In many parts of the world, a mother living with HIV can give birth without passing the virus onto her child. Thanks to advancements in treatment and prevention, vertical transmission of HIV has been nearly eliminated in some countries. Yet, in many high-burden countries, many infants are still born with HIV each year due to gaps in health-care access, treatment retention, and incident HIV infection among pregnant and breastfeeding women.

A bold new initiative, the HIV Impact Network for Vertical Transmission Elimination (HIVE), has been launched to tackle these persistent challenges in six of the 12 global alliance countries – Kenya, Mozambique, Nigeria, South Africa, Tanzania, and Zambia – that account for 25% of all pediatric infections globally. With funding from the Gates Foundation, the project brings together HIV, maternal and child health experts, ministries of health, policymakers, and frontline health care workers in a collaborative, cross-country effort to ensure that no child is born with HIV.

While the global HIV response has made tremendous progress, some barriers remain stubbornly in place. Many pregnant and breastfeeding women with HIV still struggle to access and stay on treatment, leading to preventable infections in newborns. Early infant testing and linkage to care remain critical but are often delayed due to health system weaknesses and limited follow-up mechanisms. Furthermore, a significant proportion of vertical transmissions occur due to maternal HIV infections acquired during pregnancy and breastfeeding, often compounded by limited access to preventive services during this period.

HIVE aims to address these challenges by strengthening national health systems, sharing best practices across countries, and developing innovative strategies to close treatment and retention gaps. It aligns with the priorities of the Global Alliance to End AIDS in Children by 2030, which focuses on preventing new infections in pregnant and breastfeeding women, ensuring continuous treatment for pregnant and breastfeeding women with HIV and early testing for infants.

“The impact we want to have is to help countries adopt new tools and approaches to reach women with early access to VTP services and those at risk of disengaging from care,” explained Peter Preko, MBChB, MPH, CQUIN project director & principal investigator, during the HIVE launch in December. “This includes women who are not on antiretroviral therapy or virally unsuppressed, those not engaged in vertical transmission prevention services, those who need antiretroviral therapy, and women who need prevention services such as pre-exposure prophylaxis (PrEP) in order to stay free of HIV throughout pregnancy and breastfeeding.”

At the heart of HIVE’s approach is collaboration—a dynamic partnership between ICAP at Columbia University and Pediatric-Adolescent Treatment Africa (PATA) drives the project. Drawing from the success of ICAP’s HIV Coverage, Quality, and Impact Network (CQUIN), which has improved HIV service delivery across 21 countries, HIVE aims to build upon existing health systems to efficiently scale up impactful interventions.

“We have seen many countries flatlining. We’ve also seen a huge difference between regions within our continent,” expressed Luann Hatane, MDS, PATA executive director. “So, really, the coming together of two network experts—ICAP with CQUIN and PATA—is to really prioritize and catalyze a refocus on the prevention of vertical transmission.”

Watch the launch video to hear some of thoughts by participants on the launch’s impact and the potential for cross-country learning and innovation.

From Vision to Reality: The Journey to Launch

Months of groundwork laid the foundation for HIVE’s official launch in Johannesburg, South Africa, from December 4 to 6, 2024. But the journey began long before the launch meeting.

The project kicked off with a virtual meeting on August 5, 2024, where key stakeholders aligned on HIVE’s mission and objectives. Discussions focused on:

• Urgency of addressing stalled progress in eliminating vertical transmission elimination
• Leveraging existing HIV programs like CQUIN to accelerate impact
• Introducing the concept of a Capability Maturity Model (CMM) to identify health systems and implementation gaps and to track country progress
• Establishing a timeline for baseline country visits, piloting of the CMM, and rapid initiation of interventions

Between August and October 2024, the HIVE project team embarked on baseline visits to the six participating countries. These visits provided an opportunity to engage with Ministries of Health, PEPFAR agencies, UN agencies, implementing partners, and health care providers to introduce the project and to establish relationships with key stakeholders, assess country-specific needs, challenges, and best practices in preventing vertical transmission, as well as map out potential collaborations and resource-sharing to enhance program implementation.

Among the most valuable aspects of these baseline visits were tours of health facilities, where teams observed HIV vertical transmission prevention initiatives and best practices in action. From triple elimination testing points to the integration of vertical transmission prevention with other maternal and child health services, these facility visits provided invaluable insights into how maternal and child HIV prevention programs were being implemented. The visits ended in strategic debriefing sessions, where country teams reflected on key takeaways, identified gaps, and outlined the next steps to ensure a seamless roll-out of the HIVE project.

One of HIVE’s most powerful tools is the Capability Maturity Model (CMM), a structured framework that helps countries assess their progress in eliminating vertical transmission of HIV. By October 2024, all six participating countries had piloted the CMM and made input into the development the final CMM toolkit. All countries then used the final co-created tool to conduct their baseline VTE CMM self-assessment.

Franklin Emerenini, MBBS, MSc, FMCPaed, HIVE deputy director, reflected on this milestone, saying, “We are happy to have been able to pull through this stage—developing the Capability Maturity Model and supporting countries in assessing their programs. We now have an objective assessment of where they are and what needs improvement. The next phase will focus on supporting countries to implement their action plans informed by the gaps in their CMM results.”

The launch of HIVE was more than just a meeting.  It was a pivotal moment in the fight against vertical transmission of HIV.  Through cross-country collaboration, data-driven strategies, and technical expertise, HIVE will partner with member countries to accelerate progress toward the elimination of vertical transmission. With strong partnerships, continuous exchange of knowledge, and targeted interventions, the vision is clear: every mother with HIV must receive the care she needs, and every child should be born HIV-free.

Stay tuned for updates on HIVE’s impact in the months ahead.