Elimination of parent to child transmission of HIV, Syphilis and HBV
Prepared by Dr Tammy Meyers, Dr Nicholas Medland (RAG Chair) and members of the RAG’s Clinical Care – HIV, Viral Hepatitis and SRH Sub-Groups
UPDATED ON: 29 June 2020
Disclaimer: The recommendations provided are the opinions of the authors and are not intended to provide a standard of care, or practice. This document does not reflect a systematic review of the evidence but will be revised to include relevant future systematic review findings. The recommendations are not intended to replace national guidance.
This document does not cover management of COVID in pregnancy or neonates. Links to relevant guidance are provided at the end.
Efforts must be made to ensure that pregnant women and their newborn infants receive uninterrupted services, with the aim of improving maternal and infant outcomes. Antenatal and perinatal care includes diagnosis and treatment of maternal transmissible diseases such as HIV, syphilis and hepatitis B infections. The Regional framework for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis in Asia and the Pacific, 2018–2030, sets out steps for countries to reach targets for improved maternal health and elimination of these diseases in children.
The following important services should continue to be offered
Antenatal visits must continue but the nature of contact may change significantly to reduce COVID-19 risk and manage service demand.
HIV, syphilis and HBsAg testing should occur at first antenatal contact - All pregnant women should be tested for HIV, syphilis and HBsAg at least once and as early as possible.
Syndromic management of STIs as indicated
Be aware of other signs and symptoms of STIs during pregnancy and newborn infant and manage accordingly, including miscarriage, ectopic pregnancy, preterm labour (under 37 weeks), low birthweight, birth defects and disabilities, stillbirth or neonatal death. If possible the cause should be investigated and documented with reporting to health authorities.
The World Health Organization
UNFPA - COVID-19 Technical Brief for Antenatal Care Services
University of Birmingham, COVID-19 in Pregnancy (PregCOV-19LSR)
RANZCOG - Coronavirus Disease (COVID-19) in Pregnancy A guide for resource-limited environments http://www.ranzcog.edu.au/COVID-19-limited-resources
Elizabeth Glazer Paediatric AIDS Foundation - COVID-19 and its Impact on Pregnancy and Potential Mother-to-Child SARS-CoV-2 Viral Transmission. Evidence to Action Webinar April 15 2020 https://www.youtube.com/watch?time_continue=1181&v=NM1sMsmW0uQ&feature=emb_title
SARS-CoV-2 has been detected in saliva (8), faeces (9, 10), and in semen in some (11), but not all (12, 13), studies. A small study detected no SARS-CoV-2 in vaginal fluids (14), however angiotensin-converting enzyme2 (ACE 2), which is the receptor used by SARS-CoV-2 to enter host cells, is expressed in the vagina, uterus and ovaries (15). Currently there is no evidence that transmission of SARS-CoV-2 occurs via the faecal-oral route or via exposure to semen, or vaginal secretions.
There are no data currently available on whether different types of sexual practices have different levels of risk for transmission of SARS-CoV-2.