Making it happen – Eliminating mother to child transmission of HIV and Syphilis in Belize
Making it happen – Eliminating mother to child transmission of HIV and Syphilis in Belize
May 2024
Stephannie Lizama traveled from the village of San Lazaro to the Orange Walk health center in the north-east of Belize that morning, a journey that takes over three hours by foot. At 31 weeks pregnant with her second child, she had been experiencing some sickness and was keen to receive her prenatal checks.
Credit: PAHO/WHO/Ary Silva
After arriving at the maternal and child health clinic, Stephannie participated in a group talk with other pregnant women about the importance of prenatal screening for a variety of health issues, including HIV and Syphilis. She then had a physical examination, followed by a blood test at the on-site laboratory.
The blood test is a priority for Stephanie. “If I find out I have HIV or Syphilis, I can make sure the baby is ok,” she said. “Because it can be transmitted to the baby and cause complications. That is what I want to avoid.”
This achievement follows more than a decade of work to strengthen prevention and treatment services for mother and child health, in line with the countries’ commitment to the Pan American Health Organization’s (PAHO) Strategy and Plan of Action for the Elimination of mother-to-child transmission of HIV and congenital syphilis in the region of the Americas.
Since beginning its journey towards certification, Belize has implemented a number of measures to ensure that every pregnant woman, accessing either the public or private health care system, is tested for HIV and syphilis two to three times during pregnancy, and upon admission for delivery. The mother then continues to receive follow-up care until 18 months post-partum.
Credit: PAHO/WHO/Ary Silva
“The first thing we do when a woman comes into the clinic is run a rapid pregnancy test,” Sharon Cooper Espinosa, a public health nurse at the Matron Roberts Polyclinic in Belize city, said. “Once we establish that a lady is pregnant, we order lab tests for HIV, Syphilis, and hemoglobin, among others.”
If a woman tests positive for HIV or Syphilis, she is contacted immediately and given treatment to prevent transmission to her unborn child. “This entails several things,” Nurse Espinosa explained. If a woman tests positive for syphilis, she is given a series of penicillin injections for three consecutive weeks. In the case of HIV, the woman is given daily antiretrovirals (ARVs) to take along with her prenatal vitamins. The team then follows up with the woman a week later to ensure adherence to treatment and to prevent any complications. If a woman fails to attend a follow-up appointment, a nurse is sent to check on her at home. When a woman tests positive, partners are also encouraged to get tested and, if necessary, begin treatment.
Credit: PAHO/WHO/Ary Silva
Credit: PAHO/WHO/Ary Silva
To ensure that no pregnant woman is left behind, the Belize Ministry of Health and Wellness also organizes regular mobile health clinics, which travel from village to village in more remote areas of the country, such as San Lazaro.
“Close monitoring of women is key to success,” Dr. Natalia Largaespada Beer, Technical Advisor of the Maternal and Child Health Unit at the Ministry of Health in Belize, said, highlighting the use of available technology as key to ensuring communication between national and local teams to follow up on testing and treatment of women and their babies.
“The process we went through for validation was very thorough,” she added. “If you look at the HIV transmission rate, we had a reduction of 81 percentage points, comparing 2007 to 2023.”
“But it is not just about certification. It is about helping to protect the child when the evidence is overwhelming that if a mother adheres to treatment, the child has a chance to be born free of HIV, and if she is treated adequately for syphilis during pregnancy, the child will be born free of syphilis. The child is why we do all that we do.”
Credit: PAHO/WHO/Ary Silva
For Dr. Karen Lewis- Bell, PAHO/WHO Representative in Belize, achieving elimination has been a huge achievement for the country, particularly following its elimination of malaria in 2023. “One of the priority areas for PAHO’s technical cooperation with Belize is the prevention and control of communicable diseases,” she said, highlighting the organization’s work to ensure capacity building, provision of norms and standards, as well as practical support with reagents for testing, as key elements of cooperation.
“The elimination of mother to child transmission of HIV and syphilis can only be achieved when there is strong teamwork and quality health services being provided,” as well as collaboration between the public and private sectors, added the Minister of Health and Wellness of Belize, Hon. Kevin Bernard.
“Every child has the right to be born and remain free from HIV and syphilis.”
When the news came that Belize had achieved certification, “I was overwhelmed with joy and happiness because we’ve really helped these families,” Dr. Largaespada Beer said. “The science says it is possible. It is the health care workers and the family that need to make it happen. We are proud we made it happen and we are proud and committed to continue our efforts.”
The mother-to-child transmission of HIV and Syphilis is one of more than 30 communicable diseases that countries of Latin America and the Caribbean have committed to eliminate as part of the PAHO Elimination initiative.
The initiative, which was relaunched during the Organization’s 60th Directing Council in 2023, seeks to harness the lessons learned from the COVID-19 pandemic, as well as from previous elimination experiences, to accelerate disease elimination in the Region.
