Mother to child transmission (MTCT) of sexually transmissible diseases including HIV ,and syphilis is currently a great concern to health authorities around the world. As doctors around the world battle to keep down rising figures amid the Covid 19 pandemic, Sri Lanka can take pride in adding another feather to her cap in health achievements by being able to eliminate mother to child transmission and reach the WHO goal ahead of time. In November 2019 The Global Validation Committee declared Sri Lanka as a country which has eliminated Mother To child Transmission (MCTC) .
The Sunday Observer spoke to the Coordinator of EMTC Dr Lilani Rajapaksa and Consultant Venereologist, National STD/Aids Control Programme, who was responsible for the report submitted to the World Health Organization ( WHO) to find out the story behind this achievement .
Responding to our question she briefly summarised the history of the program and its important milestones in eliminating mother to child transmission of HIV and other sexually transmitted diseases such as syphilis. “”In 1954, The NSACP commenced a program for the prevention of congenital syphilis. In 2002, it started a programme for the prevention of mother to child transmission of HIV. It was in 2013, that these two programs were combined for the “Elimination of mother to child transmission (EMTCT) of HIV and syphilis. Since then we went all out to make this programme a success”.
Asked who was enlisted in this effort, and what was unique about it she said, “” It was a collective effort with a number of persons from various sectors and stakeholders being part of it. The remarkable feature of this program is the link between several institutions at different levels. At the central level under the guidance of the Director General of Health Services and Deputy Director General Public Health Services, National STD AIDS Control Program worked closely with the central unit responsible for maternal and child health in the country, the Family Health Bureau .
At the provincial level the Provincial and regional Director of Health Services, venereologists, community physicians and medical officer maternal and child health guide the district health care system to implement the program in the community. District STD clinic team and medical officers of health (MOH) offices implement the programme in the community. Obstetric care and paediatric services are provided by the major institutions in the district. Throughout this period the program also worked closely with NGOs, KPs and PLHIV and their contribution at all levels is appreciated.””
When the program was initiated, we asked what facilities were put in place to achieve the goal of ending mother to child transmission within or before the goal set by the WHO.
In reply she said, “”With the launch of the EMTCT of HIV and syphilis program in 2013, field-level health care workers providing MCH services were instructed to offer HIV screening services to all pregnant women following counselling. Leaflets and posters were developed to increase awareness on the importance of VDRL and HIV testing services. Healthcare workers were trained on the services emphasizing the voluntary testing approach.
Laboratory facilities were improved to cope with the increased demand for HIV testing. Test kits and laboratory equipment such as ELISA machines were procured. International funding agencies, namely UNICEF, World Bank and WHO supported the program. With further scaling up, EMTCT services covered the whole country by end-2016””
On management of pregnant women with syphilis and those likely to transmit the disease to their unborn child she told the paper, ’If the HIV screening test is reactive, the pregnant woman is referred to the STD clinic for confirmatory tests and lifelong HIV care services including EMTCT services. “”
In retrospect how successful has the program been so far? We asked.
Her reply was, “”With improvements in detection and management of HIV and syphilis in pregnant women, rates of MTCT for both diseases have fallen well below global elimination targets – consistently less than five per 100 000 live births. The performance of the EMTCT program currently meets or exceeds 95% targets for ANC attendance, early screening and treatment for both HIV and syphilis””
In conclusion we asked if there were future challenges they were likely to face. Her reply was, “This program contributed to the development of the country by assuring child health, reducing maternal illnesses and deaths and by increasing access to services for women in disadvantaged situations. It normalised HIV testing and promoted open discussion on HIV. The challenge at the moment is maintenance of these achievements.”