How a Data-Driven Approach is Strengthening Health Systems and Accelerating the Fight Against HIV Vertical Transmission

The VTE Capability Maturity Model (CMM) is a powerful health systems strengthening tool that helps countries assess their progress in eliminating vertical transmission of HIV. It evaluates a country’s performance across various domains, each addressing a critical aspect of HIV prevention, care and treatment cascade. These domains range from testing policies and treatment guidelines to the effectiveness of community engagement, and the strength of monitoring and evaluation systems.

By using the VTE CMM, countries can pinpoint areas where their programs are performing well and identify gaps that need attention. For example, while a country might have high testing coverage for pregnant women, it might find that retention in care for infants exposed to HIV is lower than expected. This insight allows countries to design targeted interventions that address these specific challenges, with the goal of ultimately making their programs more effective and mature over time, with sustained impact.

Another key benefit of the CMM is that it fosters collaboration and consensus-building country stakeholders. The self-assessment process involves a diverse range of participants — government officials, health professionals, implementing partners and community representatives. This inclusive approach ensures that all parties are aligned, have buy-in and that resources are allocated where they are most needed. The result is a stronger collective commitment to the goal of eliminating vertical transmission and improving overall health outcomes.

Beyond reducing vertical transmission, the VTE CMM aims to strengthen the health systems that support these efforts. By identifying gaps and weaknesses in VTP programs, it helps countries address broader health system challenges. This ensures that the infrastructure needed to prevent vertical transmission is sustainable and capable of delivering high-quality care for years to come.

The 26 Domains of the HIVE CMM

The VTE CMM consists of 26 domains, each targeting a different aspect of health systems. These domains are divided into two categories: enabling domains and outcome domains.

Enabling domains are the foundational elements (health system related issues) that ensure the success of vertical transmission elimination efforts. These include availability of policies/guidelines in line with international normative guidelines in various areas such as HIV testing at key points (antenatal, labor & delivery, postnatal/breastfeeding), HIV testing for infants exposed to HIV, prevention methods like pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women (PBFW), postnatal prophylaxis for infants, viral load monitoring, and differentiated ART services. Other enabling domains focus on operational guidance, national scale up plans for differentiated service delivery (DSD) for (PBFW, coordination, community engagement, training, monitoring and evaluation (M&E) systems, procurement and stock management. Outcome domains, on the other hand, measure the direct results of these efforts. These include indicators such as health facility coverage for DSD for PBFW, HIV testing and treatment coverage, timely linkage to treatment, continuity of treatment and retention in care for PBFW and infants exposed to HIV, and the overall impact of vertical transmission services. These outcome indicators provide a clear picture of how well the health system is performing and where improvements are needed.

How the VTE CMM Works

The process of using the VTE CMM begins with relevant country stakeholders meeting to conduct a country self-assessment in a participatory, evidence-based process.  Led by MOH, the stakeholders assign a maturity stage to each of the 26 domains using a staging questionnaire supported by a set of standard operation procedures on how the self-assessment should be conducted. The set of guiding questions for each domain offers a structured and objective review of progress in the prevention of vertical transmission of HIV. To settle on a score, there must be evidence from national level country data and relevant supporting documents.

Once the questionnaire is completed, each domain is color-coded according to its maturity stage. This color-coding provides a visual representation of the current state of each domain, making it easy for countries to identify areas of strength and those that require further attention.

Red indicates early or preliminary stages of planning and development. It is useful to identify the next steps to take in the scale-up process. Orange indicates that work has begun, and the initial efforts are ongoing. It also highlights areas that can be prioritized for improvement. Yellow indicates that efforts have resulted in measurable progress, such as a draft review or achievement of more than twenty-five percent progress towards a target. Light green indicates that considerable progress has been made, resulting in over 50 percent to a target or working systems in need only of finalization. And lastly, dark green indicates the achievement of a highly evolved implementation of the domain and that further improvements and refinements can be made as needed.

Based on the results, countries can then develop post-staging action plans that specifically address the identified gaps, helping them focus their efforts on the areas that will drive the most progress.

The Capability Maturity Model is not just a tool for assessment, it is a catalyst for change. It provides a clear, data-driven approach to building stronger, more resilient health systems, ensuring that countries are on the right path to eliminating vertical transmission. Ultimately, the VTE CMM brings us one step closer to a world where no child is born with HIV.