Breaking the Plateau in Reducing Mother-to-Child Transmission of HIV

Over thirty years ago, Elizabeth Glaser recognized a problem: pregnant women who were diagnosed with HIV had no way to protect their babies from acquiring the virus. She sounded the alarm that led to tangible action and inclusion of women and children in HIV research, drug development, and clinical trials. Since 2000, EGPAF and global partners in local and national governments, donors, and civil society have driven evidence-based programming to reduce new pediatric HIV infections by more than half.  

Today, progress in prevention of mother-to-child transmission (PMTCT) of HIV has plateaued, and we must sound the alarm again to strategically address the challenges that remain.  

COVID-19 has further complicated the global public health landscape, straining fragmented health systems and diverting critical resources from the AIDS response. 

Yet, even before COVID-19 exacerbated disparities, the pace of the decline in pediatric infections had slowed in recent years. The UNAIDS global target set for the year 2020—fewer than 20,000 new child infections—was missed by a substantial margin as the latest data shows that 140,000 children were still newly infected with HIV in 2019.  

The most recent UNAIDS strategy, End Inequalities, End AIDS, reflects the urgent need to adapt our approach in light of the significant, but uneven strides made to date—specifically noting that while global coverage of antiretrovirals among pregnant and breastfeeding women remains high (85% in 2019), expansion has clearly stagnated. 

It is in this complex landscape that I recently kicked off EGPAF’s latest webinar, Evidence to Action: How Do We Break the Plateau We See in Mother-to-Child HIV Transmission?

The discussion featured expert voices on the topic including Dorothy Mbori-Ngacha, UNICEF HIV Specialist; Dr. Lynne Mofenson, EGPAF Senior HIV Technical Advisor; Dr. Vicky Ilunga, EGPAF DRC Technical Director; and Dr. Christopher Makwindi, EGPAF Eswatini Technical Director. Their presentations highlighted select challenges and posed novel solutions, including unequal PMTCT coverage across west and central Africa, high rates of HIV transmission during the breastfeeding period, and innovations in PrEP and contraception for HIV-positive pregnant women.  

The event also featured Dee Mphafi, an extraordinary young woman from Lesotho living with HIV who shared her personal experience navigating PMTCT services to have her beautiful baby girl and described the nuanced struggle that many mothers face to stay healthy. 

In the prevention and treatment of HIV, consistency is important—yet hearing from Dee reminded us that people’s lives are not static. Adolescent girls, young women, and mothers need care that endures through every stage of their lives, prioritizing their own health and ability to plan their families' futures.  

To be successful, HIV/AIDS programming must prioritize flexible solutions, grounded in evidence and tailored to local circumstances. 

Stakeholders must work with women’s needs at the center—recognizing the obstacles to antiretroviral adherence or consistent clinic visits and responding with improved options and comprehensive community-level support.  

Until every woman accesses the services she needs to ensure her own health and the health of her family, our work is not done. Ending mother-to-child transmission of HIV is the key to an AIDS-free generation.