Elimination of mother to child transmission of HIV in Africa using health system lessons from Brazil

Mother-to-child transmission of HIV (MTCT) remains a major driver of pediatric HIV infections in sub-Saharan Africa, which accounts for over 80% of new global infections among children under 15 years, despite the availability of highly effective prevention strategies. While substantial progress has been achieved, elimination of mother-to-child transmission (EMTCT) outcomes across Africa remains uneven, reflecting persistent health system weaknesses, social and gender-related barriers, and fragmented service delivery. Brazil’s 2025 World Health Organization (WHO) validation for the EMTCT of HIV demonstrates that sustained reductions in vertical transmission below 2% are achievable through integrated, rights-based, and system-wide approaches. Brazil’s success was underpinned by universal antenatal care coverage, routine opt-out HIV testing, immediate initiation of lifelong antiretroviral therapy, integrated maternal–child health services, strong legal and political commitment, and robust monitoring systems. However, persistent equity gaps in Brazil highlight the need for deliberate, rights-based social policies alongside biomedical interventions. For Africa, accelerating progress toward EMTCT will require integrated maternal and child health platforms, strengthened primary health care systems, reliable supply chains, community co-engagement, and data-driven governance, supported by sustained political and financial commitment. Applying these lessons offers a pragmatic pathway to eliminating pediatric HIV while advancing health system equity.