Prevention of Mother-to-Child Transmission of HIV and Syphilis

This chapter credits prevention of mother-to-child transmission (PMTCT) with decreasing the number of HIV-infected infants and offers it as a unique opportunity to accelerate PMTCT of HIV and syphilis concurrently. Comparisons of MTCT of syphilis and MTCT of HIV are difficult because of differences in the precision of infant diagnosis. Some evidence suggests that women coinfected with HIV and syphilis may have greater than twofold increased risk of HIV transmission than women with HIV infection alone. Consequences of pediatric HIV suffer from a high risk of early mortality, severe malnutrition, and growth faltering while consequences of pediatric syphilis may result in lifelong disability. Testing for HIV needs to include not only diagnostic services but also careful counseling of women. Cost-effectiveness analyses allow policy makers to prioritize approaches for disease prevention. Lessons from case studies show success in South Africa, successful rapid point-of-care models, and an integrated model from Haiti that treated infants born to HIV-infected mothers but who escaped HIV transmission following ART and formula feeding and developed congenital syphilis.