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Cuba Offers Example for Countries Striving to Eliminate Mother-to-Child Transmission of Syphilis, HIV

December 21, 2016
Gillings School of Global Public Health

Cuba was the first country in the world, and, as of August 2016, remained the only country in the Americas, to receive official validation from the World Health Organization for having eliminated mother-to-child transmission of both syphilis and HIV.

Lola Virginia Stamm is associate professor of epidemiology at the UNC Gillings School of Global Public Health. Recently, she co-authored two commentaries that reflect on Cuba’s success as an example for future interventions.

One editorial, titled “The Cuban Experience in the Elimination of Mother-to-Child Transmission of Congenital Syphilis,” was published in the November issue of the American Journal of Public Health. The other commentary, titled “Elimination of Mother-to-Child Transmission of Syphilis in the Americas—A Goal That Must Not Slip Away,” was published online ahead of print as part of the January issue of Sexually Transmitted Diseases.

Mother-to-child transmission (MTCT) of syphilis, which can cause preterm birth, stillbirth, fetal and infant death and congenital infection, is preventable via universal screening for maternal syphilis during pregnancy. This screening should ideally occur in the first trimester, followed by treatment of infected women and their sexual partners with intramuscular benzathine penicillin G.

This screening and treatment plan is one pillar outlined by the World Health Organization (WHO) in its global initiative, implemented in 2007, to eliminate congenital syphilis. The other three pillars include ensuring sustained political commitment, increasing accessibility and quality of maternal and newborn health services, and establishing surveillance, monitoring and evaluation systems.

In a similar approach, in 2010, the Pan American Health Organization initiated a regional strategy for the Americas with the broader goal of the dual elimination of MTCT of both syphilis and HIV. This approach centers on integrating screening programs for both infections into routine prenatal care with a simple, cost-effective, finger-prick blood test that can be performed even in low-resource settings without traditional laboratories.

To receive validation that they have eliminated MTCT of both syphilis and HIV, countries must demonstrate for at least one year achievement of less than 50 cases of congenital syphilis and less than 30 cases of pediatric HIV per 100,000 live births.

Additionally, countries must provide at least two years of data showing that more than 95 percent of pregnant women attended at least one antenatal care visit, were screened for syphilis and HIV, received their test results, and, in the cases of women who screened positive, were adequately treated. These countries also are expected to maintain effective quality surveillance systems to monitor cases of MTCT of syphilis and HIV.

While the dual elimination of MTCT of syphilis and HIV is not an easy goal, Cuba’s success has shown that it is an attainable one. That Cuba achieved this major public health victory despite the country’s modest economic resources is attributable to a strong primary health-care infrastructure, well-connected data information systems, and a core of highly trained doctors and nurses who provide basic services to all, free of charge.

Currently, several other countries in the Americas are poised to eliminate MTCT of syphilis. With the Zika virus epidemic, however, low-income countries in the region face unanticipated challenges that could hinder efforts related to syphilis.

“It is imperative,” said Stamm, “that the commitment of these countries to the elimination of MTCT of syphilis be strengthened and sustained. We must ensure that this goal, which is almost within reach, does not slip away.”

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