About Dual Elimination

What is dual elimination?

Dual elimination refers to the elimination of mother-to-child transmission of HIV and syphilis, sexually transmitted infections that cause substantial global health burden. The use of dual elimination tools, such as dual rapid tests for HIV and syphilis, can significantly reduce maternal and neonatal morbidity and mortality in developing countries.


In 2012 an estimated 230,000 children in Sub-Saharan Africa were newly infected with HIV. However, nearly all of these infections can be prevented by comprehensive prevention of mother-to-child transmission (MTCT) services.


Syphilis, another sexually transmitted infection (STI), also remains a public health challenge in Sub-Saharan Africa, with recent estimates suggesting that more than 500,000 pregnant women in Sub-Saharan Africa have probable active syphilis. Without treatment, approximately half of these pregnancies will result in adverse birth outcomes, such as early fetal loss and stillbirth, neonatal death, prematurity and low birth weight, and clinical evidence of syphilis in infants. Mother-to-child transmission (MTCT) of syphilis, or congenital syphilis, can be detected and treated inexpensively, but only about one third of antenatal clinic attendees in Sub-Saharan Africa receive syphilis testing.


The prevention of mother-to-child transmission (MTCT) of HIV and syphilis infections can be addressed with similar strategies, therefore combining the delivery and implementation of HIV and congenital syphilis services in antenatal care clinics (ANC) can enhance the effectiveness of current programs on elimination of MTCT of HIV and syphilis. However, a recent study suggested that these programs are greatly limited by such factors as delayed testing and long turnaround time of test results. Therefore, provider-initiated provision of dual rapid tests for HIV and syphilis could improve testing and treatment to accelerate elimination of MTCT of HIV and syphilis in Sub-Saharan Africa.


Engaging the support of healthcare providers in Sub-Saharan Africa through education in dual elimination strategies, including the use of such tools as dual HIV and syphilis rapid tests, can contribute significantly to reducing maternal and infant morbidity and mortality from both HIV and syphilis. 

  • Number of MTCT HIV and syphilis infections in Africa by country (click to view pdf)

  • Dual Elimination: Mother-to-child transmission (EMTCT) of HIV and Syphilis, presented by Teodora Wi (click to view pdf)

  • Dual Elimination: Efforts to eliminate maternal-to-child transmission of HIV and syphilis and the use of and performance of rapid dual HIV and syphilis test, presented by Jeffrey D. Klausner, MD, MPH (click to view pdf)

  • Sexually Transmitted Infections (STIs): The importance of a renewed commitment to STI prevention and

  • control in achieving global sexual and reproductive health, World Health Organization (click to view pdf)

  • Elimination of Mother-to-Child Transmission of HIV and Syphilis in the Americas, 2014 Update, Pan American Health Organization (click to view pdf)


1. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva; 2013.

2. UNICEF East Asia and Pacific Regional Office. Elimination of new paediatric HIV infections and congenital syphilis in Asia-Pacific, 2011-2015. Bangkok; 2011.

3. Newman L, et al. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLOS Medicine, 2013.

4. Kuznik A, et al. Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis. PLOS Medicine, 2013.

5. Gomez GB, et al. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and analysis. Bulletin of the World Health Organization, 2013, 91(3):217-26.

6. Dinh TH, et al. Integration of preventing mother-to-child transmission of HIV and syphilis testing and treatment in antenatal care services in the northern Cape and Gauteng provinces, South Africa. Sexually Transmitted Diseases, 2013, 40(11):846-51.