Context:
- Despite major advances in antenatal HIV screening and treatment, a disturbing trend has emerged where infants are diagnosed with HIV even though mothers tested HIV-negative during pregnancy.
- This phenomenon, termed the “silent HIV transmission gap”, highlights systemic gaps in repeat testing, follow-up, and maternal health surveillance, raising serious concerns for child health and public health systems.
Key Highlights:
Nature of the Silent Transmission Gap
- Mother-to-child transmission (MTCT) continues even when initial antenatal tests are negative.
- Occurs due to new maternal HIV infections during pregnancy or breastfeeding, which remain undetected.
Scientific Reasons Behind the Gap
- Window Period:
- After new HIV infection, standard antibody tests may fail to detect the virus.
- High Viral Load:
- Newly infected pregnant women often have very high viral loads, increasing the risk of transmission to the child.
Critical Risk Phases
- Late pregnancy, delivery, and breastfeeding are periods of maximum transmission risk.
- Single-time testing during early pregnancy is insufficient.
Recommended Public Health Measures
- Repeat HIV testing during pregnancy, at delivery, and throughout breastfeeding.
- Early virologic testing (PCR-based) for infants soon after birth.
- Immediate initiation of ART for HIV-positive mothers and infants.
Relevant Prelims Points:
- Issue: Persistent mother-to-child HIV transmission despite negative antenatal tests.
- Causes:
- Window period of HIV infection
- New maternal infections during pregnancy
- Lack of repeat testing protocols
- Government Focus Areas:
- Prevention of Parent-to-Child Transmission (PPTCT) programmes
- Benefits of Early Detection:
- Reduced infant mortality
- Prevention of lifelong HIV infection
- Challenges:
- Poor follow-up during breastfeeding
- Testing gaps in resource-limited settings
- Impact:
- Undermines HIV elimination goals in children
Relevant Mains Points:
- Key Definitions:
- Viral Load: Quantity of HIV in blood, directly linked to transmission risk
- Window Period: Time between infection and detectability
- MTCT: HIV transmission during pregnancy, childbirth, or breastfeeding
- Static + Conceptual Linkages:
- Public health surveillance
- Maternal and child healthcare systems
- Way Forward:
- Institutionalise mandatory repeat HIV testing protocols
- Strengthen postnatal follow-up and counselling
- Integrate HIV services with RMNCH+A programmes
- Use technology for tracking high-risk pregnancies
UPSC Relevance (GS-wise):
- GS 2: Social Justice – Health systems, maternal and child welfare
- GS 3: Science & Technology – Virology, diagnostics, public health innovation
- Prelims: HIV, viral load, window period, MTCT