Elimination of mother-to-child transmission

Fast facts:

• About 120,000 [Confidence bounds: 83,000-170,000] new HIV infections among children under five occurred in 2023, dramatically declining from 300,000 [220,000-440,000] in 2010 and representing a 62 per cent decline.

Progress in reducing mother-to-child transmission of HIV has been dramatic since the introduction in 2011 of the ‘Global Plan towards the Elimination of New HIV Infections among Children and Keeping their Mothers Alive’ – largely because of increased access to PMTCT-related services and increased number of pregnant women living with HIV being initiated on lifelong antiretroviral medicines. But progress is not fast enough to reach the 2025 targets set by UNAIDS and partners as part of the Super-Fast-Track Framework to end AIDS. Acceleration of treatment for all pregnant and breastfeeding women living with HIV is still needed to achieve elimination of new infections among children and halve HIV-related deaths among pregnant women and new mothers.

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Of the approximately 2.1 million paediatric AIDS-related deaths averted between 2000 and 2023 by ART and cotrimoxazole, the impact was more pronounced in the last 13 years of the response. Eastern and Southern Africa Region (ESAR – 75 per cent) and West and Central Africa Region (WCAR 16 per cent) accounted for 91 per cent of the averted paediatric AIDS-related deaths.

Between 2000 and 2023, about 4 million children born from HIV infected mothers were prevented from maternal transmission of HIV as a result of the implementation and acceleration of the PMTCT programme mainly through the Super-Fast-Track Framework to end AIDS. For instance, in 2022, without the implementation of the PMTCT programme globally, new child HIV infections would have been nearly three times (350,000) higher than the current number of 120,000. Of the new child HIV infections averted in over two decades, ESAR (79 per cent) and WCAR (13 per cent) accounted for 92 per cent.

There has been a slight decrease in the number of pregnant women receiving treatment to stop HIV transmission to their children

Fast facts:

• As a result of higher testing coverage in high HIV burden countries, an increasing number of pregnant women in low- and middle-income countries know their HIV status – either by receiving HIV testing during antenatal care or by knowing their HIV positive status prior to their pregnancy.

In 2022, 84 [72- >95] per cent of pregnant women living with HIV globally were receiving effective antiretroviral medicines for prevention of mother-to-child transmission (PMTCT), up from 49 [43-61] per cent in 2010. Almost 100 per cent of pregnant women receiving ARVs were receiving lifelong antiretroviral therapy (ART). Regional variations exist in access to antiretroviral treatment for pregnant and breastfeeding women.

Fast facts:

• Access to antiretroviral medicines for pregnant women ranges from 94 [82- >95] per cent in Eastern and Southern Africa to 33 [24-43] per cent in Middle East and North Africa.

Expanding HIV testing and counselling services among pregnant women is critical for identifying those in need of follow-up care and increasing coverage of subsequent interventions that can prevent mother-to-child transmission, as well as provide care and treatment to the mother for their own health.

As per current guidance from the World Health Organization (WHO), transmission of the virus from mother to child can be significantly reduced if lifelong antiretroviral treatment is administered.

Without any intervention, between 15 per cent and 45 per cent of babies born to HIV-positive mothers are likely to become infected. And half of all infants infected with HIV are likely to die before their second birthday if they do not receive treatment.

Reducing HIV transmission from mother to child requires a range of interventions, beginning with voluntary and confidential counselling and testing for the virus. This should be followed by lifelong antiretroviral treatment for pregnant women with HIV and the administration of antiretroviral drugs to their newborns as a preventive measure, as well as safe delivery practices, and retention of the mother and infant into long-term care and treatment including maintaining suppressed viral load levels.

About than 2 in 3 pregnant women were already on antiretroviral treatment prior to their current pregnancy in 2023. Great gains have been made since 2010 to ensure that pregnant women are on lifetime antiretroviral medicines to prevent mother-to-child-transmission and for their own health; however, there are regional variations.

In West and Central Africa, Latin America and the Caribbean, East Asia and the Pacific, Eastern Europe and Central Asia, and South Asia, nearly half of all pregnant women are newly initiating antiretroviral therapy during their current pregnancy. Eastern and Southern Africa (72 per cent) and Middle East and North Africa (75 per cent) had about three out of four women on lifelong antiretroviral therapy during their current pregnancy.

Estimates from 2023 also show that about a quarter of all pregnant women or mothers needing ART are aged 15-24 years, with some regional variation. South Asia and Eastern and Southern Africa had the largest proportion of mothers needing ART aged 15-24 (25 per cent) compared to Eastern Europe and Central Asia, which has the smallest proportion (16 per cent).

The critical strategies through which elimination of new HIV infections among children and keeping mothers alive can be achieved include knowledge of HIV status, early initiation and retention on antiretroviral treatment, and attainment of viral suppression.

WHO guidelines recommend that all infants born to HIV-positive mothers should receive antiretroviral drugs preventively. Data show that the use of services related to the prevention of mother-to-child transmission of HIV is expanding. Poor service delivery in the post-partum period with significant low rates of maternal retention, populations living in hard-to-reach areas, aggravated by weak health systems, and the fear, stigma and denial that continue to discourage women from being tested for HIV are significant barriers to wider uptake of services. Almost 60 percent of new HIV infections among children in 2023 were due to the mother not receiving ART or dropping off from ART during either pregnancy or breastfeeding. This notion is highlighted by the fact that despite PMTCT coverage increasing from 2010 to 2023 by nearly 35 percentage points, the mother-to-child-transmission (MTCT) rate globally dropped by more than half during the same period from 22 per cent in 2010 to 10 per cent in 2023. This is still far from the five (5) per cent path-to-elimination threshold for breastfeeding countries and two (2) per cent for non-breastfeeding countries.

For information on UNICEF’s programme and policy work on HIV and AIDS, visit the Children & AIDS community of practice.

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