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Background: Despite significant progress made, coverage of PMTCT interventions in some priority countries was still below that needed to reach the goal for elimination of new HIV infections among children. In some of the countries, many women are still not reached and, when reached, retention in care is poor. Overall, low performing countries are characterized by persistent regional disparities in geographic coverage of PMTCT services due to system constraints.
Methods: Country data from UNAIDS 2014 estimates and 2015 Global AIDS Response Progress Reporting were analysed over time to determine trends, unmet need and future forecasts intervention performance. . In-country assessments and bottleneck analyses were conducted to supplement and corroborate national findings and determine geographic disparities within countries.
Results: In 2014, 73% of 1.5 million pregnant women living with HIV in low- and middle-income countries (LMICs) received the effective PMTCT ARVs compared to 77% in the 21 priority countries in SSA. At this rate of scale-up, however, the 90% PMTCT HIV treatment target by 2015 may be achieved in 2017. There were 220,000 new HIV infections among children in 2014 globally; nearly a 60% reduction since 2000, 24% reduction between2000-2009 and 45% between 2009-2014. At this rate of decline, the 90% decline 2015 target may not be achieved until 2029. Between 2000 and 2014, an estimated 1.3 million new HIV infections were averted by PMTCT LMICs. Of the 220,000 new child HIV infectionsglobally in 2014, 50% were in 6 countries (Nigeria, Kenya, India, Malawi, Uganda and South Africa). Since 2000 there has been a shift in the countries contributing to 50% of new infections, except for Nigeria. Bottleneck analyses conducted show that slow progress is associated with policy and systemic factors weak human resource capacity and policies that do not support task shifting, inadequate supervision of staff, poor quality of services, including laboratory capacity; weak referral and follow-up care systems, inadequate community engagement and supply chain constraints.
Conclusions: Despite the progress in PMTCT, many children continue to be infected. Addressing the remaining policy and systemic factors is needed to meet the new Fast Track global 90 90 90 2020 treatment to end AIDS among children.

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