South Africa
South Africa has the largest population of pregnant and breastfeeding women living with HIV globally, with an estimated 260,000 pregnant women in need of antiretroviral therapy.
Background
While the country achieved the global 95% target for antiretroviral therapy (ART) coverage among pregnant women in 2024, South Africa continues to face significant challenges in preventing vertical transmission, especially during the postnatal period. In 2024, approximately 6,600 new pediatric HIV infections were reported, making South Africa the country with the second-highest number of new pediatric infections globally. Approximately 53% of these transmissions occurred during breastfeeding.
Maternal HIV infections acquired during pregnancy and breastfeeding remain a key driver of vertical transmission in South Africa, contributing to 15% of antenatal and 44% of postnatal infections. Nonetheless, key indicators such as early infant diagnosis coverage, which has reached 73%, reflect ongoing progress in addressing these challenges.
South Africa’s HIV services are coordinated through a multi-tiered system involving national, provincial, district, and local stakeholders to ensure a comprehensive response to the epidemic. At the national level, the South African National AIDS Council (SANAC) provides strategic oversight. Provincial AIDS councils (PACs) develop coordinated strategies and mobilize resources, supporting district AIDS councils (DACs), which in turn bring together key stakeholders to implement and monitor district-level responses. Local AIDS councils (LACs) focus on grassroots coordination, service delivery, and community engagement.
Progress toward elimination targets, 2024
| Elimination of vertical transmission | |
|---|---|
| Pregnant women who received ART for VTP (#) | 256,000 |
| Pregnant women needing ART for VTP (#) | 260,000 |
| Coverage of pregnant women who received ART for VTP (%) | 95 |
| Early infant diagnosis < 2 months of age (%) | 73 |
| New HIV infection among children (#) | 6,600 |
| New HIV infections averted due to VTP interventions | 61,000* |
| Final vertical transmission rate including during breastfeeding (%) | 2.5 |
| Number of HIV-exposed children who are uninfected | 4,300,000* |
| Source: UNAIDS country estimates 2025* | |
HIVE Engagement
South Africa joined HIVE in August 2024 and completed its first baseline assessment using the HIVE Vertical Transmission Elimination Capability Maturity Model (VTE CMM).
Findings from the assessment highlighted several strengths in the national VTP program, including:
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- Supportive policies for training, procurement, and coordinating services
- Improving linkage to ART
- Strengthening the monitoring of PrEP for pregnant and breastfeeding women
- Enhancing systems for longitudinal tracking of early infant diagnosis
- Bolstering overall monitoring and evaluation frameworks for VTP
Overview of South Africa’s 2024 VTP self-assessment results
Through its engagement with the HIVE network, South Africa will also benefit from technical cross-country learning and the co-creation of solutions to address persistent service delivery challenges, including sharing best practices for vertical transmission elimination.
For more information on CMMs, please visit the CQUIN website.
Service Disruptions and Landscaping Survey
The US government stop-work order in early 2025 had a limited direct impact on vertical transmission services in South Africa due to the government’s pre-existing integration of these services into maternal and child health platforms. Since VTP services were already managed by NDOH staff within public health facilities, they continued largely uninterrupted despite the broader withdrawal of PEPFAR-supported personnel and partners. However, the withdrawal of technical assistance and disruptions in monitoring systems indirectly affected oversight activities such as data transcription, viral load result tracking, and reporting, which are critical to ensuring the effectiveness and quality of vertical transmission prevention.
In response to these challenges, the South African government has committed to strengthening its capacity to sustain VTP services independently. This includes:
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- Reallocating national resources to maintain data management and sample transport
- Ensuring continuity in early infant diagnosis and follow-up testing
The NDOH has also initiated task shifting and staff redeployment strategies to fill the gaps left by withdrawn partners, particularly in data and monitoring roles that support vertical transmission tracking.
For long-term sustainability, South Africa is incorporating VTP into broader health system strengthening efforts, including the development of a national sustainability framework and integration of services. The government’s proactive role in securing domestic financing, conducting provincial-level assessments, and engaging multi-sectoral stakeholders reflects a strategic shift toward full national ownership of HIV programs, including vertical transmission prevention. These steps are critical to ensure that gains in eliminating mother-to-child transmission are not reversed and that services remain resilient in the face of external funding shocks.
Alignment with the Global Alliance
South Africa’s action plan to end AIDS in children by 2030 prioritizes several key strategies, including:
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- The integrated “triple elimination” of vertical transmission of HIV, syphilis, and hepatitis B, with optimal DTG-based ART regimens for pregnant and breastfeeding women
- Adopting patient-centered approaches to expand vertical transmission prevention coverage and improve continuity of care
- Structuring primary care models to ensure integrated postnatal care for both mother and infants at a single service delivery point.
Efforts to enhance the quality of care include strengthened viral load testing and mental health support. Additionally, the plan emphasizes targeted support for pregnant and breastfeeding adolescents living with HIV, as well as enhanced inter-departmental collaboration to improve psychosocial support for HIV-positive women.
To strengthen program effectiveness, South Africa is also prioritizing improved data collection and viral load monitoring to track and optimize mother-infant outcomes.
