A Guide Through the WHO eMTCT Validation Process

Last week, Cuba became the first country to receive validation from the World Health Organization (WHO) for the elimination of mother-to-child transmission of HIV and syphilis. This historic announcement represented considerable progress in the ongoing global efforts to end AIDS in children. EGPAF is supportive of the validation process as mandated and carried out by the WHO, and is hopeful that soon, many other countries will undergo a similar process to demonstrate the considerable strides being made in eliminating mother-to-child transmission of HIV.

Per WHO’s official guidance, the validation process is a very thorough and meticulous process. The Q&A below helps breakdown the various steps in the validation process and defines some terms.

What does the term “validation” mean?

According to the WHO, the term “validation” is used when a country has successfully met the criteria for eliminating mother-to-child transmission (eMTCT) of HIV at a specific moment in time. Additionally validation “implies that countries will also need to maintain ongoing, routine, effective programme interventions and quality surveillance systems to monitor eMTCT of HIV.”

What does the term “elimination” mean for this validation process?

Typically, when disease or infection incidence falls to zero within a geographical area, it is considered “eliminated.” However, HIV still remains a major public health threat, and while prevention measures of mother-to-child transmission (PMTCT) have been increasingly effective, nearly 700 children are newly infected with HIV every day because many mothers lack access to life-saving services. Therefore, currently the minimum eMTCT impact targets as outlined by the WHO are:

Additionally, to accomplish eMTCT of HIV, there are four process targets that need to be met including:

  1. Antenatal care coverage (at least one visit) of more than or equal to 95%,
  2. Coverage of HIV and/or syphilis testing of pregnant women of more than or equal to 95%, treatment
  3. Coverage of HIV-positive pregnant women of more than or equal to 90% and treatment of syphilis-seropositive pregnant women of more than or equal to 95%.

What are some of the other criteria that countries need to meet before applying for eMTCT of HIV?

Countries are eligible to apply to validation when they have met the impact targets for one year and they have consistently met the process targets for two years. Additionally there must be evidence that the eMTCT of HIV has been achieved in at least one of the lowest-performing administrative units (these units are known to perform poorly on various health indicators).  Countries must also already have an established national monitoring and surveillance system that captures data accurately to detect the majority of MTCT of HIV. Lastly, the validation criteria must haven been met by taking basic human rights considerations into account.

What are the validation procedures?

If a country determines that they have met the global eMTCT validation requirements, they can then officially apply for validation. The validation process has the following stages starting with a request for validation:

1. Request for Validation

2. Pre-Validation

3. Country Validation

4. Regional Validation

5. Global Validation

6. Official Validation

While the process is lengthy, establishing and implementing standardized, global evaluation and validation processes is a crucial part of tracking and understanding our progress in the global effort to end the AIDS epidemic.