2019-2023 trends in indicators for the prevention of mother-to-child transmission of HIV in Cameroon: reflections for the path to elimination by 2030

2019-2023 trends in indicators for the prevention of mother-to-child transmission of HIV in Cameroon: reflections for the path to elimination by 2030 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 2019-2023 trends in indicators for the prevention of mother-to-child transmission of HIV in Cameroon: reflections for the path to elimination by 2030 Justin Ndié, Jean-Pierre Yves Awono Noah, Christelle Ngo Yana, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7710306/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Prevention of mother-to-child transmission (PMTCT) remains a priority in Cameroon for achieving HIV elimination, despite the implementation of priority interventions aimed at improving PMTCT indicators. Objective This study aimed to analyse trends in HIV PMTCT indicators in Cameroon between 2019 and 2023. Methods A retrospective study was conducted from 2019 to 2023 across ten regions of Cameroon (Adamawa, East, Far North, Center, Littoral, North, Northwest, Southwest, and South). The study population included pregnant women and HIV-exposed infants. A standardized form was designed and used to extract PMTCT indicators from the Annual Reports of the National AIDS Control Committee (NACC). Data were processed and analysed using Excel and R version 4. Results Between 2019 and 2023, key indicators of the prevention of mother-to-child transmission (PMTCT) program in Cameroon showed significant progress. Antenatal care (ANC) coverage increased from 80.3% in 2019 to 87.6% in 2021 before declining to 81.2% in 2023 (p < 0.001). HIV testing rates rose steadily from 87.3% to 97.9% in 2022, slightly decreasing thereafter (p < 0.001), while HIV positivity rates declined from 3.6% to 2.2% (p < 0.001). ARV coverage among women improved from 86.5% to 93.7% (p < 0.001), and nevirapine coverage among HIV-exposed infants increased from 86.9% to 95.1% (p < 0.001). Early infant diagnosis (PCR testing) showed high uptake, reaching 99.7% in 2023 (p < 0.001). HIV positivity among infants decreased from 4.7% to 3.3% (p < 0.001), while ARV coverage in HIV-positive infants rose markedly from 55.2% in 2019 to over 82% from 2020 onward (p < 0.001). Overall, the PMTCT program achieved remarkable improvements in service coverage and reductions in HIV positivity, despite fluctuations in ANC uptake. Conclusion The analysis of PMTCT indicators in Cameroon from 2019 to 2023 shows overall improvement, though regional disparities persist and some national targets remain unmet. Strengthening strategies to increase service uptake is essential to further reduce mother-to-child HIV transmission. HIV PMTCT Mother-to-child transmission e-MTCT Cameroon Figures Figure 1 Figure 2 Background Globally, the incidence of paediatric HIV infection was 130,000 in 2022 [ 1 ]. Over 90% of these infections are transmitted from mother to child, and in the absence of antiretroviral therapy, about 50% of infected children will die before their second birthday [ 2 – 4 ]. In sub-Saharan Africa, HIV prevalence among pregnant women remains high, and in the absence of any intervention, the mother-to-child transmission (MTCT) rate ranges from 13% to 48% [ 2 ]. Indeed, an HIV-infected woman can transmit the virus to her baby during pregnancy, labor, delivery, or breastfeeding [ 5 – 10 ]. The combined risk of mother-to-child transmission (MTCT) of HIV in utero and during delivery is 15–30%, and the risk increases to 20–45% in breastfed children in the absence of any intervention [ 11 ]. Interventions conducted during pregnancy, labour, delivery, and breastfeeding—collectively known as the prevention of mother-to-child transmission (PMTCT) cascade—are effective in preventing vertical transmission of HIV [ 12 , 13 ]. It includes services aimed at eliminating HIV MTCT (prenatal care, HIV testing, disease staging, and antiretroviral treatment), reducing infant mortality (ARV prophylaxis, exclusive breastfeeding for the first six months, and Cotrimoxazole prophylaxis to prevent opportunistic infections), and improving maternal health [ 14 ]. In Cameroon, the prevention of mother-to-child transmission and paediatric management of HIV remain a government priority. Indeed, HIV infection remains high among pregnant women, with an HIV prevalence of 5.7% and an MTCT rate at six weeks of 5% [ 15 ]. UNAIDS estimated 4,500 new HIV infections among children and an MTCT rate of 12.8% at 18 months [ 15 ]. Although significant progress has been made in reducing mother-to-child transmission (MTCT) of HIV globally, very few countries have fewer than 50 new infections per 100,000 live births and a transmission rate below 5% in breastfeeding populations and below 2% in non-breastfeeding populations [ 16 , 17 ]. The success of prevention of mother-to-child transmission (PMTCT) programs is assessed based on the PMTCT cascade. This study aims to analyse the trend of PMTCT indicators in Cameroon from 2019 to 2023. Methods and materials Study design and setting A retrospective cross-sectional study was conducted from 2019 to 2023 across 10 regions of Cameroon (Adamawa, Centre, East, Far North, Littoral, North, Northwest, West, South, and Southwest). Study population The study population consisted of pregnant women and exposed children. Data collection A template was developed in Excel 2021 to extract the following PMTCT indicators: the number of expected pregnant women, the number of pregnant women attended (Antenatal care + Weeks of Amenorrhea), the number of pregnant women tested for HIV, the number of pregnant women testing HIV-positive, the number of HIV-positive pregnant women on ART, the number of exposed children born to HIV-positive pregnant women, the number of exposed children on NVP, the number of exposed children tested for HIV, the number of exposed children testing HIV-positive, and the number of exposed children on ART. Annual reports from 2019 to 2023 from the NACC [ 18 – 26 ] were reviewed and compiled. Data collection was conducted through a review of these five NACC annual reports and extraction of the PMTCT indicators. Variables of study The main outcome of the PMTCT Cascade for Pregnant Women is summarized in Table 1 . Table 1 PMTCT Cascade for Pregnant Women Attending ANC Indicator Definition / Numerator Denominator Calculation Method Expected pregnant women Expected number of pregnant women attending ANC (according to the priority program target population defined by Health Information Cell for the given year) — Demographic estimates from Health Information Cell ANC Coverage Number of pregnant women who attended ANC or delivery services Expected number of pregnant women (pregnant women ANC + Delivery) ÷ Expected pregnant women Proportion of HIV + pregnant women Number of pregnant women newly tested HIV positive (ANC and delivery) + pregnant women with known HIV-positive status Total number of pregnant women tested for HIV (New HIV + pregnant women + Known HIV + pregnant women) ÷ pregnant women tested ART Coverage (Pregnant women) Number of HIV + pregnant women who received ART Total number of HIV + pregnant women HIV + pregnant women on ART ÷ Total HIV + pregnant women The main outcome of the PMTCT Cascade for HIV-Exposed Infants (HEI) is presented in Table 2 . Table 2 PMTCT Cascade for HIV-Exposed Infants (HEI) Indicator Definition / Numerator Denominator Calculation Method HEI initiated on NVP Number of HIV-exposed infants who received Nevirapine prophylaxis Number of identified HIV-exposed infants HEI on NVP ÷ Identified HEI HEI tested with PCR1 Number of HEI tested by PCR at 6 weeks Number of identified HIV-exposed infants HEI tested PCR1 ÷ Identified HEI HIV-positive HEI Number of HEI who tested HIV-positive by PCR at 6 weeks Number of HEI tested by PCR at 6 weeks HIV + HEI (PCR1) ÷ HEI tested PCR1 ART coverage among HIV + HEI Number of HIV-positive HEI who received ART Number of HIV-positive HEI (PCR1) HIV + HEI on ART ÷ HIV + HEI Data management and analysis After data collection, the data were aggregated and analysed using Excel and R 4. PMTCT indicators were described using proportions. Parametric tests for comparing k proportions and the Marascuilo procedure were performed to compare PMTCT indicators at the national and regional levels to determine whether they were equal or if at least two differed significantly, with a significance level of 5%. Results are presented in tables and graphs. Ethical consideration This study used only aggregated and anonymized secondary data extracted from the official annual reports of the National AIDS Control Committee (NACC) , Cameroon. As these publicly available surveillance data contain no individual-level identifiers, ethics approval by an Institutional Review Board (IRB) or ethics committee was not required under national regulations, and informed consent from participants was not applicable [ 27 , 28 ]. Results Antenatal care (ANC) coverage increased significantly, rising from 80.34% in 2019 to 87.62% in 2021 before declining to 84.80% in 2022 and 81.22% in 2023 (p < 0.001, Table 3 ). The East region had ANC coverage above 100%, whereas the Far North (< 70%), Northwest (< 65%), and Southwest (< 60%) regions had the lowest coverage (< 80%) (Fig. 1 ). The proportion of pregnant women tested for HIV also increased significantly, from 87.27% in 2019 to 97.16% in 2023 (p < 0.001). The Centre, Littoral, Northwest, West, Southwest, and South regions had HIV testing rates among pregnant women above 90%, while the North and Far North regions had the lowest testing rates (Fig. 1 ). Among pregnant women tested for HIV, 3 out of 100 were HIV-positive in 2019, compared to about 2 out of 100 in 2023 (p < 0.001, Table 3 ). The North and Far North regions had the lowest proportions of HIV-positive pregnant women, while the South and East regions had the highest. The proportion of HIV-positive pregnant women receiving antiretroviral treatment (ART) increased from 86.48% in 2019 to 93.72% in 2023 (p < 0.001). The Southwest, Centre, East, Far North, and Littoral regions had ART coverage below 90%. The proportion of exposed children born to HIV-positive mothers receiving nevirapine (NVP) prophylaxis increased from 86.91% in 2019 to 95.05% in 2023 (p < 0.001, Table 3 ). Except in the East, Far North, South, and Southwest regions, the proportion of exposed children on NVP initially dropped in 2020 before gradually increasing (Fig. 2 ). The proportion of exposed children tested for HIV using PCR increased significantly, from 89.72% in 2019 to 99.69% in 2023 (p < 0.001). However, the Littoral, East, and Far North regions had the lowest proportions of exposed children tested by PCR between 2019 and 2023 (Fig. 2 ). Among exposed children tested by PCR, the proportion who were HIV-positive decreased significantly, from 5.28% in 2019 to 3.41% in 2023 (p < 0.001). The West and Northwest regions had the lowest proportions of HIV-positive exposed children, while the North region showed peaks in seropositivity (Fig. 2 ). Furthermore, the proportion of HIV-positive exposed children identified by PCR who received ART increased significantly, from 55.20% in 2019 to 82.20% in 2023 (p < 0.001). The North and Centre regions had the lowest proportions of HIV-positive children on ART, whereas the Northwest had the highest (Fig. 2 ). Table 3 Évolution des indicateurs PTME entre 2019 et 2020 au Cameroun Indicators 2019 2020 2021 2022 2023 p ANC Coverage 80.34% 86.56% 87.62% 84.80% 81.22% < 0.001*** Testing Rate 87.27% 93.70% 96.48% 97.87% 97.16% < 0.001*** Positivity Rate 3.62% 3.31% 2.71% 2.47% 2.24% < 0.001*** ART Coverage 86.48% 83.91% 92.30% 93.82% 93.72% < 0.001*** Nevirapine Coverage among Exposed Children (EC) 86.91% 85.07% 91.46% 94.34% 95.05% < 0.001*** HIV Testing Rate among Exposed Children by PCR 89.72% 100.11% 89.27% 98.47% 99.69% < 0.001*** HIV Positivity Rate among Exposed Children (EC) 4.73% 4.44% 4.27% 4.00% 3.32% < 0.001*** ART Coverage among HIV-Positive Exposed Children 55.20% 82.60% 79.30% 82.40% 82.20% < 0.001*** Discussion This study examines the evolution of indicators for the prevention of mother-to-child transmission (PMTCT) of HIV in Cameroon between 2019 and 2023, based on annual reports and the 2023 progress report. The results show generally positive trends for both pregnant women and exposed children, including increased HIV testing, improved maternal ART coverage, enhanced neonatal prophylaxis, and decreased maternal and infant HIV positivity rates. However, coverage of antenatal care (ANC) visits declined from 86.56% in 2020 to 81.22% in 2023 (p < 0.001), remaining below the 100% threshold recommended by the WHO for the elimination of mother-to-child HIV transmission [ 29 , 30 ]. This decline is particularly pronounced in the Far North, Northwest, and Southwest regions, which are affected by insecurity and sociopolitical crises, whereas the East and Adamawa regions show coverage rates close to 100%, likely due to underestimation of pregnant women and the exclusion of refugees from official estimates [ 31 ]. The HIV testing rate among pregnant women increased from 87.27% in 2019 to 97.16% in 2023, reflecting the effectiveness of national policies such as counselling and testing at all entry points, exemption from payment fees since 2020, performance-based financing, the health voucher program in certain areas, and systematic re-testing of women who previously tested negative [ 32 ]. The maternal HIV positivity rate decreased from 3.31% in 2019 to 2.24% in 2023, highlighting the positive impact of systematic testing and adherence to antiretroviral therapy (ART), although a slight increase was observed in the Adamawa and East regions due to the influx of refugees [ 33 ]. ART coverage among HIV-positive women increased from 84.52% in 2019 to 90.38% in 2023, despite a temporary decline between 2019 and 2020 in certain regions due to stock shortages, low retention, and supply chain issues related to insecurity [ 34 ]. Interventions such as the “Last Mile Delivery” have helped improve the supply and distribution of antiretroviral drugs [ 31 ]. Among HIV-exposed children, ARV prophylaxis coverage increased from 87.20% in 2019 to 94.85% in 2023, thanks to the systematic provision of Nevirapine and community-based actions, including the sensitization of traditional birth attendants and the active identification and referral of exposed infants in health facilities [ 32 ]. PCR testing at 2 months or later reached nearly 100% in several regions, and the HIV positivity rate among exposed infants declined from 5.28% in 2019 to 3.41% in 2023, reflecting the combined effectiveness of maternal and paediatric PMTCT interventions [ 35 , 36 ]. Despite these advances, several challenges remain: irregularities in the supply chain, low retention of women on ART, and limited access to care in crisis-affected areas. To achieve the second 95% (optimal ART coverage), it is essential to strengthen community-based interventions, optimize the distribution of commodities through the “Reach Every District” approach, and sustain the “Test and Treat” strategies [ 36 , 37 ]. Conclusion The analysis of PMTCT indicators in Cameroon between 2019 and 2023 highlights substantial progress, particularly in HIV testing coverage, maternal ART initiation, infant prophylaxis, and early infant diagnosis. These achievements have contributed to significant declines in both maternal and infant HIV positivity rates. However, persistent regional disparities especially in the North-West, South-West, and Far North regions underscore the impact of sociopolitical crises, supply chain disruptions, and limited access to antenatal care services. Without targeted interventions to strengthen service delivery, optimize retention in care, and ensure equitable access across all regions, Cameroon may fall short of achieving WHO’s 2030 e-MTCT validation criteria. Strengthening community-based approaches, sustaining supply chain innovations, and prioritizing high-burden regions will be essential to accelerate progress towards elimination of mother-to-child HIV transmission. Limitation of the study This study has several limitations. First, it relied on secondary data extracted from annual reports of the National AIDS Control Committee (NACC), which may be affected by reporting delays, underreporting, or inconsistencies across regions. Second, demographic estimates used to calculate expected numbers of pregnant women may be imprecise, particularly in regions hosting large refugee populations, leading to potential over- or under-estimation of coverage indicators. Third, the analysis was limited to quantitative indicators and did not capture contextual or qualitative factors, such as barriers to antenatal care attendance, adherence to ART, or health system constraints. Finally, the retrospective design limits causal inference, although the trends described remain highly relevant for monitoring national progress towards e-MTCT. Abbreviations ANC: Antenatal Care ART: Antiretroviral Therapy BID: Islamic Development Bank (Health Project Execution Unit-BID) CI: Confidence Interval CIRCB: Chantal Biya International Reference Centre EC: Exposed Children e-MTCT: Elimination of Mother-to-Child Transmission HEI: HIV-Exposed Infants HIV: Human Immunodeficiency Virus MINSANTE: Ministry of Public Health NACC: National AIDS Control Committee NVP: Nevirapine p: p-value PCR: Polymerase Chain Reaction PECPA: Project to eliminate mother-to-child transmission of HIV PMTCT: Prevention of Mother-to-Child Transmission STI: Sexually Transmitted Infection UNAIDS / ONUSIDA: United Nations Programme on HIV/AIDS UNICEF: United Nations Children's Fund USAID: United States Agency for International Development WHO: World Health Organization Declarations Ethics approval and consent to participate Not applicable. Informed consent Not applicable. Consent for publication Not applicable. Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Not applicable. Authors' contributions JN, JPYAN , CNY, RKD and FAN managed and analysed data, implemented the methodology, interpreted results and wrote the first draft of the manuscript. JN, JPYAN , CNY, RKD and FAN prepared the final draft, with critical revisions made by NWY, HLS, JDA, CNB, BK, JF, JA and ACZKB is the lead author, conceptualized, formulated research goals and objectives, contributed to the acquisition of project financial support, led methodology development and results interpretation. All authors have read and agreed to submit to the current journal; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work. All authors read and approved the final manuscript. Acknowledgements This article was partly supported by PETVISIDAME (2CMR1017) within the framework of the 2023 PMTCT forum in Cameroon. We thank all central staff from the Ministry of Public Health in Cameroon. We would also like to thank UNICEF Cameroon and the Health Project Implementation Unit of the Islamic Development Bank for providing the necessary and accurate resources. Additional information Additional file 1. 2019 - 2023 PMTCT_Indicators Database (.xlsx) References ONUSIDA. Fiche d’information — Dernières statistiques sur l’état de l’épidémie de sida [Internet]. 2023. Available from: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_fr.pdf Nguefack HLN, Gwet H, Desmonde S, Oukem-Boyer OOM, Nkenfou C, Téjiokem M, et al. 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Supplementary Files 20192023PMTCTIndicatorsDatabase.xlsx Additional information Additional file 1. 2019 - 2023 PMTCT_Indicators Database (.xlsx) Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 10 Jan, 2026 Reviewers agreed at journal 10 Jan, 2026 Reviewers agreed at journal 09 Dec, 2025 Reviewers invited by journal 19 Nov, 2025 Editor assigned by journal 14 Oct, 2025 Submission checks completed at journal 12 Oct, 2025 First submitted to journal 12 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7710306","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547501702,"identity":"06d9baaf-698f-449d-a883-650a8c69402a","order_by":0,"name":"Justin 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Awono","lastName":"Noah","suffix":""},{"id":547501704,"identity":"bb7238f0-2622-476b-b911-f20faf1a27e5","order_by":2,"name":"Christelle Ngo Yana","email":"","orcid":"","institution":"Family Health Department","correspondingAuthor":false,"prefix":"","firstName":"Christelle","middleName":"Ngo","lastName":"Yana","suffix":""},{"id":547501705,"identity":"c1eb6b5b-fb9c-44a6-8671-a81d91064f40","order_by":3,"name":"Rogacien Kana Dongmo","email":"","orcid":"","institution":"Division of Operational Research in Health","correspondingAuthor":false,"prefix":"","firstName":"Rogacien","middleName":"Kana","lastName":"Dongmo","suffix":""},{"id":547501706,"identity":"e6dcd967-c1be-434f-a919-d4ae63364456","order_by":4,"name":"Francis Ateba Ndongo","email":"","orcid":"","institution":"Division of Operational Research in Health","correspondingAuthor":false,"prefix":"","firstName":"Francis","middleName":"Ateba","lastName":"Ndongo","suffix":""},{"id":547501707,"identity":"cc26acf2-662e-4b1d-a49d-9564a1f8a70b","order_by":5,"name":"Njamnshi Wepnyu Yembe","email":"","orcid":"","institution":"Division of Operational Research in Health","correspondingAuthor":false,"prefix":"","firstName":"Njamnshi","middleName":"Wepnyu","lastName":"Yembe","suffix":""},{"id":547501708,"identity":"51c310ff-ead7-4719-af86-b66ae3265f6f","order_by":6,"name":"Hernandez Léle Siaka","email":"","orcid":"","institution":"Health Project Execution Unit-BID","correspondingAuthor":false,"prefix":"","firstName":"Hernandez","middleName":"Léle","lastName":"Siaka","suffix":""},{"id":547501709,"identity":"61107af0-90f7-4125-9a47-8eef393a120b","order_by":7,"name":"Jean De Dieu Anoubissi","email":"","orcid":"","institution":"Central Technical Group - National AIDS Control Committee","correspondingAuthor":false,"prefix":"","firstName":"Jean","middleName":"De Dieu","lastName":"Anoubissi","suffix":""},{"id":547501710,"identity":"d15697f8-f426-4520-b563-4db6fd7256e0","order_by":8,"name":"Christian Noël Bayiha","email":"","orcid":"","institution":"Health Project Execution Unit-BID","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"Noël","lastName":"Bayiha","suffix":""},{"id":547501711,"identity":"a2a10ddb-7bfa-48b0-9ea1-2b25e629bc5f","order_by":9,"name":"Basile Keugoung","email":"","orcid":"","institution":"UNICEF","correspondingAuthor":false,"prefix":"","firstName":"Basile","middleName":"","lastName":"Keugoung","suffix":""},{"id":547501712,"identity":"dc325ff3-a68b-4e76-9812-b736b2c432c4","order_by":10,"name":"Joseph Fokam","email":"","orcid":"","institution":"Central Technical Group - National AIDS Control Committee","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Fokam","suffix":""},{"id":547501713,"identity":"92a5696b-9889-4c7b-ba51-f87fa20e6d21","order_by":11,"name":"Jérôme Ateudjieu","email":"","orcid":"","institution":"Division of Operational Research in Health","correspondingAuthor":false,"prefix":"","firstName":"Jérôme","middleName":"","lastName":"Ateudjieu","suffix":""},{"id":547501714,"identity":"667bedd7-60c8-49b9-ac66-8be896193936","order_by":12,"name":"Anne Cécile Zoung-Kanyi Bissek","email":"","orcid":"","institution":"Division of Operational Research in Health","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"Cécile Zoung-Kanyi","lastName":"Bissek","suffix":""}],"badges":[],"createdAt":"2025-09-25 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07:14:05","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87536,"visible":true,"origin":"","legend":"","description":"","filename":"8d0dfe52280748cf87a58c31d3086b701structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7710306/v1/832e44795552f5f43ddd7848.xml"},{"id":96970512,"identity":"513c5c3e-9ab5-4386-b171-969813670ec7","added_by":"auto","created_at":"2025-11-28 07:14:05","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98253,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7710306/v1/01a57300afeb113a10d8d04b.html"},{"id":96970502,"identity":"cea5d82f-b3be-40cc-822d-b5ae8c070c32","added_by":"auto","created_at":"2025-11-28 07:14:05","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":890161,"visible":true,"origin":"","legend":"\u003cp\u003ePMTCT Cascade Indicators Related to Pregnant Women\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7710306/v1/d3c84f6200e187891b27d902.jpeg"},{"id":96970500,"identity":"8ef19190-9234-4cf9-8155-b6e7258ca722","added_by":"auto","created_at":"2025-11-28 07:14:04","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":790610,"visible":true,"origin":"","legend":"\u003cp\u003ePMTCT Cascade Indicators for Exposed Children\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7710306/v1/79fd22abca964f0667d90cf4.jpeg"},{"id":97249177,"identity":"420af517-b907-43d3-92aa-85433a5f5aa1","added_by":"auto","created_at":"2025-12-02 13:11:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2551774,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7710306/v1/dd2b2310-ffba-4fed-9697-489b9664e0ce.pdf"},{"id":97138031,"identity":"8e848cf6-5959-4d99-9ae0-c6045f487cbe","added_by":"auto","created_at":"2025-12-01 09:58:25","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":112900,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditional file 1. 2019 - 2023 PMTCT_Indicators Database (.xlsx)\u003c/p\u003e","description":"","filename":"20192023PMTCTIndicatorsDatabase.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7710306/v1/bdd4375d7f72db87b2b3e46b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"2019-2023 trends in indicators for the prevention of mother-to-child transmission of HIV in Cameroon: reflections for the path to elimination by 2030","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobally, the incidence of paediatric HIV infection was 130,000 in 2022 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Over 90% of these infections are transmitted from mother to child, and in the absence of antiretroviral therapy, about 50% of infected children will die before their second birthday [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn sub-Saharan Africa, HIV prevalence among pregnant women remains high, and in the absence of any intervention, the mother-to-child transmission (MTCT) rate ranges from 13% to 48% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Indeed, an HIV-infected woman can transmit the virus to her baby during pregnancy, labor, delivery, or breastfeeding [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The combined risk of mother-to-child transmission (MTCT) of HIV in utero and during delivery is 15\u0026ndash;30%, and the risk increases to 20\u0026ndash;45% in breastfed children in the absence of any intervention [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Interventions conducted during pregnancy, labour, delivery, and breastfeeding\u0026mdash;collectively known as the prevention of mother-to-child transmission (PMTCT) cascade\u0026mdash;are effective in preventing vertical transmission of HIV [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It includes services aimed at eliminating HIV MTCT (prenatal care, HIV testing, disease staging, and antiretroviral treatment), reducing infant mortality (ARV prophylaxis, exclusive breastfeeding for the first six months, and Cotrimoxazole prophylaxis to prevent opportunistic infections), and improving maternal health [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Cameroon, the prevention of mother-to-child transmission and paediatric management of HIV remain a government priority. Indeed, HIV infection remains high among pregnant women, with an HIV prevalence of 5.7% and an MTCT rate at six weeks of 5% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. UNAIDS estimated 4,500 new HIV infections among children and an MTCT rate of 12.8% at 18 months [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although significant progress has been made in reducing mother-to-child transmission (MTCT) of HIV globally, very few countries have fewer than 50 new infections per 100,000 live births and a transmission rate below 5% in breastfeeding populations and below 2% in non-breastfeeding populations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The success of prevention of mother-to-child transmission (PMTCT) programs is assessed based on the PMTCT cascade. This study aims to analyse the trend of PMTCT indicators in Cameroon from 2019 to 2023.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eA retrospective cross-sectional study was conducted from 2019 to 2023 across 10 regions of Cameroon (Adamawa, Centre, East, Far North, Littoral, North, Northwest, West, South, and Southwest).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of pregnant women and exposed children.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eA template was developed in Excel 2021 to extract the following PMTCT indicators: the number of expected pregnant women, the number of pregnant women attended (Antenatal care\u0026thinsp;+\u0026thinsp;Weeks of Amenorrhea), the number of pregnant women tested for HIV, the number of pregnant women testing HIV-positive, the number of HIV-positive pregnant women on ART, the number of exposed children born to HIV-positive pregnant women, the number of exposed children on NVP, the number of exposed children tested for HIV, the number of exposed children testing HIV-positive, and the number of exposed children on ART. Annual reports from 2019 to 2023 from the NACC [\u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22 CR23 CR24 CR25\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] were reviewed and compiled. Data collection was conducted through a review of these five NACC annual reports and extraction of the PMTCT indicators.\u003c/p\u003e\n\u003ch3\u003eVariables of study\u003c/h3\u003e\n\u003cp\u003eThe main outcome of the PMTCT Cascade for Pregnant Women is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePMTCT Cascade for Pregnant Women Attending ANC\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDefinition / Numerator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDenominator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCalculation Method\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExpected pregnant women\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExpected number of pregnant women attending ANC (according to the priority program target population defined by Health Information Cell for the given year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDemographic estimates from Health Information Cell\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eANC Coverage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of pregnant women who attended ANC or delivery services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExpected number of pregnant women\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(pregnant women ANC\u0026thinsp;+\u0026thinsp;Delivery)\u0026thinsp;\u0026divide;\u0026thinsp;Expected pregnant women\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProportion of HIV\u0026thinsp;+\u0026thinsp;pregnant women\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of pregnant women newly tested HIV positive (ANC and delivery)\u0026thinsp;+\u0026thinsp;pregnant women with known HIV-positive status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal number of pregnant women tested for HIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(New HIV\u0026thinsp;+\u0026thinsp;pregnant women\u0026thinsp;+\u0026thinsp;Known HIV\u0026thinsp;+\u0026thinsp;pregnant women)\u0026thinsp;\u0026divide;\u0026thinsp;pregnant women tested\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eART Coverage (Pregnant women)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of HIV\u0026thinsp;+\u0026thinsp;pregnant women who received ART\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal number of HIV\u0026thinsp;+\u0026thinsp;pregnant women\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHIV\u0026thinsp;+\u0026thinsp;pregnant women on ART\u0026thinsp;\u0026divide;\u0026thinsp;Total HIV\u0026thinsp;+\u0026thinsp;pregnant women\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe main outcome of the PMTCT Cascade for HIV-Exposed Infants (HEI) is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePMTCT Cascade for HIV-Exposed Infants (HEI)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDefinition / Numerator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDenominator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCalculation Method\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHEI initiated on NVP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of HIV-exposed infants who received Nevirapine prophylaxis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of identified HIV-exposed infants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHEI on NVP\u0026thinsp;\u0026divide;\u0026thinsp;Identified HEI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHEI tested with PCR1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of HEI tested by PCR at 6 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of identified HIV-exposed infants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHEI tested PCR1\u0026thinsp;\u0026divide;\u0026thinsp;Identified HEI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHIV-positive HEI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of HEI who tested HIV-positive by PCR at 6 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of HEI tested by PCR at 6 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHIV\u0026thinsp;+\u0026thinsp;HEI (PCR1)\u0026thinsp;\u0026divide;\u0026thinsp;HEI tested PCR1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eART coverage among HIV\u0026thinsp;+\u0026thinsp;HEI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of HIV-positive HEI who received ART\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of HIV-positive HEI (PCR1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHIV\u0026thinsp;+\u0026thinsp;HEI on ART\u0026thinsp;\u0026divide;\u0026thinsp;HIV\u0026thinsp;+\u0026thinsp;HEI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eAfter data collection, the data were aggregated and analysed using Excel and R 4. PMTCT indicators were described using proportions. Parametric tests for comparing k proportions and the Marascuilo procedure were performed to compare PMTCT indicators at the national and regional levels to determine whether they were equal or if at least two differed significantly, with a significance level of 5%. Results are presented in tables and graphs.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical consideration\u003c/h2\u003e\u003cp\u003eThis study used only aggregated and anonymized secondary data extracted from the official annual reports of the \u003cem\u003eNational AIDS Control Committee (NACC)\u003c/em\u003e, Cameroon. As these publicly available surveillance data contain no individual-level identifiers, ethics approval by an Institutional Review Board (IRB) or ethics committee was not required under national regulations, and informed consent from participants was not applicable [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAntenatal care (ANC) coverage increased significantly, rising from 80.34% in 2019 to 87.62% in 2021 before declining to 84.80% in 2022 and 81.22% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The East region had ANC coverage above 100%, whereas the Far North (\u0026lt;\u0026thinsp;70%), Northwest (\u0026lt;\u0026thinsp;65%), and Southwest (\u0026lt;\u0026thinsp;60%) regions had the lowest coverage (\u0026lt;\u0026thinsp;80%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe proportion of pregnant women tested for HIV also increased significantly, from 87.27% in 2019 to 97.16% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The Centre, Littoral, Northwest, West, Southwest, and South regions had HIV testing rates among pregnant women above 90%, while the North and Far North regions had the lowest testing rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong pregnant women tested for HIV, 3 out of 100 were HIV-positive in 2019, compared to about 2 out of 100 in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The North and Far North regions had the lowest proportions of HIV-positive pregnant women, while the South and East regions had the highest.\u003c/p\u003e\u003cp\u003eThe proportion of HIV-positive pregnant women receiving antiretroviral treatment (ART) increased from 86.48% in 2019 to 93.72% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The Southwest, Centre, East, Far North, and Littoral regions had ART coverage below 90%.\u003c/p\u003e\u003cp\u003eThe proportion of exposed children born to HIV-positive mothers receiving nevirapine (NVP) prophylaxis increased from 86.91% in 2019 to 95.05% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Except in the East, Far North, South, and Southwest regions, the proportion of exposed children on NVP initially dropped in 2020 before gradually increasing (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe proportion of exposed children tested for HIV using PCR increased significantly, from 89.72% in 2019 to 99.69% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the Littoral, East, and Far North regions had the lowest proportions of exposed children tested by PCR between 2019 and 2023 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong exposed children tested by PCR, the proportion who were HIV-positive decreased significantly, from 5.28% in 2019 to 3.41% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The West and Northwest regions had the lowest proportions of HIV-positive exposed children, while the North region showed peaks in seropositivity (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, the proportion of HIV-positive exposed children identified by PCR who received ART increased significantly, from 55.20% in 2019 to 82.20% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The North and Centre regions had the lowest proportions of HIV-positive children on ART, whereas the Northwest had the highest (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026Eacute;volution des indicateurs PTME entre 2019 et 2020 au Cameroun\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eANC Coverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80.34%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.56%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e87.62%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e84.80%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e81.22%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTesting Rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e87.27%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93.70%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96.48%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e97.87%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e97.16%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositivity Rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.62%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.31%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.71%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.47%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.24%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eART Coverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86.48%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83.91%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92.30%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e93.82%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e93.72%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNevirapine Coverage among Exposed Children (EC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86.91%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85.07%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e91.46%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e94.34%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e95.05%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIV Testing Rate among Exposed Children by PCR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89.72%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.11%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89.27%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e98.47%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e99.69%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIV Positivity Rate among Exposed Children (EC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.73%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.44%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.27%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.00%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.32%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eART Coverage among HIV-Positive Exposed Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55.20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82.60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e79.30%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e82.40%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e82.20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examines the evolution of indicators for the prevention of mother-to-child transmission (PMTCT) of HIV in Cameroon between 2019 and 2023, based on annual reports and the 2023 progress report. The results show generally positive trends for both pregnant women and exposed children, including increased HIV testing, improved maternal ART coverage, enhanced neonatal prophylaxis, and decreased maternal and infant HIV positivity rates. However, coverage of antenatal care (ANC) visits declined from 86.56% in 2020 to 81.22% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), remaining below the 100% threshold recommended by the WHO for the elimination of mother-to-child HIV transmission [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This decline is particularly pronounced in the Far North, Northwest, and Southwest regions, which are affected by insecurity and sociopolitical crises, whereas the East and Adamawa regions show coverage rates close to 100%, likely due to underestimation of pregnant women and the exclusion of refugees from official estimates [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe HIV testing rate among pregnant women increased from 87.27% in 2019 to 97.16% in 2023, reflecting the effectiveness of national policies such as counselling and testing at all entry points, exemption from payment fees since 2020, performance-based financing, the health voucher program in certain areas, and systematic re-testing of women who previously tested negative [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The maternal HIV positivity rate decreased from 3.31% in 2019 to 2.24% in 2023, highlighting the positive impact of systematic testing and adherence to antiretroviral therapy (ART), although a slight increase was observed in the Adamawa and East regions due to the influx of refugees [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. ART coverage among HIV-positive women increased from 84.52% in 2019 to 90.38% in 2023, despite a temporary decline between 2019 and 2020 in certain regions due to stock shortages, low retention, and supply chain issues related to insecurity [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Interventions such as the \u0026ldquo;Last Mile Delivery\u0026rdquo; have helped improve the supply and distribution of antiretroviral drugs [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Among HIV-exposed children, ARV prophylaxis coverage increased from 87.20% in 2019 to 94.85% in 2023, thanks to the systematic provision of Nevirapine and community-based actions, including the sensitization of traditional birth attendants and the active identification and referral of exposed infants in health facilities [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePCR testing at 2 months or later reached nearly 100% in several regions, and the HIV positivity rate among exposed infants declined from 5.28% in 2019 to 3.41% in 2023, reflecting the combined effectiveness of maternal and paediatric PMTCT interventions [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Despite these advances, several challenges remain: irregularities in the supply chain, low retention of women on ART, and limited access to care in crisis-affected areas. To achieve the second 95% (optimal ART coverage), it is essential to strengthen community-based interventions, optimize the distribution of commodities through the \u0026ldquo;Reach Every District\u0026rdquo; approach, and sustain the \u0026ldquo;Test and Treat\u0026rdquo; strategies [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe analysis of PMTCT indicators in Cameroon between 2019 and 2023 highlights substantial progress, particularly in HIV testing coverage, maternal ART initiation, infant prophylaxis, and early infant diagnosis. These achievements have contributed to significant declines in both maternal and infant HIV positivity rates. However, persistent regional disparities especially in the North-West, South-West, and Far North regions underscore the impact of sociopolitical crises, supply chain disruptions, and limited access to antenatal care services. Without targeted interventions to strengthen service delivery, optimize retention in care, and ensure equitable access across all regions, Cameroon may fall short of achieving WHO\u0026rsquo;s 2030 e-MTCT validation criteria. Strengthening community-based approaches, sustaining supply chain innovations, and prioritizing high-burden regions will be essential to accelerate progress towards elimination of mother-to-child HIV transmission.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eLimitation of the study\u003c/h2\u003e\u003cp\u003eThis study has several limitations. First, it relied on secondary data extracted from annual reports of the National AIDS Control Committee (NACC), which may be affected by reporting delays, underreporting, or inconsistencies across regions. Second, demographic estimates used to calculate expected numbers of pregnant women may be imprecise, particularly in regions hosting large refugee populations, leading to potential over- or under-estimation of coverage indicators. Third, the analysis was limited to quantitative indicators and did not capture contextual or qualitative factors, such as barriers to antenatal care attendance, adherence to ART, or health system constraints. Finally, the retrospective design limits causal inference, although the trends described remain highly relevant for monitoring national progress towards e-MTCT.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC: Antenatal Care\u003c/p\u003e\n\u003cp\u003eART: Antiretroviral Therapy\u003c/p\u003e\n\u003cp\u003eBID: Islamic Development Bank (Health Project Execution Unit-BID)\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u003c/p\u003e\n\u003cp\u003eCIRCB: Chantal Biya International Reference Centre\u003c/p\u003e\n\u003cp\u003eEC: Exposed Children\u003c/p\u003e\n\u003cp\u003ee-MTCT: Elimination of Mother-to-Child Transmission\u003c/p\u003e\n\u003cp\u003eHEI: HIV-Exposed Infants\u003c/p\u003e\n\u003cp\u003eHIV: Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eMINSANTE: Ministry of Public Health\u003c/p\u003e\n\u003cp\u003eNACC: National AIDS Control Committee\u003c/p\u003e\n\u003cp\u003eNVP: Nevirapine\u003c/p\u003e\n\u003cp\u003ep: p-value\u003c/p\u003e\n\u003cp\u003ePCR: Polymerase Chain Reaction\u003c/p\u003e\n\u003cp\u003ePECPA: Project to eliminate mother-to-child transmission of HIV\u003c/p\u003e\n\u003cp\u003ePMTCT: Prevention of Mother-to-Child Transmission\u003c/p\u003e\n\u003cp\u003eSTI: Sexually Transmitted Infection\u003c/p\u003e\n\u003cp\u003eUNAIDS / ONUSIDA: United Nations Programme on HIV/AIDS\u003c/p\u003e\n\u003cp\u003eUNICEF: United Nations Children\u0026apos;s Fund\u003c/p\u003e\n\u003cp\u003eUSAID: United States Agency for International Development\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJN, JPYAN\u003c/strong\u003e, \u003cstrong\u003eCNY, RKD\u003c/strong\u003e and\u003cstrong\u003eFAN\u003c/strong\u003e managed and analysed data, implemented the methodology, interpreted results and wrote the first draft of the manuscript.\u0026nbsp;\u003cstrong\u003eJN, JPYAN\u003c/strong\u003e, \u003cstrong\u003eCNY, RKD\u003c/strong\u003e and\u003cstrong\u003eFAN\u003c/strong\u003e prepared the final draft, with critical revisions made by \u003cstrong\u003eNWY, HLS, JDA, CNB, BK, JF, JA and ACZKB\u003c/strong\u003e is the lead author, conceptualized, formulated research goals and objectives, contributed to the acquisition of project financial support, led methodology development and results interpretation. All authors have read and agreed to submit to the current journal; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article was partly supported by PETVISIDAME (2CMR1017) within the framework of the 2023 PMTCT forum in Cameroon. We thank all central staff from the Ministry of Public Health in Cameroon.\u0026nbsp;We would also like to thank UNICEF Cameroon and the Health Project Implementation Unit of the Islamic Development Bank for providing the necessary and accurate resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditional file 1. 2019 - 2023 PMTCT_Indicators Database (.xlsx)\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eONUSIDA. Fiche d\u0026rsquo;information \u0026mdash; Derni\u0026egrave;res statistiques sur l\u0026rsquo;\u0026eacute;tat de l\u0026rsquo;\u0026eacute;pid\u0026eacute;mie de sida [Internet]. 2023. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/342813\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/342813\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV, PMTCT, Mother-to-child transmission, e-MTCT, Cameroon","lastPublishedDoi":"10.21203/rs.3.rs-7710306/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7710306/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePrevention of mother-to-child transmission (PMTCT) remains a priority in Cameroon for achieving HIV elimination, despite the implementation of priority interventions aimed at improving PMTCT indicators.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to analyse trends in HIV PMTCT indicators in Cameroon between 2019 and 2023.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective study was conducted from 2019 to 2023 across ten regions of Cameroon (Adamawa, East, Far North, Center, Littoral, North, Northwest, Southwest, and South). The study population included pregnant women and HIV-exposed infants. A standardized form was designed and used to extract PMTCT indicators from the Annual Reports of the National AIDS Control Committee (NACC). Data were processed and analysed using Excel and R version 4.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBetween 2019 and 2023, key indicators of the prevention of mother-to-child transmission (PMTCT) program in Cameroon showed significant progress. Antenatal care (ANC) coverage increased from 80.3% in 2019 to 87.6% in 2021 before declining to 81.2% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). HIV testing rates rose steadily from 87.3% to 97.9% in 2022, slightly decreasing thereafter (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while HIV positivity rates declined from 3.6% to 2.2% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). ARV coverage among women improved from 86.5% to 93.7% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and nevirapine coverage among HIV-exposed infants increased from 86.9% to 95.1% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Early infant diagnosis (PCR testing) showed high uptake, reaching 99.7% in 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). HIV positivity among infants decreased from 4.7% to 3.3% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while ARV coverage in HIV-positive infants rose markedly from 55.2% in 2019 to over 82% from 2020 onward (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Overall, the PMTCT program achieved remarkable improvements in service coverage and reductions in HIV positivity, despite fluctuations in ANC uptake.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe analysis of PMTCT indicators in Cameroon from 2019 to 2023 shows overall improvement, though regional disparities persist and some national targets remain unmet. Strengthening strategies to increase service uptake is essential to further reduce mother-to-child HIV transmission.\u003c/p\u003e","manuscriptTitle":"2019-2023 trends in indicators for the prevention of mother-to-child transmission of HIV in Cameroon: reflections for the path to elimination by 2030","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-28 07:14:00","doi":"10.21203/rs.3.rs-7710306/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-10T16:06:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191934591045008184979578405380224567398","date":"2026-01-10T13:28:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52429287625982895462766554819706635631","date":"2025-12-09T17:14:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-19T11:10:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-15T03:19:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-12T12:05:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-10-12T12:02:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"49c579aa-81bf-445c-9639-e7faf243c5fc","owner":[],"postedDate":"November 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-28T07:14:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-28 07:14:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7710306","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7710306","identity":"rs-7710306","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}