the similarity of modes of transmission, the prolonged period of silence and latency in the infected mothers with the potential to cause life-long consequences and significant morbidity and mortality in the mother-baby pair. Antenatal care, including regular check-up, happens to be an established gateway to screening, identification, prophylaxis, and management for all the three infections. The state of West Bengal has a strong track record in service delivery for HIV, syphilis, and hepatitis programs. The state has made exceptional progress in reaching out to high-risk groups, such as those in closed settings, engaging with the private sector and professional bodies. Moreover, West Bengal has established effective coordination mechanisms between different health programs. Currently, West Bengal’s overall antenatal care performances are at par with or surpass the national averages, which have paved the way for undertaking TEVTHSH initiative. THE BUILD-UP SUMMARY The blueprint of the intervention was forged in mid-2023 through consultations among the officials of the State Task Force and Technical Advisory group, with the former having key-officials of all relevant program divisions and the later a multidisciplinary group with the coherent technical experts. Field-level actions toward the initiative began with an elaborate prepilot situational assessment in four select districts (September 2023) that culminated in the development of a minutely worked out contextual intervention package. The explicit Declaration of Intent of the state was made through the Kolkata Commitment in a mega Consultation in December 2023. A pilot was thereafter implemented from April 2024. Based on the encouraging learning from the pilot, the State has now moved to a State-wide scale-up of the TE initiative from early 2025. William J Clinton Foundation, all major Professional Academic Organizations, namely, FOGSI, API, IAP, IPHA, IADVL, IAPSM, NNF, CINI India, and WHO have been partners in this journey. Earliest detections in pregnancy and leak proof linkage to care, to prevent vertical transmission, are the prime objectives. A person-centered systems approach has been at the core of the initiative beginning with obstetric care to infection specific care of mother to care and follow-up of the exposed baby. TRIPLE ELIMINATION OF VERTICAL TRANSMISSION OF HIV, SYPHILIS, AND HEPATITIS B FRAMEWORK A detailed cross-sectional assessment across 150 relevant service delivery points in the four selected districts was conducted during pre-pilot situational assessment, which also factored around 40 infected beneficiaries receiving services. The areas of improvement emerging from the assessment were: Standardized protocol for referral, linkage, treatment and care; standardized inventory and commodity management; strengthened recording and reporting with back-and-forth communication channels; governance system for sustained accountability. A need-based intervention package with the following key considerations was developed, based on the findings: Development of SOP module with standardized protocol for screening, referral, linkage, treatment and care of pregnant women and baby, till the age of 18 months (for both public and private health facilities) Guideline for behavioral risk-profiling of the screened negative pregnant woman has been introduced to ensure necessary retesting at later stages of pregnancy Maternal syphilis management has been decentralized to block level along with availability of Benzathine Penicillin-G (BPG). Pregnant woman screening reactive for syphilis is entitled to receive all three weekly doses of BPG Decentralization of delivery of HIV and HBV positive mother at block level Ensuring timely Hepatitis B Birth Dose (HBBD) vaccine administration to all newborns and both HBBD and Hepatitis B Immunoglobulin (HBIG) administration to the exposed infant on time. Private facilities may avail HBBD and HBIG on request from the respective District Health Authorities for the beneficiaries who are in need and administer at free of cost. This activity needs extensive promotion in private sector and involvement of more representatives from private facilities. Many private facilities are still not administering HBBD to newborn Relooking existing synergy between the relevant program divisions and strengthening coordination among them Establishing coordination between labor room, SNCU, ICTC, ARTC, VHTC, and DSRC to ensure ensured the appropriate management of HIV, syphilis, and Hepatitis B-positive mother and exposed infant Revamping governance structure with set key roles and responsibilities Guidance on key commodities, such as testing, prophylactic, and treatment commodities Development and distribution of IEC materials on TEVTHSH for both for both public and private health facilities Establishing robust supervision and monitoring framework along with a dedicated web portal for data reporting (capturing information from obstetric care to disease specific care of mother and appropriate management and follow-up of the exposed infant). Driven by significant progress and learning from the pilot, the Government of West Bengal has rolled out the EVTHSH initiative across the entire State in April 2025. Accordingly, capacity building for rest of the districts to equip district workforce to undertake EVTHSH initiative is ongoing. Concerned state program divisions are ensuring availability of key commodities. Focus is also on increased engagement with private health facilities and professional bodies working in the coherent fields. CALL TO ACTION We, the related professional associations, commit ourselves and call upon other stakeholders to support and facilitate, without delay, the following actions to ensure that all pregnant women and newborn, especially HIV, syphilis, and Hepatitis B-positive mothers and their exposed infants, receive appropriate preventive and therapeutic services. Harmonization of multisectoral policies and strategies to eliminate the vertical transmission of HIV, syphilis, and Hepatitis B Active involvement and partnership of healthcare facilities and providers engaged in the healthcare delivery in the private sector Establishment of linkage between private practitioners and Health Authorities for better tracking of beneficiaries and ensuring appropriate management on time Increase awareness and engagement of all relevant stakeholders, community, government functionaries, political and religious leaders, civil society organizations and international organizations Capacity building and training of members of the professional associations to ensure appropriate management of pregnant women and exposed infants as per the TEVTHSH protocol Strengthening of monitoring and evaluation system through the collection and analysis of good quality data which can contribute to decision-making process and program management Dialog and co-operation with policy makers and programmes heads of National and State level regarding seamless implementation of effective TEVTHSH Role of professional associations is pivotal in community awareness generation regarding TEVTHSH. Their collective action can also promote inclusivity and reduce remnants of social stigma Including TEVTHSH as agenda in academic discussions/conferences of professional associations for its widespread circulation among the stakeholders Our collective aim is to ensure appropriate counseling, screening and management of all pregnant women, and newborn to enable them to live life and thrive with good health, well-being, and dignity. WAY FORWARD On this day of World Health Day, April 7, 2025, let us unite and take a pledge to eliminate the vertical transmission of HIV, syphilis, and Hepatitis B in the state of West Bengal. We can collaborate to implement standardized screening and management protocol in West Bengal. We can conduct capacity building programmes to enhance healthcare worker’s skill in early diagnosis, prenatal and postnatal care, newborn care and preventive approaches. Thus, together we advocate for community awareness initiative to promote “Healthy Beginning, Hopeful Future.” We, the professional associations, affirm our commitment as partners to the West Bengal initiative of Triple Elimination of Vertical Transmission of HIV, syphilis, and Hepatitis B by the year 2026. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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