On 8th October 2018, Malaysia was validated by the World Health Organization (WHO) as having eliminated mother-to-child transmission of HIV and syphilis. Malaysia is only the 12th country globally to have achieved this.

These are the 3 lessons learnt from Malaysia’s experience:

1. Mother-to-child transmission of HIV and syphilis is a public health problem

HIV and syphilis can be transmitted from mother to baby during pregnancy, labour, delivery or breastfeeding.

Without intervention, there is a 30-45% risk of mothers with HIV passing on the virus to their babies during pregnancy, labour, delivery and breastfeeding.

Antiretroviral (ARV) treatment can reduce the viral load to negligible levels, which leads to virtually no chance of transmitting the virus.

For pregnant women with untreated syphilis, 40% of the pregnancies will have complications like congenital syphilis, premature birth, and stillbirth. Syphilis in pregnant women can be treated effectively with antibiotics.

2. Early detection and ARV treatment can eliminate transmission

Prevention starts with early detection. The Ministry of Health Malaysia implemented the prevention of mother-to-child transmission (PMTCT) programme in 1997 as a pilot project and rolled it out country-wide in 1998.

PMTCT provides for universal antenatal HIV screening during pregnancy, where mothers are tested for HIV and syphilis. Malaysia practises the opt-out policy for screening, but healthcare providers will advise mothers about the importance of knowing their HIV status, and that effective treatment is available.

Mothers who test positive will be given free ARV treatment during pregnancy, delivery and for life after childbirth.

Mothers are also given options for safe modes of delivery, which are either Caesarean section or vaginal delivery if the viral load is suppressed. Once the baby is born, he/she will be given ARV prophylaxis for six weeks, and infant formula to replace breastfeeding.

As long as women adhere to ARV treatment, undergo safe modes of delivery and avoid breastfeeding, the chances of transmitting HIV are practically zero.

3. Ending the HIV epidemic is an ongoing journey

WHO’s validation means that Malaysia has reduced mother-to-child transmission to a very low level, but this level has to be sustained.

Malaysia’s next target is to embark on universal screening and vaccination for Hepatitis B to achieve triple elimination (HIV, syphilis and Hepatitis B).

With the HIV epidemic in Malaysia is currently being driven by sexual transmission, there is still some way to go before achieving the “Three Zeros” commitment by 2030: zero new infections, zero discrimination and zero AIDS-related deaths.

Listen to the podcast 'Doctor in the House: How Malaysia Eliminated Mother-To-Child Transmission of HIV/Syphilis':

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