After years of continuous progress in the elimination of MTCT of HIV and syphilis, the data reported show a decelerating trend in recent years. Syphilis is on the rise throughout the Regions with many countries reporting outbreaks, disproportionally affecting key populations, but also resonating in the general population resulting in higher prevalence of syphilis among pregnant women and increasing incidence of congenital syphilis. The number of new HIV cases among children decreased during the past decade, evolving to a stabilized trend in recent years, most likely due to the inconsistent progress on the coverage of HIV testing and treatment services among pregnant women.
The Covid-19 pandemic disrupted immunization programs across the Region, with record declines in vaccination coverage. However, the reported data indicates a stalled progress and challenges to sustain vaccination coverages in the Region during the years preceding the pandemic, highlighting the need to address not only issues related to the apparent disruption, but also systemic challenges to ensure access to hepatitis B vaccines.
Congenital Chagas deserves attention due to its high prevalence among women of childbearing age and pregnant women in the Americas. Effective vector control and donor screening in transfusion centers have resulted in a significantly decreased rate of new infections in recent decades, making the MTCT the most important cause of new infections in many countries. Advocacy, political support, and programmatic efforts, including the design and update of information systems are needed to eliminate congenital Chagas.
Countries have been slow in adapting and revising their national systems to incorporate hepatitis B and Chagas disease key programmatic and impact indicators, limiting the monitoring of the EMTCT of these diseases. This issue can be added to other limitations of the EMTCT data in the Region, including underreporting of the number of perinatal HIV, congenital syphilis, and Chagas disease cases, under recording of seropositive pregnant women and subsequent treatment, the use of non standardized case definitions for congenital syphilis. Improving the information systems and the generation and analysis of disaggregated EMTCT Plus data in the Region, are crucial to understand gaps and to inform tailored national policies to ensure access to services by specific vulnerable and most affected populations.
This report highlights some worrisome trends, and although the progress of EMTCT has been affected by the COVID-19 pandemic, it is not yet possible to determine the extension of this impact. Its seems that the COVID-19 aggravated an ongoing situation, considering that countries have reported decreasing levels of activities related to prevention, testing, and treatment indicators in years prior to the pandemic. Some countries however, managed to sustain previous achievements, indicating a quicky recovery and encouraging results for the future.
Efforts to recovery from the pandemic, transforming resilient health systems, play a meaningful role to revert the situation. However, it is also critical to regain political commitment to the specific goals and objectives of the EMTCT Plus initiative, expressed by political will, strengthened public health capacity at the local levels, and community collaboration. PAHO/WHO, in collaboration with key partners such as UNICEF and UNAIDS, will provide technical cooperation to countries, particularly those with major gaps and programmatic challenges to strengthen their efforts toward triple (HIV, syphilis, and hepatitis B) and quadruple EMTCT of HIV, syphilis, Chagas disease, and hepatitis B.