Elimination of mother-to-child transmission

More pregnant women than ever before receive 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 2020, 85 [69- >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 17 [14-23] per cent in 2010. Almost 100 per cent of pregnant women receiving ARVs were receiving lifelong antiretroviral therapy (ART).
• Among the 35 HIV priority countries set out in the UNICEF Strategic Plan, 88 [71- >95] per cent of pregnant women living with HIV were receiving effective antiretroviral medicines for PMTCT in 2020.

Regional variations exist in access to antiretroviral treatment for pregnant and breastfeeding women

Fast facts:

• Access to antiretroviral medicines for pregnant women ranges from 95 [78- >95] per cent in Eastern and Southern Africa to 41 [30-47] per cent in Middle East and North Africa.
• Antiretroviral treatment coverage dropped drastically in South Asia in the last year from 71 [56->95] per cent to 56 [44-77] per cent perhaps due to impact of COVID-19.
• Among the 35 UNICEF HIV priority countries, antiretroviral treatment coverage for prevention of mother-to-child transmission was 88 [71->95] per cent in 2020.

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.

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 according to the WHO guidelines.

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.

About 2 in 3 pregnant women were already on antiretroviral treatment prior to their current pregnancy in 2020. Great gains have been made since 2010 to ensure that pregnant women are on lifetime antiretroviral medicines to prevent mother-to-child-transmission; however, there are regional variations.

In West and Central Africa, East Asia and the Pacific and South Asia, nearly half of all pregnant women are newly initiating antiretroviral therapy during their current pregnancy. Middle East and North Africa region shows a significant proportion (79 per cent) of women on lifelong antiretroviral treatment during their current pregnancy compared to Eastern and Southern Africa (68 per cent) and Latin America and the Caribbean (61 per cent), respectively.

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.

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