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Analysis Vertical Transmission of HIV

How are countries in sub-Saharan African monitoring the impact of programmes to prevent vertical transmission of HIV?

BMJ 2019; 364 doi: (Published 26 March 2019) Cite this as: BMJ 2019;364:l660
  1. Ameena Goga, chief specialist scientist, deputy director1 2,
  2. Yagespari Singh, senior scientist1,
  3. Debra Jackson, technical adviser3 4,
  4. Solomon Mukungunugwa, deputy national coordinator5,
  5. Rose Wafula, PMTCT programme manager6,
  6. Michael Eliya, PMTCT coordinator7,
  7. Wingston Felix Ng’ambi, lecturer in epidemiology8,
  8. Linda Nabitaka, medical officer9,
  9. Witness Chirinda, specialist scientist1,
  10. Sanjana Bhardwaj, technical adviser10,
  11. Shaffiq Essajee, senior adviser11,
  12. Chika Hayashi, technical adviser11,
  13. Yogan Pillay, deputy director general12
  1. 1Health Systems Research Unit, South African Medical Research Council, South Africa
  2. 2Department of Paediatrics, University of Pretoria, South Africa
  3. 3School of Public Health, University of the Western Cape, Cape Town, South Africa
  4. 4Unicef, Health Section, New York, USA
  5. 5PMTCT, Paediatric HIV Care Treatment, AIDS and TB Unit, Ministry of Health, Harare, Zimbabwe
  6. 6National Aids and STI Control Program, Kenya
  7. 7Ministry of Health, HIV and AIDS Department, Lilongwe, Malawi
  8. 8Health Economics and Policy Unit, Department of Health Systems and Policy, College of Medicine, Lilongwe Campus, University of Malawi, Lilongwe, Malawi
  9. 9Ministry of Health, Kampala, Uganda
  10. 10Unicef Nigeria, formerly Unicef Pretoria, South Africa
  11. 11Data and Analytics Section, Unicef, New York, USA
  12. 12HIV/AIDS, TB, MCWHN, National Department of Health, Pretoria, South Africa
  1. Correspondence to: A Goga Ameena.Goga{at}

Ameena Goga and colleagues describe how five countries in sub-Saharan Africa are monitoring the effectiveness of national programmes to prevent vertical transmission of HIV

Key messages

  • Monitoring vertical transmission of HIV is important in high HIV prevalence low and middle income countries where health systems are often weak or stretched beyond capacity

  • WHO recommends three methods to measure the effectiveness of programmes that prevent vertical transmission of HIV: statistical modelling, surveys or surveillance, and analysis of programme data

  • Kenya, Malawi, South Africa, Uganda, and Zimbabwe all use statistical modelling to monitor programme effectiveness

  • All countries are strengthening routine programmatic monitoring, which requires additional systems such as allocating unique identifiers, and developing interclinic data linkages to trace clients who transfer between facilities

Vertical transmission of HIV can occur during pregnancy, delivery, or through breast feeding. The main driver of vertical transmission is a high maternal viral load.1 Between 2002 and 2016, low and middle income countries (LMICs) in sub-Saharan Africa with high HIV prevalence improved their policies to prevent vertical transmission of HIV. In 2002, national policies recommended single dose nevirapine at the onset of labour, with limited or no breast feeding. By 2016, all Global Plan priority countries in sub-Saharan Africa (where 90% of the world’s HIV positive pregnant women live) had adopted Option B+ with promotion of breast feeding.2 Option B+ was a dramatic policy change recommending lifelong triple antiretroviral therapy (ART) for all pregnant and lactating women living with HIV. The aim is to protect the child from HIV infection, ensure the mother’s future health, and prevent horizontal transmission of HIV.

Monitoring country level effectiveness of these policy changes is critical, both to ensure they are making a difference to people’s lives and to track progress towards achieving global goals. These goals include the Sustainable Development Goal of …

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