Elimination of Mother-to-Child Transmission of HIV and Syphilis in Malaysia
Malaysia is the first country in the World Health Organization (WHO) Western Pacific Region to be granted this certification which is an excellent achievement. Antenatal screening for HIV was introduced in 1998 in Malaysia making that country an early adopter (globally) of the national prevention of mother-to-child transmission of HIV and syphilis in maternal and child health services1. Due to substantial efforts over the last two decades, the number of babies born with HIV or syphilis in Malaysia has now been reduced to a level compatible with the global elimination criteria (see below). Given treatment following mother-to-child-transmission is not 100% effective, prevention of transmission is recognised as being an effective approach to combat increasing infection rates. ‘Elimination of transmission’ is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.
In May and June 2018, NRL staff member Sandy Walker participated in a mission to assess the programme to eliminate mother-to-child transmission (EMTCT) of HIV and syphilis in Malaysia. NRL joined the Regional Validation Team (RVT) 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. The RVT was composed of technical experts to assess key areas including programme assessment, data quality, human rights, gender equality and community engagement; and (with NRL’s participation) laboratory quality assurance. The findings of the RVT were reviewed and confirmed by the Global Validation Advisory Committee and released in October 2018 granting Malaysia certification of having eliminated mother-to-child transmission of HIV and syphilis. For the very first time within the Asia-Pacific region, the assessment of EMTCT validation was conducted virtually (via a series of video conference calls and sessions as well as plenary presentations regarding the EMTCT programme). Further assessment of EMTCT and laboratory services in two subnational facilities (one health clinic and one hospital) was conducted via video-link that enabled NRL to view aspects of the facilities remotely and ask questions of participating staff.
There are 13 000 women in the WHO Western Pacific Region who are living with HIV and become pregnant each year1. Of these, one in four do not receive antiretroviral therapy (ART) thereby resulting in a 15–45% chance of transmitting the virus to their baby during pregnancy, labour, delivery or breastfeeding1. When both mother and baby receive ART, the risk of HIV transmission drops to just over 1%1. In this same region it is estimated that 45 000 pregnant women are infected with syphilis which can result in many complications including neonatal infections and death1. With effective screening and treatment with penicillin, most of these complications can be eliminated.
The WHO 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 to achieve this status. A country that is “validated” has met the internationally set targets at a specific point in time and is required to maintain ongoing programmes following validation.
The following Impact Indicators – must have been met for at least 1 year:
fewer than 50 new pediatric 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.
And Process Indicators – must have been 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.
1. World Health Organization Western Pacific, accessed 14 November,