Prevention of Vertical Transmission
USAID's investments in providing care and support for women living with HIV during pregnancy, delivery, and the postpartum period help to achieve the goal of ending preventable child and maternal deaths. Since 2003, USAID support has enabled 3.3 million babies to be born HIV-free to mothers living with HIV.
According to recent global estimates by UNAIDS, women carry the burden of HIV, and AIDS is still the leading cause of death for women of reproductive age. Pregnant women living with HIV are at a greater risk of experiencing pregnancy complications compared to women who are living without HIV. Pregnant women living with HIV are also at increased risk of life-threatening infections such as sepsis and opportunistic infections, including TB, pneumonia, and meningitis.
The vast majority of maternal deaths are preventable when women have access to quality antenatal and postnatal care, and safe delivery attended by skilled personnel that is supported by emergency obstetric care. While the death of a mother is a tragedy in itself, it also has devastating effects on the survival of her children, the economic stability of the family, and the productivity of the community.
Providing care and support for women living with HIV during pregnancy, delivery, and the postpartum period presents unique challenges, not only for the prevention of vertical transmission of HIV (PVT), but also for the woman’s own health and survival. According to recent global estimates by UNAIDS, 82% of pregnant women living with HIV were receiving antiretroviral therapy (ART) to prevent vertical transmission of HIV, allowing an estimated 220,000 infants to be born HIV-free. Despite these successes, an estimated 130,000 children under the age of 15 acquired HIV in 2022, and the proportion of pregnant women living with HIV receiving ART has not meaningfully increased since 2014, indicating the importance of renewed focus on efforts to prevent vertical transmission of HIV.
Comprehensive HIV care, including early HIV testing and immediate linkage to treatment for infants diagnosed with HIV are crucial to ensure a healthy infant. Globally, 68 percent of infants born to pregnant women living with HIV received a virologic test within the first two months of birth. The fast rate of HIV progression and the high morbidity and mortality among infants and children with perinatally-acquired HIV means that early infant diagnosis and rapid enrollment of infants living with HIV in care and treatment programs should be a priority. Several countries have achieved elimination of vertical transmission of HIV, but none of these countries are in sub-Saharan Africa, a region that accounts for 82 percent of the global burden of vertical HIV transmission.
Our Approach and Results
As an implementing agency of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID supports PEPFAR to implement HIV services for women, infants, and children. USAID also has a core goal of ending preventable child and maternal deaths by providing comprehensive maternal and infant health HIV prevention, care, and treatment services to mothers living with HIV and their infants exposed to HIV. Since 2015, USAID support has enabled 3.3 million babies to be born HIV-free to mothers living with HIV.
We make a difference by focusing our work in lower and middle income countries with the most need – those that have high rates of both HIV and maternal mortality – with a particular focus on sub-Saharan African countries. USAID engages with communities and health facilities to provide patient-centered services that span the continuum of HIV care for mothers and infants.
Examples of USAID’s work in this area include:
Preventing HIV acquisition among women through comprehensive prevention approaches, including pre-exposure prophylaxis (PrEP).
Providing access to voluntary family planning (FP) services for women living with HIV to prevent unintended pregnancies, including FP services that promote healthy timing and spacing of pregnancies to reduce the risk of adverse pregnancy outcomes such as low birth weight, preterm birth, and infant mortality.
Providing HIV testing services to pregnant and breastfeeding women living with HIV as early as possible, including repeat testing throughout pregnancy or during breastfeeding, and providing safe and ethical index testing to reach their sexual partners and biological children.
Linking pregnant and breastfeeding women living with HIV to optimized ART regimens to promote viral suppression, including dolutegravir-based regimens.
Providing comprehensive care for infants born to women living with HIV, including early infant virologic testing, HIV prophylaxis, routine infant care, and family care and support through to a definitive final diagnosis.
Identifying infants living with HIV early and facilitating rapid linkage to optimized treatment and clinical follow-up, and support through pediatric HIV services.
Supporting expansion of HIV testing devices used at health facilities (“point-of-care”), which allow same-day results for viral load testing for pregnant and breastfeeding women, as well as infant HIV diagnosis permitting rapid linkage to ART.
Analyzing and addressing barriers to continuity of care for the mother and infant through patient-centered and family-based innovations in PVT service delivery, including differentiated service delivery (DSD), multi-month dispensing (MMD) of ART, and telehealth models.
Providing ongoing clinical and supply chain technical assistance, and engaging non-clinical partners as valuable stakeholders.
USAID also works to provide PVT services to certain populations who are at higher risk of HIV and who have poorer maternal and infant health outcomes, including adolescent girls and young women and key populations. USAID’s PVT programs collaborate with orphans and vulnerable children (OVC) programs, strengthening bi-directional referrals between the health facility and community, in order to increase enrollment of mother-baby pairs at risk of interruption in treatment, such as adolescent and young mothers living with HIV and their infants. OVC programs provide family-based case management, comprehensive services, and routine tracking of mother-baby pairs to help improve their health, including access to timely diagnostic testing, and ascertainment of the infant’s HIV status after breastfeeding ends.
USAID leverages deep technical expertise to work in partnership with host country governments, multilateral organizations, the private sector, service providers, and local stakeholders to integrate evidence-based maternal health and HIV and AIDS information and services to reduce maternal mortality and save lives.
USAID's preventing vertical transmission efforts have led to achievements in the following areas:
Supported 4,299,412 pregnant women to know their HIV status at the first antenatal care visit, representing 98% of pregnant women attending ANC;
Newly identified 54,932 pregnant women living with HIV at first antenatal care visit, and enrolled 57,012 pregnant women on life-saving ART;
Supported viral load suppression among pregnant women (95 percent) and breastfeeding women (95 percent) living with HIV;
Tested 217,203 infants of pregnant women living with HIV by two months of age, and an additional 106,494infants between two and 12 months of age;
Newly identified 3,974 infants living with HIV and linked 3,491 infants to ART; and,
Ensured that 99 percent of infants born to women living with HIV had a final outcome documented at the end of the breastfeeding period.
Increased client-centered programming by expanding access to multi-month dispensing (MMD) of ART for 2.04 million women over 15 years of age living with HIV.
Working through community and facility approaches to increase the number of breastfeeding women living with HIV receiving viral load tests to their highest points ever, from 109,602 in FY22 to 151,584 in FY23.