South Africa

South Africa is expanding choice-based HIV prevention for pregnant and breastfeeding women, integrating PrEP, including long-acting options, within maternal, child and women’s health services.

Background

Despite significant progress toward eliminating vertical transmission of HIV in South Africa, an estimated 6,600 new pediatric HIV infections occurred in 2024, with 53% happening during breastfeeding and 47% during pregnancy. Maternal HIV acquisition remains a major contributor to new pediatric infections, accounting for approximately 44% of infections during breastfeeding and 15% during pregnancy, highlighting the critical need to strengthen HIV prevention among HIV-negative pregnant and breastfeeding women (PBFW). 

South Africa has strengthened HIV prevention within maternal, child and women’s health (MCWH) services by integrating HIV testing, repeat testing, partner testing, STI screening, and PrEP into routine antenatal and postnatal care. The country has also expanded HIV prevention options through the introduction of oral PrEP and approval of lenacapavir (LEN), supported by national clinical guidelines, provider training, and strengthened monitoring systems

South Africa's VTP Cascade Performance

South Africa continues to achieve high HIV testing coverage among pregnant women. In the year 2025, between 156,000 and 184,000 women received HIV testing each quarter, while approximately 476,000 women received repeat HIV testing during pregnancy and breastfeeding. HIV positivity at 1st ANC testing declined from 4.2% in Quarter 1 to 3.9% by Quarter 4, while HIV positivity among women undergoing repeat testing remained low at 0.15–0.18%, reflecting continued progress in identifying women living with HIV while emphasizing the importance of preventing maternal HIV acquisition during this period.  

The country has strengthened integrated maternal HIV prevention through routine ANC and postnatal HIV testing, repeat testing, partner testing, STI screening, and one stop maternal and infant service delivery. However, maternal HIV acquisition during pregnancy and breastfeeding continues to contribute substantially to pediatric HIV infections, reinforcing the need to increase PrEP uptake and continuation among HIV negative pregnant and breastfeeding women. 

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

An open box of lenacapavir

South Africa has fully integrated PrEP within routine maternal, child, and women’s health services, ensuring HIV-negative pregnant and breastfeeding women are offered HIV prevention services alongside antenatal, postnatal, family planning, STI, and partner testing services. Pregnant women receive HIV risk assessment at every visit, while women requesting PrEP are offered services regardless of assessed HIV risk. 

The country has demonstrated substantial progress in scaling up PrEP within ANC services. Between 2023 and 2025, PrEP uptake among eligible antenatal women increased from 12% to 28%, representing a 2.3-fold increase. During 2025 alone, PrEP initiation increased from 18% of eligible HIV-negative ANC clients in Quarter 1 to 30% in Quarters 3 and 4, with ANC PrEP initiations increasing from 32,557 in Quarter 1 to almost 50,000 by Quarter 3. ANC clients now account for 45% of all new PrEP initiations, compared with only 14% in 2023, demonstrating successful integration of HIV prevention within maternal health services. 

South Africa is also expanding HIV prevention choices through phased implementation of LEN starting with 360 primary health facilities in high HIV burden districts. Pregnant and breastfeeding women have been prioritized, supported by a national prioritization framework, data-driven facility selection, and integration within existing maternal health services. 

To support program monitoring, South Africa has introduced the SyNCH digital platform, a national PrEP module that enables longitudinal monitoring of PrEP initiation, continuation, switching, discontinuation, adverse events, pregnancy outcomes, appointment scheduling, client reminders, and mobility across facilities. In addition, the system will be able to disaggregate pregnancy status and breastfeeding status. The system includes real-time dashboards, built-in data quality checks, and national reporting functionality to support program improvement and the scale-up of long-acting HIV prevention. 

HIVE Engagement

South Africa completed a baseline VTP Capability Maturity Model (CMM) assessment in 2024. The assessment highlighted strong national leadership, integrated maternal HIV prevention policies, and robust HIV testing platforms, while identifying opportunities to strengthen PrEP uptake, postnatal follow-up, community demand creation, longitudinal client tracking, and monitoring of HIV prevention services for pregnant and breastfeeding women. 

Overview of South Africa’s 2024 VTP self-assessment results

Since joining HIVE, South Africa has actively contributed to webinars and in-person communities of practice meetings by sharing experiences integrating oral PrEP, CAB-LA, and lenacapavir within maternal and child health services. Through the PrEP community of practice, South Africa has showcased lessons on integrated service delivery models, provider training, PrEP counseling algorithms, digital innovations, and implementation of long-acting HIV prevention.  

Planned activities include participating in supportive supervision visits, conducting rapid assessments to identify barriers to PrEP uptake, sharing best practices through webinars and communities of practice, and disseminating innovations in integrated HIV prevention and digital monitoring systems to other HIVE countries. Â