Human immunodeficiency virus (HIV), syphilis, and hepatitis B infections can be transmitted from an infected mother to her child during pregnancy, childbirth, or breastfeeding, leading to disability and death. In 2005, an estimated 2.4 million children were living with HIV. Syphilis during pregnancy is linked to premature birth, miscarriage, stillbirth, and congenital syphilis in newborns. Hepatitis B virus can cause chronic hepatitis B, with the risk of chronicity being significantly higher if exposure occurs in infancy, at about 90%. Mother-to-child transmission remains a major source of hepatitis B cases.
The World Health Organization (WHO) has established a triple elimination policy to address this issue. This policy has been adopted by our country through the Ministry of Health Regulation (Permenkes) No. 52 of 2017. The objective is to ensure that even if a mother is infected with HIV, syphilis, or hepatitis B, the infection is not transmitted to her child. Key measures include early detection and immediate treatment upon diagnosis. This triple elimination effort is implemented from primary to tertiary healthcare facilities, such as Dr. Soetomo General Hospital, which serves as a referral center.
Our research aimed to evaluate the implementation of triple elimination at Dr. Soetomo General Hospital in Surabaya in 2018. The study found that the majority of new pregnant patients in 2018 were young adults, had high school education or equivalent, were housewives, and were referred from other hospitals. Joint screening for HIV, syphilis, and hepatitis B was conducted on 97 patients (14.1%). Screening for HIV and hepatitis B was performed on 149 patients (21.6%), while screening for HIV and syphilis, and syphilis and hepatitis B, was conducted on six patients each (0.9%). HIV screening alone was done on 21 patients (3.0%), and hepatitis B screening alone on 200 patients (29%). No cases were found where the patient had HIV, syphilis, and hepatitis B concurrently. There were 29 HIV-positive patients (4.2%), three with syphilis (0.4%), and 26 with hepatitis B (3.8%), with two patients (0.3%) co-infected with HIV and hepatitis B.
The most common risk factor for HIV was having a partner with HIV risk factors, seen in 23 patients (79.3%). The identified risk factors for syphilis and hepatitis B included having multiple sexual partners. HIV management included the administration of antiretroviral (ARV) therapy to 25 patients (86.2%) and immediate cesarean section for four patients (13.8%). Syphilis treatment involved benzathine penicillin G (BPG) injections for two patients (66.7%). Hepatitis B management included referrals to the Internal Medicine Clinic for 13 patients (50.0%), though only one patient (3.8%) was tested for HBeAg and one for HBV DNA, with subsequent antiviral therapy (tenofovir) administered.
In conclusion, early detection of HIV, syphilis, and hepatitis B in pregnant women at hospitals can be improved. Incomplete medical record documentation could lead to underreporting, as many pregnant women are referral patients who might have been tested at previous healthcare facilities without their results being recorded. The management of HIV, syphilis, and hepatitis B cases is relatively effective but requires collaboration with other specialties, such as internal medicine and dermatology. The use of electronic medical records is expected to facilitate better documentation, referrals, and coordinated care.
By focusing on early detection, effective treatment, and integrated healthcare approaches, the triple elimination strategy aims to protect the health of both mothers and their children, reducing the transmission rates of these serious infections.
Source Article : https://unair.ac.id/pelaksanaan-triple-eliminasi-untuk-mencegah-penularan-hiv-sifilis-dan-hepatitis-b-dari-ibu-hamil-ke-anak/
Link Journal : https://www.balimedicaljournal.org/index.php/bmj/article/view/3376