At-scale evidence from 26 national household surveys on the prevention of mother-to-child transmission of HIV cascade.

Prevention of mother-to-child transmission of HIV (PMTCT) can virtually eliminate vertical HIV transmission, yet more than 160 000 children were newly infected with HIV in 2016. We conducted a pooled analysis of national household surveys from 26 sub-Saharan African countries and calculated PMTCT coverage and access using unconditional and conditional likelihoods. Logistic regression analysis adjusted for country of residence was used to measure the association between socio-demographic factors and PMTCT coverage. The largest loss in the PMTCT cascade access occurred at being offered a HIV test at an antenatal care (ANC) clinic visit, with only 62.6% of women visiting an ANC clinic being offered a HIV test. Logistic regression analysis adjusted for country of residence indicated that completing primary school was associated with a higher likelihood of completing each step in the PMTCT cascade, including being offered a HIV test [odds ratio 2.18 (95% CI: 2.09-2.26)]. Urban residence was associated with a higher likelihood of completing each step in the PMTCT cascade, including being offered a HIV test [odds ratio 2.23 (95% CI: 2.15-2.30)]. To increase progression through the PMTCT cascade, policy-makers should target the likelihood an ANC client is offered a HIV test and the likelihood of facility delivery, steps where access is the lowest. Low educational attainment women and women in rural areas appear to have the lowest coverage in the cascade, suggesting that policy-makers target these individuals.