Malaysia eliminates mother-to-child transmission of HIV and syphilis

08 October 2018
A girl who is HIV-positive holds a teddy bear in Ruili City, Yunnan Province.

Malaysia has today been certified as having eliminated mother-to-child transmission of HIV and syphilis.

“Thanks to Malaysia’s efforts over the past several years, parents can now 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.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Dr Shin presented Malaysia’s Minister of Health, Dr Dzulkefly Ahmad, with a certificate of elimination during the session of 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 1998. 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,” said Dr Dzulkefly. “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 strong political support and regular engagement with civil society." 

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 Mr 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 fetal loss and stillbirth, low birthweight, 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 Ms 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 mother-to-child transmission. Malaysia should be congratulated for being one of the first countries to introduce national initiatives to prevent mother-to-child transmission of HIV and syphilis in maternal and child health services.”

WHO validation

Malaysia’s assessment was conducted by independent experts on the elimination of mother-to-child transmission. The assessment itself was conducted by a Regional Validation Team 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. Their findings were reviewed and confirmed by the Global Validation Advisory Committee.

END

 

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 that 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 of HIV per 100 000 live births;
  • HIV mother-to-child transmission rate of less than 5% in breastfeeding populations, less than 2% in non-breastfeeding populations; and
  • fewer than 50 new cases of mother-to-child transmission of 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.

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UNICEF East Asia & Pacific

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