By Michael Gwarisa
Zimbabwe’s ambition to eliminate mother-to-child transmission (EMTCT) of HIV, syphilis and hepatitis B is under growing threat as rising adolescent pregnancies and declining antenatal care (ANC) attendance undermine progress towards meeting World Health Organisation (WHO) validation targets.
Although the country has made remarkable gains in preventing babies from acquiring HIV and congenital syphilis, health officials say increasing numbers of teenage mothers, coupled with late ANC booking and gaps in hepatitis B prevention, are slowing Zimbabwe’s march towards becoming one of the few countries in the world to achieve WHO validation for triple elimination.
Speaking while officiating at the National Validation Committee Meeting for the Triple Elimination of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B in Harare, Minister of Health and Child Care Dr Douglas Mombeshora said Zimbabwe had made commendable progress but warned that major challenges remain.
“Our elimination of Mother-to-Child Transmission programme has become one of the cornerstones of Zimbabwe’s HIV response,” said Dr Mombeshora.
“In 2025, maternal antiretroviral therapy coverage reached 92 percent while mother-to-child transmission of HIV declined to 6.45 percent. While this is commendable, more still needs to be done to attain maternal ART coverage of 95 percent or more and reduce mother-to-child transmission of HIV to less than five percent.”
Dr Mombeshora said Zimbabwe had successfully integrated HIV, syphilis and hepatitis B services into routine maternal and child health care, resulting in significant reductions in new paediatric HIV infections and positioning the country among Africa’s leading performers in preventing congenital syphilis.
However, he warned that the country’s biggest obstacle is no longer HIV testing or treatment, but ensuring women access antenatal care early enough to benefit from available services.
“Our data shows us that more and more teen mothers are booking for ANC, exposing the scourge of teenage pregnancies and child marriages leading to school dropouts,” he said.
“In fact, our Achilles heel in the triple EMTCT agenda is the low ANC booking rate, which is standing at 85 percent, not least because of user fees and other structural barriers.”
The minister called for innovative financing mechanisms, including scaling up maternal health voucher programmes, to encourage early ANC attendance and institutional deliveries.
The concerns were echoed by Dr Angela Mushavi, National Prevention of Mother-to-Child Transmission and Paediatric HIV Care and Treatment Coordinator in the Ministry of Health and Child Care, who presented Zimbabwe’s latest EMTCT performance.
She revealed that more than half of all women seeking antenatal care are adolescents and young women, highlighting a worrying trend that threatens to reverse years of progress.
Between January and December 2025, Zimbabwe recorded 1,732 pregnancies among girls aged 10 to 14 years, 97,189 among those aged 15 to 19 years and 129,441 among young women aged 20 to 24 years.
“In our data, 51 percent of ANC attendance is among adolescent girls and young women. This is really worrying because some of them are very young and have had to drop out of school because they are pregnant,” said Dr Mushavi.
She said while HIV testing during pregnancy remains exceptionally high at 99 percent and syphilis testing reached 95 percent, the country continues to fall short of WHO’s Gold Tier validation targets, which require at least 95 percent coverage for antenatal care, HIV and syphilis testing and treatment, alongside a vertical HIV transmission rate below five percent.
Zimbabwe’s current HIV transmission rate at the end of the breastfeeding period stands at 6.48 percent.
Children also remain disproportionately affected by treatment gaps, with paediatric antiretroviral therapy coverage at just 53 percent.
Dr Mushavi said hepatitis B remains the weakest component of Zimbabwe’s triple elimination programme.
Hepatitis B testing coverage among pregnant women stood at just 22 percent during the first quarter of 2026, although treatment coverage had improved to 87 percent from 82 percent in 2025.
She said Zimbabwe is finalising a new Triple EMTCT Strategic Plan for 2027 to 2030 with support from UNAIDS, UNICEF, WHO and the National AIDS Council to accelerate progress towards elimination.
UNICEF Deputy Representative Fiachra McAsey applauded Zimbabwe for reducing mother-to-child HIV transmission from 8.22 percent in 2022 to an estimated 6.21 percent in 2025 but cautioned that the country remains above the global elimination threshold.
“The journey is not yet complete,” said McAsey.
“Most new paediatric HIV infections occur among women who are diagnosed late, are not initiated on treatment, are lost to follow-up or acquire HIV during pregnancy or breastfeeding. These are preventable missed opportunities.”
He said strengthening early ANC attendance, ensuring uninterrupted treatment and placing adolescent girls and young women at the centre of HIV prevention efforts would be critical to achieving validation.
“High rates of adolescent pregnancy further increase the risk of HIV transmission to infants. Investing in integrated HIV prevention, sexual and reproductive health, maternal health and social support services for adolescent girls is fundamental to ending AIDS in children.”
UNAIDS Country Director Trouble Chikoko said Zimbabwe’s aspiration to attain WHO Gold Tier validation was both legitimate and achievable but stressed that success would require more than strong HIV programme performance.
“Validation will not be achieved through HIV programme performance alone,” he said. “It will require strong evidence, quality EMTCT services and sustained outcomes across HIV, syphilis and hepatitis B.”
He urged Zimbabwe to prioritise hepatitis B testing and treatment, strengthen retention of women on HIV treatment, improve viral suppression, promote male involvement in maternal health services and invest more in community health workers and peer supporters to improve early ANC booking and treatment adherence.
WHO Representative to Zimbabwe Dr Desta Tiruneh said Zimbabwe had positioned itself among the continent’s leaders by becoming one of the earliest countries to adopt a comprehensive triple elimination strategy.
Globally, only 24 countries have achieved validation for eliminating one or two of the infections, while only the Maldives has been validated for eliminating all three.
Dr Tiruneh said hepatitis B now represents the greatest remaining challenge. He urged Zimbabwe to urgently introduce the hepatitis B birth-dose vaccine, describing it as the single most effective intervention for preventing newborn infections.
“The hepatitis B elimination targets and the triple elimination targets cannot be achieved without implementation of the hepatitis B birth dose,” he said.
“The long-term health and economic benefits of preventing liver cancer and cirrhosis far outweigh the initial investment.”
Despite the challenges, speakers remained optimistic that Zimbabwe is within reach of international validation if it sustains political commitment, strengthens integrated maternal health services, removes barriers to antenatal care and addresses the growing burden of adolescent pregnancies. For health officials, the message from the validation meeting was clear: Zimbabwe has built one of Africa’s strongest EMTCT programmes, but unless adolescent pregnancies decline and more women access antenatal care early, the country’s goal of ensuring every child is born free from HIV, syphilis and hepatitis B will remain just out of reach.
