Cuba Validated as the First Country to Eliminate Mother-to-Child Transmission of Human Immunodeficiency Virus and Congenital Syphilis: Lessons Learned from the Implementation of the Global Validation Methodology

TheWorld Health Organization (WHO) estimates that each year 150,000 [110,000–190,000] infants are born with human immunodeficiency virus (HIV) and 350,000 perinatal deaths are caused by untreated maternal syphilis at the global level. Results from HIV clinical trials demonstrated effectiveness of antiretroviral therapy for prevention of HIV transmission from mother to child. However, the goal of elimination of mother-to-child transmission (EMTCT) of HIV remained largely aspirational until the adoption of the HIV elimination target by the Americas region in 2010 and the launch of the Global Plan for EMTCT of HIV in 2011. An effective intervention against congenital syphilis—early serologic detection of infection in women before or during pregnancy, and treatment of syphilis-infected women with parenteral penicillin—has been available for 70 years. However, until recently, syphilis testing in antenatal care (ANC) remained limited in countries with constrained laboratory capacity. In 2007, WHO launched a strategy for the elimination of congenital syphilis as a public health problem. Congenital syphilis elimination had already been established as a priority in the Americas a decade before the launch of the global strategy. The Member States of the Pan American Health Organization (PAHO) formally adopted the dual EMTCT target in 2010. The Regional framework combined the target for EMTCT of HIV with the existing regional commitment for elimination of congenital syphilis; and defined dual elimination as (1) reduction of the rate of MTCTof HIV to 2% or less per year, along with reduction of the incidence of MTCT of HIV to 0.3 cases or less per 1000 live births, and (2) reduction of the incidence of congenital syphilis to 0.5 cases or less (including stillbirths) per 1000 live births. These targets were developed based on evidence regarding effectiveness of treatment and modeled predictions of the transmission levels that can be reached with optimal coverage of detection and treatment services. To monitor progress, PAHO developed a regional monitoring framework and prepared periodic progress reports.