Fifteen years of HIV and syphilis outcomes among a prevention of mother-to-child transmission program in Haiti: from monotherapy to Option B+ Marie Marcelle Deschamps 1 , Deanna Jannat-Khah 2 , Vanessa Rouzier 1 , Jerry Bonhomme 1 , Julma Pierrot 1 , Myung Hee Lee 3 , Elaine Abrams 4 , Jean Pape 1,3 and Margaret L. McNairy 2,3 1 Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince, Haiti 2 Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA 3 Center for Global Health, Weill Cornell Medicine, New York, NY, USA 4 ICAP and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA Summary objective To evaluate mother and infant outcomes in the largest prevention of mother-to-child- transmission (PMTCT) programme in Haiti in order to identify gaps towards elimination of HIV and syphilis. methods Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999 to 2014, we assessed maternal enrolment in PMTCT, receipt of antiretrovirals before delivery, maternal retention through delivery as well as infant enrolment in PMTCT, HIV testing and HIV infection. Four PMTCT programme periods were compared: period 1 (1999–2004, mono ARV), period 2 (2005–2009, dual ARV), period 3 (2010–2012, Option B) and period 4 (Oct 2012–2014, Option B+). Kaplan–Meier methods were used to assess retention in PMTCT care. results Among 4665 pregnancies, median age was 27 years and median CD4+ was 494 cells/ll (IQR 328–691). A total of 75% of women received antiretrovirals before delivery, and 73% were retained in care through delivery. Twenty-two percent of women were lost before delivery, <1% died and 6% had stillbirths or abortions. Ninety-four percent of infants who were born alive enrolled in PMTCT, of whom 92% had complete HIV testing. One hundred and sixty-one infants were HIV+, giving a 5.4% HIV transmission rate (9.8%, 4.6%, 5.8% and 3.6% in periods 1–4). Retention among women through 12 months after PMTCT enrolment did not significantly differ across periods. However, among women who received antiretrovirals at the time of enrolment, retention 12 months later was lower in the Option B+ period (83%) than in periods 2 and 3 (94% and 93%) (P < 0.001). Syphilis infection among women decreased from 16% in period 1 to 8% in period 4, whereas syphilis testing of infants increased from 17% to 91%. conclusion Despite dramatic reductions in MTCT in Haiti, interventions are needed to improve retention to achieve MTCT elimination of HIV and syphilis. keywords prevention of mother-to-child-transmission, HIV, retention Introduction There have been tremendous strides towards the elimina- tion of mother-to-child-transmission (MTCT) of HIV and syphilis throughout many low- and middle-income coun- tries (LMICs). The overall number of children newly infected with HIV in LMICs dropped by 35% from 400 000 in 2009 to 160 000 in 2016 [1]. The rate of MTCT of HIV in Latin American and the Caribbean has fallen by 53%, from 15% in 2010 to 8% in 2015, and new infections among children <14 years declined from 10 600 in 2000 to 2100 in 2015 [2, 3]. In September 2010, the Pan American Health Organization (PAHO) advocated for dual elimination of MTCT of HIV and syphilis in the region, defined as <2% infant HIV infec- tion and <0.05 cases of congenital syphilis per 1000 live births [3]. While several countries in the Caribbean have achieved elimination of vertical transmission as defined by PAHO, Haiti continues to have one of the highest HIV MTCT rates in the region at 4.7% in 2015 [2, 4–6]. Haiti remains the poorest country in the Western hemisphere 724 © 2018 John Wiley & Sons Ltd Tropical Medicine and International Health doi:10.1111/tmi.13075 volume 23 no 7 pp 724–737 july 2018