Trends in Prevention of Mother-to-Child Transmission of HIV at PEPFAR-Supported Sites in Mozambique, 2017-2023

BackgroundMozambique has implemented Prevention of Vertical Transmission (PVT) of HIV as part of national programming since 2002. Despite gains, vertical transmission rates remain high, estimated at 9% in 2023. We describe PVT progress at PEPFAR-supported sites. MethodsWe analyzed routine data from 656 PEPFAR-supported sites reported for fiscal years (October-September) 2017-2023. We calculated the proportion of pregnant women (PW) at first antenatal care (ANC1) who knew their status, HIV test positivity (positive tests divided by the total number of tests conducted); the proportion of PW on antiretroviral therapy (ART); the proportion of PW on ART with documented viral load (VL) test; the proportion of PW and breastfeeding women (BFW) with viral load suppression (VLS, defined as <1,000 copies/mL); the proportion of HIV-exposed infants (HEI) tested by 12 months who tested HIV positive; and the proportion of HEI-positives on ART. Data were analyzed by fiscal year. ResultsDuring 2017-2023, the proportion of PW who knew their HIV status at ANC1 increased from 90.4% (863,181/954,933) to 99.9% (1,047,870/1,049,225); HIV-positivity among PW at ANC1 decreased from 9.7% (84,038/863,181) to 8.1% (84,429/1,047,870); PW on ART remained above 99%; the proportion of PW who received a VL test increased from 24.5% (9,862/40,293) to 74.9% (46,292/61,818); and VLS increased from 51.4% (5,073/9,862) to 88.5% (40,950/46,292) and 60.8% (8,643/14,205) to 92.7% (149,893/161,695) among PW and BFW, respectively. During 2017-2023, HEI testing coverage increased from 76.5% (64,322/84,038) to 96.0% (82,689/86,132), and HEI HIV positivity declined from 8.5% (5,487/64,322) to 2.5% (2,075/82,689); during 2018-2023, the proportion of HIV positive HEI on ART increased from 82.7% (3,521/4,256) to 93.3% (1,936/2,075). ConclusionPEPFAR-supported sites have achieved progress in PVT. Continued implementation of sound interventions to improve ART initiation and retention, VLS, and HEI treatment linkage can lead to further reductions in vertical transmission and the elimination of mother-to-child transmission of HIV as a public health problem in the country.