TABLE 2. Changes and challenges for the elimination of mother-to-child transmission (EMTCT) of HIV and congenital syphilis (CS) in countries of Latin America and the Caribbean, 2014-2016.

Country	Changes in information systems, to obtain MTCT indicators quickly and accurately	Significant changes towards the EMTCT of CS and HIV	Continuing difficulties in achieving EMTCT of HIV and CS	Actions and national developments to reach EMTCT of HIV and CS
Argentina	Improved surveillance increasing reports of MSa and CS cases	NRb	Lack of personnel; unclear definitions of responsibilities for MS case active follow-up; need to scale up access to timely diagnosis and treatment; lack of CS case audits	Evaluating the possibility of monitoring jurisdictions’ compliance with the targets; reinforcing guideline use and staff training
British Virgin Islands	Amended registers to capture testing at the ANCc and delivery sites	EMTCT validation exercise in 2016	Need to upgrade laboratory quality	Efforts under way to achieve accreditation and implement quality assurance program for the national laboratory
Chile	Implemented a monitoring system of EMTCT process indicators	Prioritized EMTCT at all levels of health care	Need to implement a second HIV test in pregnancy and sexual partner testing; need to improve primary prevention strategies	National strategy for EMTCT, including case studies; improvement plan for critical nodes, surveillance system, and registries
Dominica, Grenada, St. Lucia, and St. Vincent and the Grenadines	NAd	NA	NA	NA
Dominican Republic	Integrated syphilis-related variables within HIV database	Reexamining surveillance and control of MS	The process of reform in the health system is a temporary obstacle to EMTCT; need for training on syphilis diagnosis and treatment	Developing a national strategy on EMTCT that prioritizes challenges
El Salvador	Resumed SIP as a tool for provision of ANC and delivery in the public health system; established platforms for real-time monitoring of HIV-positive pregnant women and exposed children	Established a monitoring system to close cases of HIV-exposed children	Need to implement case audits and SIP Web; need to improve test coverage and data collection and availability	Developing MS and CS care cascades; joint work among health programs; an intersectoral panel for EMTCT
Guatemala	No changes	NR	Difficulties in improving ANC and testing coverage; underreporting of cases	RTe for syphilis and HIV in primary care
Guyana	Reviewed EMTCT protocols and mechanisms for data processing, analysis, and dissemination	NR	Need to enforce use of unique identifiers; need to report syphilis treatment; need to improve data on live births and ANC coverage	NR
Haiti	Increased health facilities’ reporting on EMTCT	Evaluated progress on EMTCT of HIV and CS; implemented a road map towards elimination in 2020	Low access to institutional deliveries; confirmation tests not available; problems in screening and management of pediatric cases; lack of follow-up with MS cases and sexual contacts; weak management of laboratory data; shortages of benzathine penicillin	Implemented a road map on EMTCT
Honduras	No changes	A new organization model, with decentralization of health services, had a negative impact on the information system	No information and monitoring on the EMTCT indicators; suboptimal coverage of screening in pregnancy and newborns	Updating and extending SIP with a national platform
Panama	NR	NR	Need to extend and qualify ANC; need to increase RT syphilis use in primary care; need to improve SIP data quality; need to avoid supply shortages	Intensifying efforts on EMTCT; implementation of SIP Web; training health workers; reinforcing MS and CS surveillance
Paraguay	Mandatory notification of MTCT cases; health worker training; Experto system expansion	Prioritized EMTCT of HIV and CS, through broader use of RTs, availability of benzathine penicillin, and health worker training; updated national guidelines	Low coverage of ANC and syphilis testing in pregnancy; late start of ANC; lost opportunities to access and test pregnant women at first visit; low adherence to syphilis treatment guidelines	Strategic Plan for HIV/STIs 2014-2018; Reproductive and Sexual Health Plan 2014-2018 integrates EMTCT; Adolescent Health Plan; new guidelines for EMTCT
Peru	Implemented new policy for epidemiological surveillance of HIV and STIs	Included notification of MS and MTCT of HIV and CS cases; improved nominal identification of HIV and MS cases and exposed children; individual monitoring at regional and local level, especially in marginal and rural areas; updated diagnostic algorithms for HIV and syphilis	Major problems in poor and rural areas	NR
Trinidad and Tobago	Started to use variables included in its ANC program (syphilis diagnosis, treatment, and care)	Enhanced surveillance activities, including with contact tracers to find cases	Logistics issues; late referral of MS cases for treatment; staffing issues; need to implement SIP at all levels of the program	Positive changes in political will; commitment by health care providers; community awareness; increasing coverage of HIV and syphilis testing
Turks and Caicos Islands	NA	NA	NA	NA
Uruguay	Instituted CS case audits	NR	NR	NR
Venezuela	No changes	NR	Lack of RT; suboptimal ANC coverage; low engagement of primary care team with EMTCT	Incorporation of RT for syphilis and HIV; national plan for EMTCT

Source: Prepared by the authors, based on the study results.

^aMS = maternal syphilis.

^bNR = not reported.

^cANC = antenatal care.

^dNA = not available.

^eRT = rapid test.