ArticlePLOS global public health2026
Evaluation of Sierra Leone's Elimination of Mother-to-Child Transmission of HIV program, 2024: The need for a Life Stages approach to triple elimination.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- High screening coverage and positivity rates of HIV, syphilis, and hepatitis B among pregnant women accessing antenatal care in Sierra Leone.Public health action · 2026Article
- Retention of pregnant women living with HIV across health care levels in Sierra Leone.Public health action · 2026Article
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Authors and funding
23 authors.
Funding
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Abstract
The elimination of Mother-to-Child Transmission (eMTCT) Cascade Analysis is a key intervention to understand the effectiveness and gaps in national HIV prevention program for pregnant women and their infants. This comprehensive evaluation aimed to assess the step-by-step processes of eMTCT services, from the entry points at antenatal care (ANC) to outcomes for HIV-exposed infants (HEIs) and propose actionable recommendations using the life stages approach to improve maternal and child health outcomes in Sierra Leone.We used a retrospective cohort study to understand the entry of HIV-positive pregnant women into the eMTCT program and the outcome of their infants. The assessment was conducted in June 2024 across 118 selected health facilities nationwide. Data was analysed using Microsoft Excel to assess the steps from entry into the eMTCT program to HIV testing outcomes and delivery process for infants, including final infant/child outcome for HIV-positive pregnant and breastfeeding women.Of the 80,264 pregnant women attending their first ANC visit between January and December 2022, 74,401(92.7%) received HIV tests. Of the 2,083 newly diagnosed HIV-positive pregnant women, 1,612 (77.4%) were initiated on antiretroviral therapy (ART) at their first ANC visit, highlighting a critical gap where 22.6% missed early treatment initiation. Only 753 (36.1%) HIV-positive women had documented facility-based delivery, indicating significant drop-offs in retention and continuity of care. Among 761 HEIs, 671 (88.2%) received ART for prophylaxis within 72 hours of birth; however, only 466 (61.2%) underwent their first virological test within 6-8 weeks of birth, and 176 (24.1%) received a second virological test 12 weeks after cessation of breastfeeding. While Sierra Leone's eMTCT program has made substantial progress in ANC attendance and HIV testing, critical gaps persist in ART initiation, facility delivery of HIV-positive women and retention in care. Adopting a life stage approach is critical to address these gaps through targeted interventions, improved data quality, and enhanced follow-up care.
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