Challenges of eliminating mother-to-child transmission of HIV, syphilis and hepatitis B in China: a cross-sectional survey

Abstract

BackgroundChina's Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B Virus programme (iPMTCT Programme) was launched in 2010 and has been extended nationwide since 2015. China also set up the Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Syphilis, and Hepatitis B virus in 2016. This study aimed to assess the progress that has been made in eliminating mother-to-child transmission of HIV, syphilis and hepatitis B, and to identify the challenges that remain. MethodsData on testing coverage among 17·58 million pregnant women who attended antenatal care services, and services received by pregnant women with HIV, syphilis or hepatitis B infection and by children exposed to infection were extracted from the Management Information System of China's iPMTCT Programme. Document review, group discussions and field observations were conducted to assess the iPMTCT in line with the four evaluation components set out in the WHO EMTCT validation guidelines: program assessment, data quality, laboratory quality assurance, and human rights, gender equality, and community engagement. Informed consent was obtained from pregnant women when they received services in the health facilities. FindingsThe mother-to-child transmission rate of HIV was 4·9% (the reported number of children with HIV was 55 of 2172 children exposed to HIV, and the adjusted mother-to-child transmission rate was 4·9% [114·6 of 2333]) in 2017, which decreased from 12·8% in 2005. Between 2011 and 2017, the number of reported congenital syphilis cases declined from 13 294 to 3 846, and the reported number of children with HIV through mother-to-child transmission reduced from 79 to 55. In 2017, the coverage of HIV, syphilis and hepatitis B screening tests among pregnant women was over 99·5%. Of the pregnant women who were screened and diagnosed with HIV or syphilis, 89·6% and 80·0% received treatment, respectively. The rate of early infant diagnosis in children exposed to HIV reached 84·3% in 2017. Nearly all (99·7%) of infants exposed to hepatitis B virus received hepatitis B immune globulin vaccine at birth in 2017. The following factors were identified as the main gaps to be bridged to achieve the goals of eliminating mother-to-child transmission of HIV, syphilis and hepatitis B: inconsistency in the definitions of progress indicators; lack of a system to collect follow-up data on outcomes in children exposed to hepatitis B virus; a relatively weak laboratory network at grass-roots level (inadequate number and quality of laboratories); limited capacity of health facilities at grass-roots level; inadequate quality of reported data; and insufficient involvement of community-based organizations (CBOs). InterpretationThe mother-to-child transmission rate of HIV and reported congenital syphilis cases has decreased since the program launched, and comprehensive PMTCT services are available for all pregnant women across the country. Universal coverage of screening in pregnant women and HBIG vaccination in infants exposed to infection has been achieved. To achieve elimination of mother-to-child transmission of all three viruses, efforts are needed to strengthen multisectoral collaboration, increase treatment rates among women with infection, develop a standardised indicator system in accordance with WHO EMTCT validation tools, improve reporting and quality control mechanisms, strengthen laboratory networks, improve the capacity of the private sector, and extend the involvement of CBOs. FundingThe Chinese government and UNICEF China.