To address the evolving needs of the HIV response, HIVE’s technical team has adapted its country support and developed a three-phase approach for the six countries in the HIVE network to achieve their national vertical transmission elimination (VTE) goals and maintain the continuity of maternal and child health care (MCH) since March 2025. This pivot follows the lead of ICAP’s Coverage, Quality, and Impact Network, CQUIN, an affiliate network, reflecting a shared commitment to adaptive strategies that respond to evolving network priorities in HIV programming across diverse contexts.

“In the early phase of funding disruptions, the HIVE team conducted systematic landscaping interviews alongside weekly network-wide discussions across HIVE member countries, which revealed threats to every component of national VTE service delivery,” said Maureen Syowai, MBChB, MSc, CQUIN and HIVE program director. “Based on the response and discussions with ministries of health and other stakeholders, HIVE envisioned a three-phase response to support the six countries in the network.”

Despite the evolving funding landscape, HIVE continues to prioritize the prevention of vertical transmission of HIV in children and keeping mothers healthy, underscoring a commitment to mitigating disruptions in VTP service delivery and reflecting a commitment to service continuity and impact. HIVE’s technical team conceptualized the three interlinked phases for the pivot around an initial emergency response phase focused on needs assessment and rapid support. That led to an intermediate response focused on VTP service prioritization and expanding joint learning and experience sharing, and a longer-term agenda aimed at supporting member countries to reimagine their HIV response as centered on sustainability, coverage, and quality.

Phase 1: Stabilization

In the first phase, which began in March 2025, the HIVE network was engaged in assessing and documenting the decisions countries had already made in response to recent HIV health system challenges through an intensive situational analysis, analyzing the information and data used to make these decisions, and understanding how countries were adapting their VTP plans over time as new details unfolded. HIVE disseminated key findings, best practices, and challenges across member countries through webinars, targeted country visits, and virtual engagements with country teams. Country teams further highlighted these insights during the June 2025 HIVE Strategic Planning Meeting.

Phase 2: Redesign

Recognizing that countries may not have access to previous levels of external funding, Ministry of Health teams are now rethinking the structure of their HIV and VTP programs. The June 2025 HIVE Strategic Planning Meeting marked a pivotal moment for countries in the HIVE network, providing a platform for them to share adaptation strategies, including the integration of HIV testing and antiretroviral therapy (ART) services into maternal health services and primary health care systems. To this end, HIVE continues to provide platforms for countries to discuss strategies to mitigate disruptions in VTP service delivery, such as retraining existing MCH staff to provide pre-exposure prophylaxis (PrEP) counseling and streamlining VTP laboratory and data systems. Two network-wide webinars have already featured cross-country lessons on optimizing and sustaining national VTP programs, with more planned in the months ahead.

Phase 3: Reimagining VTP Service Delivery

As countries reimagine VTP service delivery, the next step is implementation. This phase will require countries to update training materials, revise protocols, strengthen data systems, and ensure that services remain responsive to community needs.

Community-led monitoring, recipient feedback loops, and flexible monitoring and evaluation (M&E) frameworks are central to HIVE’s support, ensuring that redesigned programs are not only functional but also equitable and effective.

“This is not just about surviving the crisis,” said Franklin Emerenini, MBBS, MSc, FMCPaed, HIVE deputy director. “It is about rebuilding smarter, more resilient systems that put mothers and babies at the center.”

HIVE is committed to ensuring that country teams have the tools, peer support, and knowledge exchange needed to make these transitions effectively.

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