Are we testing for triple elimination? A review of national guidelines on preventing mother-to-child transmission of HIV, syphilis, and hepatitis B in the African region

IntroductionWorld Health Organization (WHO) updated guidelines for maternal HIV, syphilis and hepatitis B virus (HBV) testing for pregnant women, and advised on using dual HIV/syphilis rapid diagnostic tests (RDTs). We reviewed national testing guidelines to assess political support in alignment with WHO guidance and triple elimination of mother-to-child transmission (MTCT) priorities. MethodsWe reviewed national HIV-related guidelines from 46 African countries after 2010, including guidelines on prevention MTCT, HIV testing/self-testing, HIV antiretroviral treatment, and/or HIV pre-exposure prophylaxis. Data was extracted data on recommendations for maternal testing for HIV (frequency and timing), syphilis (any test/test type); and HBV. Testing recommendations for all three infections in the most recent country guidelines were compared to WHO guidelines. ResultsTesting policies on HIV, syphilis, or HBV during pregnancy and/or postpartum from 38 (83%) countries were identified; 18 (47%) had policies updated after 2019 and 11 (29%) were high HIV burden. All 38 countries with HIV testing guidelines addressed maternal HIV retesting, while 68% had guidelines recommending syphilis testing (46% of which recommended the dual RDT), and 58% had HBV testing guidelines. Maternal HIV retesting was more frequent than recommended by WHO in 2019 in 9/11 (82%) and 7/27 (26%) of high and low HIV burden countries, respectively. Half of countries had triple elimination of MTCT focused policies, and 10 (26%) had maternal HIV retesting as well as syphilis and/or HBV testing guidance. ConclusionsHalf of countries had guidelines to test for all three infections; policy evaluations to measure implementation and impact are needed.