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

Background Mozambique 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.

We 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.

During 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).

PEPFAR-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. Competing Interest Statement The authors have declared no competing interest. Funding Statement This manuscript has been supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC). The findings and conclusions in this manuscript are those of the author(s) and do not necessarily represent the official position of the funding agencies. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used PEPFAR Monitoring, Evaluation, and Reporting program. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced are available from PEPFAR Monitoring, Evaluation, and Reporting program data.