Zambia

Zambia has a high HIV burden with an estimated 1.3 million adults and 60,000 children living with HIV.

Background

Zambia has made significant progress toward eliminating vertical transmission of HIV. In 2025, HIV testing coverage at the first antenatal care (ANC) visit reached 92%, ART coverage among pregnant and breastfeeding women reached 97.4%, and the national vertical transmission rate declined from 6.6% in 2024 to 5.9% in 2025. Despite these gains, an estimated 2,960 new pediatric HIV infections continue to occur annually, with 68% attributed to HIV acquisition during the breastfeeding period and 32% during pregnancy. 

As one of the Global Alliance countries committed to ending AIDS in children by 2030, Zambia has prioritized HIV prevention among HIV-negative pregnant and breastfeeding women as a critical component of its VTP strategy. The country has progressively expanded HIV prevention options, introducing oral PrEP in 2017, CAB-LA in February 2024, and Lenacapavir (LEN) in December 2025. CAB-LA was approved for use among pregnant and breastfeeding women in August 2024, and Zambia is among the first countries globally to introduce LEN for this population. 

PrEP services are integrated within maternal and child health (MCH) platforms and delivered through ANC, family planning, immunization, and postnatal care services. The country is implementing both high-volume and decentralized service delivery models.

 

Zambia VTP Cascade Performance

Zambia continues to demonstrate strong performance across several components of the vertical transmission prevention (VTP) cascade. In 2025, 88% of pregnant women attended ANC1, 92% received HIV testing during ANC, and 97.4% of pregnant and breastfeeding women living with HIV were receiving ART. The country also improved syphilis screening coverage from 73% in 2024 to 86% in 2025, while hepatitis B testing coverage increased from 15% to 27% over the same period. Zambia’s final vertical transmission rate declined from 6.6% in 2024 to 5.9% in 2025, reflecting continued progress toward national EMTCT targets. 

Despite these gains, an estimated 2,960 new pediatric HIV infections continue to occur annually. Analysis of transmission patterns shows that 34% of new infections occur during breastfeeding, while 12% occur during pregnancy, highlighting the importance of strengthening HIV prevention services for HIV negative pregnant and breastfeeding women. Maternal HIV acquisition remains a significant contributor to new pediatric infections, hence the need for improved HIV retesting, PrEP uptake, and continuity of prevention services throughout pregnancy and breastfeeding. 

Zambia has also demonstrated strong performance in early infant diagnosis (EID), with substantial improvements in testing of HIV exposed infants before two months of age. This success has been attributed to integration of EID within immunization services, strengthened coordination between laboratory and clinical teams, introduction of point-of-care technologies, harmonized reporting systems, and routine data review meetings at facility, district, and provincial levels. 

 

Prevention of New Incident Infections Among HIV-Negative Pregnant and Breastfeeding Women

An open box of lenacapavir

Zambia is implementing a choice-based HIV prevention approach that includes oral PrEP, CAB-LA, and LEN for PBFW. PrEP services are integrated within routine MCH services, with women receiving counseling, HIV testing, risk assessment, and PrEP services through ANC, immunization, family planning, and postnatal care platforms. 

The country currently has more than 2,200 PrEP sites, with CAB-LA available in selected facilities and LEN initially introduced in high-volume facilities with established PrEP programs. Zambia plans to provide LEN to approximately 21,228 pregnant and breastfeeding women across 542 priority facilities, focusing on provinces and districts with the highest HIV incidence. By February 2026, at the University Teaching Hospital(UTH) Women and Newborn, one of the first facilities to introduce LEN for PBFW, more than 100 women had initiated LEN within the first two months of implementation, demonstrating the feasibility of integrating long-acting HIV prevention within high-volume MCH settings. 

To support monitoring of PrEP services, Zambia is transitioning from paper-based systems to a DHIS2 tracker that captures eligibility, initiation, continuation, clinical follow-up, adverse events, pregnancy outcomes, and infant outcomes. The system supports monitoring of all PrEP options and includes disaggregation by pregnancy and breastfeeding status. Zambia is also strengthening pharmacovigilance systems to monitor maternal and infant outcomes associated with long-acting injectable PrEP. 

HIVE Engagement

Zambia joined the HIV Impact Network for Vertical Transmission Elimination (HIVE) in August 2024. In the same year, Zambia conducted a baseline assessment of VTP services in the country, which identified key strengths in the VTP program such as enabling policies for HIV testing of PBW, linkage to ART, and screening and treatment of syphilis in pregnant women.  The CMM also highlighted areas for improvement along the VTP cascade, particularly in community engagement, providing PrEP for PBFW, longitudinal monitoring of early infant diagnosis services, and monitoring and evaluation systems for VTP.  

Overview of Zambia’s 2024 VTP self-assessment results

In February 2026, HIVE conducted a re-engagement and technical assistance visit with the Ministry of Health, implementing partners, civil society organizations, US Government partners, and health facilities to better understand Zambia’s HIV prevention priorities and support the rollout of long-acting HIV prevention options for pregnant and breastfeeding women. The visit focused on strengthening national engagement and alignment, assessing PrEP and LEN service delivery, reviewing monitoring and evaluation systems, and identifying priority technical assistance opportunities to support HIV prevention and elimination of vertical transmission. 

The visit identified several opportunities for collaboration through HIVE, including strengthening demand creation for PrEP among pregnant and breastfeeding women, improving community-based adherence and follow-up systems, supporting the transition from paper-based tools to electronic PrEP monitoring systems, strengthening pharmacovigilance and adverse event monitoring, and enhancing data analytics and visualization to support routine program decision-making. Zambia also expressed interest in leveraging the HIVE network to facilitate country-to-country learning and share its experiences with integrating long-acting PrEP within MCH platforms. 

Since joining the network, Zambia has actively participated in HIVE Communities of Practice, webinars, and technical learning activities. Current areas of engagement include strengthening PrEP service delivery for pregnant and breastfeeding women, improving monitoring of PrEP uptake and continuation, enhancing longitudinal mother infant tracking systems, strengthening data use for program improvement, and facilitating peer learning on the implementation of CAB-LA and LEN within MCH settings. Â