Strategies and missed opportunities in achieving triple elimination of mother-to-child transmission (EMTCT) of HIV, syphilis, and hepatitis B virus: a scoping review

Eliminating mother-to-child transmission (EMTCT) of HIV, syphilis, and hepatitis B virus (HBV) is a global public health priority. Despite progress towards reducing rates of mother-to-child transmission (MTCT) of HIV, global progress toward EMTCT of syphilis and HBV remains suboptimal. We systematically searched records in PubMed capturing the synergistic challenges and potential strategies in achieving triple EMTCT between January 1, 2013, and April 27, 2023. After screening 547 records, 50 reports met inclusion criteria. Overall, testing for HIV was well-established within antenatal care but limited for syphilis and HBV due to poor political support, inadequate funding, and insufficient operational guidance on how to deliver integrated testing within maternal and child health care. MTCT of syphilis and HBV appears to be impeded by lack of integrated systems to enable test-and-treat approaches with same-day test results and immediate treatment initiation, gaps in linkage to care, frequent stockouts of essential drugs and other commodities, prohibitive user fees, and limited clinical familiarity and training of staff in managing syphilis and HBV positive cases. To achieve triple EMTCT, co-strategies that leverage success of HIV programs to gain momentum towards prevention of congenital syphilis and MTCT of HBV, that break down siloed programs by co-delivery of testing, treatment, and training and that are supported through political will, advocacy, policy and funding are critical.