Implementation of Prevention of Mother-to-Child Transmission in the Global Eradication of HIV/AIDS: A Critical Analysis of Progress and Persistent Gaps

Abstract

The global effort to eradicate Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) has identified the prevention of vertical transmission as a critical strategic pillar. This narrative review and critical synthesis provide a comprehensive analysis of the implementation of Prevention of Mother-to-Child Transmission (PMTCT) programs within the broader HIV/AIDS eradication agenda. Drawing upon epidemiological data, policy frameworks, and regional case studies from 2000 to 2023, we assess the profound impact, persistent challenges, and evolving strategies of PMTCT. The analysis confirms that scaled-up PMTCT services have averted millions of pediatric HIV infections globally, with a documented 52% decline in new childhood infections between 2001 and 2012. However, progress is markedly heterogeneous, characterized by stalled antiretroviral therapy (ART) coverage rates among pregnant women since 2014 and persistent high transmission burdens in sub-Saharan Africa, which accounts for approximately 90% of global vertical transmissions. This paper argues that the future of PMTCT, and by extension, the feasibility of ending AIDS as a public health threat hinges on the systematic integration of services into strengthened primary healthcare systems, the dismantling of socio-structural barriers to care, and the adoption of person-centered, equity-focused implementation models. Conclusively, while PMTCT is a proven biomedical intervention, its ultimate success is a function of robust health systems and sustained political commitment. The findings underscore the urgent need for policy shifts that prioritize health system integration and address the social determinants of health to achieve equitable PMTCT coverage globally.