Preventing mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas (ETMI-plus): tests, timing and follow-up
- Safe practice
The nurse makes sure every pregnant woman is tested for HIV, syphilis and hepatitis B, and Chagas in endemic areas, and that mother and baby are followed up.
What it is
ETMI-plus is PAHO's framework (2017) to eliminate mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas disease in the Americas. It uses antenatal and newborn care to test, treat and follow up mother and baby. In Colombia, the maternal–perinatal route (Resolución 3280 de 2018) sets which tests the pregnant woman gets and when. Nursing offers the tests with counselling, reads the rapid tests at the point of care, makes sure results and treatment are not delayed, and links the newborn to follow-up.
What it requires
- PAHO impact targets: mother-to-child HIV transmission of 2% or less; congenital syphilis of 0.5 or fewer per 1000 live births; HBsAg prevalence of 0.1% or less in children of 4–6 years; 90% of newborns with T. cruzi infection cured.
- Programme targets also include 95% of pregnant women with HIV or syphilis treated in time and 95% birth-dose hepatitis B coverage with a full three-dose schedule.
- Rapid treponemal test positive at the point of care: treatment of the pregnant woman starts in the same visit, per Res. 3280; no penicillin allergy test is done.
- First reactive rapid HIV test: a second, different antibody test at once; if reactive, a blood sample for viral load and referral.
- Chagas risk factors include knowing the vector (pito), a house with earth floor, palm roof or bahareque walls below 2000 m, relatives with Chagas or transfusions mainly before 1995.
Components
- Screening and testing during routine antenatal care.
- Counselling for the mother and her partner to lower risk and secure treatment.
- Timely diagnosis and treatment: antiretrovirals, syphilis treatment of the woman and her partner, hepatitis B vaccine for the newborn, Chagas testing and treatment.
- Postnatal care: follow-up of mother and baby until cure or a confirmed diagnosis.
How it is applied (and why)
- Offer each test with pre-test counselling and record her consent — HIV testing is voluntary but recommended for every pregnant woman.
- Do the rapid tests at the point of care and give the result in the same visit — same-day results allow same-day treatment.
- With a reactive rapid test, follow the route at once: confirmation, treatment and referral — each lost week raises the risk of transmission.
- Repeat HIV and syphilis tests each trimester and check them at admission for birth — infection can be acquired during pregnancy.
- Ask about the Chagas risk factors and order the ELISA when she comes from an endemic area — congenital Chagas has no signs at birth.
- Counsel the partner: testing and treatment of the partner prevent reinfection — syphilis treated in the mother alone can come back.
- Make sure the newborn gets the hepatitis B vaccine in the first 24 hours — the birth dose prevents perinatal infection.
- Hand over the mother's results to the newborn's team and book follow-up — the baby of a positive mother needs testing and care.
In nursing practice
- Syphilis in pregnancy is followed with a non-treponemal test (VDRL or RPR) in dilutions each trimester.
- Results are shared only with the woman and the team; stigma drives women away from care.
- A woman with no antenatal care arrives in labour: rapid tests at admission, so the newborn can get prophylaxis in time.
- Mothers with HIV or hepatitis B need long-term care after birth, not only during pregnancy.
Common mistakes
- Testing only at the first visit and not in each trimester.
- Giving a reactive result without starting the route the same day.
- Forgetting the partner.
- Not passing the mother's results to the newborn team.
- Asking about Chagas only in women from rural areas instead of using the route's risk factors.
Test yourself
Think of the answer, then tap the question to see it.
Which four infections does ETMI-plus aim to eliminate from mother-to-child transmission?
HIV, syphilis, hepatitis B and Chagas disease.
When does Res. 3280 call for the rapid HIV test in pregnancy?
With counselling, at the first visit, in each trimester and at the time of birth.
What is the ETMI-plus impact target for congenital syphilis?
0.5 or fewer cases of congenital syphilis per 1000 live births.
When should the newborn receive the hepatitis B vaccine?
In the first 24 hours of life, then complete the three-dose schedule.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Mejores inversiones para acelerar la eliminación: transmisión maternoinfantil del VIH, la sífilis, la hepatitis B y la enfermedad de Chagas (ETMI-plus) (Pan American Health Organization, 2025); EMTCT Plus: framework for elimination of mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas (Pan American Health Organization, 2017); Resolución 3280 de 2018: Ruta Integral de Atención en Salud Materno Perinatal (section 4.3, antenatal care) (Ministerio de Salud y Protección Social de Colombia, 2018).
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Representative model, for educational purposes only.