Even in 2025, HIV, syphilis, and other sexually transmitted infections (STI) are on the increase in Timor-Leste. There are multiple factors driving this ongoing health challenge, with poverty, geographic barriers, and stigmas all contributing to ongoing transmission rates. One of the most crucial areas of urgent care is that of mother-to-child transmission.
Since our launch in 2018 with only 3 staff of the team, Maluk Timor’s HIV program has expanded to 12 team members, growing its ability to tackle mother-to-child STI transmission. Thanks to a relocation to the Formosa HIV/STI Integrated Centre in partnership with ASHM, we’re now co-located with midwives. This means our integrated team can provide comprehensive care to mothers and babies alike in a single visit. This program isn’t without its challenges – here’s how we’re working to prevent mother-to-child transmission in Timor-Leste.
Our targeted HIV program
Any work we can do to strengthen our HIV and STI services has a compound benefit of improving mother-to-child transmission reductions. In 2024, we created a collaborative peer group to deliver holistic care to HIV patients and expectant mothers alike.
One of the major priorities of this work was the development of the Triple Elimination (prevention of mother-to-child transmission of HIV, Hepatitis B and Syphilis) and DISTaNCE (infectious diseases) training packages. By building the HIV/STI team’s capacity to deliver these trainings to others, we’re creating more opportunities for adequate coverage across Timor-Leste.
As a part of this work, we implemented point-of-care HIV/Syphilis testing in antenatal clinics, leading to improved detection and treatment rates.
Work outside of the clinic also saw us providing HIV-related training to over 150 healthcare workers at external sites, as well as delivering health promotion and education to the broader Timorese community.
We’re proud of the 2,287 consultations carried out for patients presenting with STI symptoms, as well as the positive impact of 1,932 point-of-care HIV tests, as well as counselling, that were performed for STI patients. We also supported 365 people living with HIV enrolled in our program. Finally, we saw a significant achievement in the area of hepatitis B birth dose, with close to 100% of newborns receiving this dose (up from 44% baseline before this targeted work). Through the power of midwife education to improve vaccine coverage, a small audit, and strategically moving the fridge which stored this vaccine, this will deliver ongoing health benefits for newborn Timorese children.
Strengthened patient tracking systems
One significant risk to adequate mother-to-child transmission prevention is also one of the simplest to solve: a loss-to-follow-up rate reduction. Our work here has seen us strengthening patient tracking systems to reduce this rate, as well as working to retain registered patients under treatment. Through our targeted efforts, 29 patients who we previously couldn’t contact to follow up on their condition made a successful return to care. We also saw a 75% retention in care rate, with this many registered patients remaining under treatment to manage this life-threatening disease.
Growing advocacy and community engagement
As with so many healthcare challenges facing Timor-Leste, education is a powerful tool to use in the fight against mother-to-child transmission. We’re actively working to improve advocacy and community engagement that can change attitudes and deliver key information to those vulnerable to STIs or HIV.
In 2024, this work saw us conducting a 3-day workshop for 50 adolescents on sexual and reproductive health, looking to reduce transmission rates through direct educational efforts. We also partnered strategically with local NGOs and media to address stigmas and misinformation about HIV that were keeping patients from receiving crucial care. By engaging with policymakers, we’ve also been able to advocate for improved national HIV responses, as well as effective resource allocation.
The STEPT project
One key focus of the Maluk Timor team in 2024 was the STEPT project, designed to support the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B in Timor-Leste and delivered in partnership with ASHM. This work saw us creating a training package that makes use of hands-on, active learning, equipping team members to become experts in a topic before they’re able to teach their peers about HIV in children and drawing on the power of peer-to-peer teaching models.
We created teaching materials and tools such as simple penicillin dosing guides which have made a significant difference in helping women and babies with syphilis to receive adequate and effective care. We also consulted with the HIV team and Ministry of Health midwives to ensure our teaching materials are both relevant and practical in a Timorese context.
Through the power of small, targeted changes, we continue to see growing, meaningful results in the area of mother-to-child transmission. This means positive changes for Timorese mothers and babies, both in their early years and throughout their childhood.
Conclusion
The challenge of preventing mother-to-child transmission of STIs and HIV in Timor-Leste isn’t small – but it can be solved. Our work continues to demonstrate the power of consistency, from increased vaccine coverage through to equipping healthcare workers to deliver more effective care.
As we continue to provide vital care for Timorese mothers and infants, we’re fuelled by our global community of supporters who make this work possible each and every day. We invite you to join us in this life-changing work and contribute to the future of Timor-Leste’s children. A little goes a long way in supporting these precious lives!