How to implement the framework for the elimination of mother-to-child transmission of HIV, syphilis, hepatitis B and chagas (EMTCT plus) in a disperse rural population from the gran chaco region: A tailor-made program focused on pregnant women

Abstract

The framework for the elimination of mother-to-child transmission (EMTCT Plus) was proposed by the Pan American Health Organization in 2017 to all member states in order to widen the already existing framework for HIV and syphilis to include elimination of the infection with hepatitis B virus (HBV) and Chagas disease (ChD), now called EMTCT Plus. The objective of this wider initiative is to achieve and maintain the elimination of mother-to-child transmission (MTCT) of the infection with HIV, syphilis, ChD, and the perinatal infection by HBV as a public health problem, in line with the Strategy for Universal Access to Health and Universal Health Coverage. The EMTCT Plus framework represents an interesting challenge for member states, since it requires adequate implementation strategies to overcome health system diversities. Additionally, each country implements this framework in a different manner and according to their own national administrative structure, which can even vary within each country in federal administrations. Moreover, available data from each country constitute global national figures that do not necessarily reflect regional variations. This is the case of many intervention areas with dispersed rural populations like the Tri-Border Area between Argentina, Bolivia, and Paraguay located in the Gran Chaco region. Moreover, this region is a hotspot for neglected tropical diseases, not only for intestinal helminth infections but also for ChD. This is the area that will be used as an example in the current tutorial to aid others in the implementation of the framework. For this purpose, we have posed a series of statements that aim to describe the different components, based on our experience, that should be considered for implementation of this framework.