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. 2021 Mar;40(1):12-18.

Elimination of the Perinatal Transmission of HIV and Syphilis in Puerto Rico and Sustained Success since 2007: Convergence of Science, Women-Centered Care, and Policy

Carmen D Zorrilla  1 , Linnette Rodríguez-Figueroa  2 , Sandra Miranda-De León  3 , Bernardita López-Alvarado  3 , Eileen Pérez  4 , Silvia E Rabionet  5
Affiliations

Elimination of the Perinatal Transmission of HIV and Syphilis in Puerto Rico and Sustained Success since 2007: Convergence of Science, Women-Centered Care, and Policy

Carmen D Zorrilla et al. P R Health Sci J. 2021 Mar.

Abstract
in English, Spanish

Objective: There have been significant successes in the fight against HIV/AIDS due to the access to rapid HIV testing, interventions to reduce the mother-to-child transmission (MTCT) risk, potent and effective antiviral medications, and other biomedical prevention strategies. The purpose of this work is to demonstrate that Puerto Rico eliminated Mother-to-Child Transmission of HIV (MTCT) following the 2017 World Health Organization (WHO) criteria for validating the elimination of MTCT and Syphilis.

Methods: Existing epidemiological data from Puerto Rico was used to document the elimination of MTCT and Syphilis. Data to calculate the indicators was obtained from the various divisions of the Puerto Rico Department of Health, including vital statistics, surveillance data, and programmatic outcomes.

Results: Puerto Rico eliminated MTCT and syphilis, according to the WHO indicators, earlier than other countries. We can trace the outcomes to 1994 using the incidence rate of perinatally-acquired HIV of <50/100,000; to 2007 using HIV perinatal transmission rates for non-breastfeeding countries (<2%), to 2008 using 90% of women receiving ART at delivery, and to 2005 using the incidence rate of congenital syphilis of <50/100,000.

Conclusion: Not only have we eliminated the MTCT of HIV and syphilis, but the efforts have been sustained since 2000. The elimination of transmission of infectious diseases requires the intersection of scientific feasibility, coordinated interventions, and political will, successfully attained in Puerto Rico.

Objetivo:: Ha habido avances significativos en la lucha contra el VIH/SIDA: el acceso rápido al diagnóstico de VIH, intervenciones para reducir el riesgo de transmisión maternoinfantil y medicamentos efectivos que disminuyen el riesgo de transmisión sexual y otras estrategias preventivas. El propósito de esta investigación epidemiológica es demostrar cÓmo Puerto Rico ha eliminado la transmisión perinatal del VIH y sífilis, usando las guías publicadas por la Organización Mundial de la Salud (OMS) en el 2017.

Métodos:: Se utilizaron datos epidemiológicos para calcular los indicadores propuestos por la OMS para la validación de la eliminación de la transmisión perinatal del VIH y sífilis. Los datos fueron obtenidos del Departamento de Salud de Puerto Rico, incluyendo estadísticas vitales, datos de vigilancia y logros programáticos.

Resultados:: Puerto Rico eliminó la transmisión perinatal de VIH y sífilis antes que otros países. Podemos confirmar la eliminación en el 1994 usando la tasa de incidencia de VIH perinatal de <50/100,00; en el 2007 usando la tasa de transmisión de VIH perinatal en países sin lactancia (<2%); en el 2008 considerando que el 90% de las mujeres reciben medicamento al momento del parto; y en el 2005 usando la tasa de incidencia de sífilis congénita de <50/100,000.

Conclusión:: No sólo hemos eliminado la transmisión perinatal del VIH y de la sífilis en Puerto Rico, sino que se ha sostenido desde el año 2000. La eliminación de la transmisión de enfermedades infecciosas no es fácilmente alcanzable; requiere la intersección de la ciencia con intervenciones coordinadas y voluntad política.

Keywords: Elimination of Mother to Child HIV Transmission; HIV and Syphilis; HIV and pregnancy; Perinatal HIV transmission; Women-centered HIV Care.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Figure 1.
Figure 1.
Incidence rate of perinatally-acquired HIV infections (per 100,000 live births) by year of birth, Puerto Rico, 1980–2016
Figure 2.
Figure 2.
Rate of HIV Mother-to-Child Transmission (MTCT) by year of birth, Puerto Rico, 2005–15
Figure 3.
Figure 3.
Proportion of pregnant women with at least one prenatal visit, Puerto Rico, 2005–16
Figure 4.
Figure 4.
Proportion of HIV-positive pregnant women who received antiretroviral therapy during pregnancy or birth, Puerto Rico, 2005–15
Figure 5.
Figure 5.
Incidence rate of congenital syphilis (per 100,000 live births) by year of birth, Puerto Rico, 2005–2016
Figure 6.
Figure 6.
Timeline of advances, recommendations, and public policies regarding perinatal HIV transmission prevention in Puerto Rico and the US.
See this image and copyright information in PMC

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