The achievement of the status of Elimination of Mother to Child Transmission of HIV and Syphilis (EMTCT) in Sri Lanka demonstrates the country’s commitment to public health. It builds on a strong foundation of primary health care services laid several decades ago. EMTCT of HIV and Syphilis is the latest in a series of public health achievements in Sri Lanka. High-quality maternal and child health services, multi-sectoral support, strong community engagement, and concerted efforts by partners such as WHO, UNICEF, UNAIDS, UNFPA and civil society organizations all contributed to the EMTCT of HIV and Syphilis.
Sri Lanka has a low prevalence of HIV, and the first case of HIV infection in a pregnant woman was reported in 1990. The programme for the prevention of mother-to-child transmission (PMTCT) of HIV was established in 2002, and in 2013, the Ministry of Health (MOH) amalgamated the PMTCT programmes for HIV and Syphilis into one programme. The National STD/AIDS Control Programme collaborated with the Family Health Bureau to initiate the scaling up of antenatal HIV and Syphilis testing services across the country. Operating through government STD clinics and maternal and child health (MCH) services with the assistance of UNICEF, WHO, and the World Bank, services covered the entire country by 2016. In 2018, government STD clinics offered HIV testing services for 95.9% of pregnant women in Sri Lanka.
Sri Lanka adopted universal Syphilis screening of pregnant women as early as in 1952. Therefore, all pregnant women who attend antenatal care services are offered screening tests for Syphilis. In 2018, 96.4% of pregnant women attended antenatal care services at least once during pregnancy, and of them 99.3% were tested for Syphilis. Screening for HIV and Syphilis and the management of infected women during pregnancy is fully integrated within the MCH services at every level.
The EMTCT programme in Sri Lanka follows a comprehensive approach adopted for preventing HIV and Syphilis infections among women. All four prongs of the EMTCT strategy were strongly implemented through well-integrated services for the community, including interventions for pregnant women, their partners, key populations, adolescents and others at risk of STDs/HIV. A constant updating of MTCT guidelines based on emerging evidence was a key factor in this success.
The HIV programme in Sri Lanka focuses on preventing HIV transmission among at-risk populations. The key features of this programme were expanded access and coverage of quality HIV testing and counselling, safe blood and tissue transfusion, and a commitment to provide quality care, support and treatment for people living with HIV/AIDS and Syphilis delivered free of charge to the patient.
These concerted actions resulted in low and declining rates of transmission of HIV and Syphilis. The findings of the national, regional, and global validation teams confirmed that Sri Lanka met the impact and process indicators for the validation of the elimination of mother-to-child transmission of HIV and Syphilis.
The World Health Organization’s Regional Office for South-East Asia deems it a great honour to acknowledge this remarkable public health success and certify Sri Lanka for the ‘elimination of mother-to-child transmission of HIV and Syphilis’. Sri Lanka must continue multi-sectoral coordination and ensure sustained universal access to high-quality and decentralized EMTCT services, including at the primary health care level, to sustain this elimination over the years.