Introduction In 2010, the Pan American Health Organization (PAHO) member countries approved the Strategy and Plan of Action for Elimination of Mother-to-Child Transmission (MTCT) of HIV and Congenital Syphilis, with the goal of elimination by 2015. Elimination targets are MTCT of syphilis of ≤ 0.5 cases per 1,000 live births; MTCT of HIV of ≤ 0.3 cases per 1,000 live births; and transmission of HIV from HV-infected mothers to their infants of ≤ 2%. PAHO has supported Latin American and Caribbean countries to achieve these goals, by developing several technical resources, a system for reporting indicators of elimination, and methodology for validating elimination.
Methods In 2012, we piloted validation methodology in St. Lucia and Chile, countries with robust elimination programmes. Teams of external experts travelled to each country to assess the national surveillance system and verify reported data; the national laboratory system; and programmatic aspects important for achieving and sustaining elimination. The assessment included review of databases and reports, triangulation and re-calculation of data, mapping of health services delivery, interviews with national and regional stakeholders, and visits to service delivery sites.
Results The validation methodology was able to identify national strengths and challenges in surveillance, health services, laboratory, and programme. It also was able to demonstrate sub-national variances and inequities in achieving and maintaining elimination targets, and barriers to health services access in underserved populations. Data verification and triangulation led to re-calculation of some indicators, but others could not be calculated due to data gaps.
Conclusion The validation methodology is useful for assessing progress in elimination of MTCT of HIV and syphilis, but also as a tool for countries to review their programmatic actitivies to identify opportunities for accelerating achievement of elimination. Challenges in re-calculation of indicators emphasise the importance of comprehensive information systems that collect data necessary to verify elimination.
- congenital syphilis
- other-to-Child Transmission