The Government’s commitment to eliminate Mother-To-Child-Transmission (MTCT) of HIV and Syphilis (Sexually transmitted infection) by 2020 is likely to remain on paper if one goes by the target achieved so far, as has also been stressed in the recently released report, the National Strategic Plan for HIV/AIDS and STI 2017-2024 of the Union Health Ministry.
As per the report, in 2015, India has tested only half of the pregnant women for HIV and put only half of the estimated pregnant women on Anti- Retroviral Therapy (ART) and the final MTCT rate is estimated to be 27 per cent. Similarly, only 9 million pregnant women were tested for Syphilis, translating into coverage of around 30 per cent in 2016. A total 29.7 million pregnancies are reported annually in the country.
This is a major gap in view of achieving 95 per cent coverage target for elimination of congenital syphilis by 2020. This gap is higher in States with less HIV and Syphilis testing facilities such as Uttar Pradesh and Bihar as compared to high prevalence States such as Maharashtra, Tamil Nadu and Karnataka.
Also, the penetration in private sector is also sub-optimal. Almost 40 per cent of the total deliveries are conducted at private sector facilities; however only 10 per cent of the total HIV testing among pregnant women under the National Aids Control Organisation (NACO) is through the private sector, says the report.
Studies show that without any intervention, the risk of HIV transmission from an infected pregnant woman to her newborn is between 20 and 45 per cent.
This can be reduced to 1 per cent through the early screening of a positive mother and her immediate initiation on ART.
Gaps in follow-up coverage are also huge. Out of an estimated 29.7 million pregnancies per year, about 74.2 per cent attended at least one antenatal care (ANC) visit. Out of the 27.6 million ANC registered in Government portal, 59 per cent were tested for HIV. Also, against estimated PMTCT need of 35,255, the coverage is around 45 per cent in 2015.
There are gaps in early infant diagnosis and continuum of care as well. In the absence of strong IT enabled and automated system, the follow-up of birth cohort under MTCT becomes challenging, the report says as it calls for a focused approach as well as steady finance, absence of which means, possibility of increasing HIV cases.