ISGlobal | Barcelona Institute for GlobalHealth


Initiatives: Maternal, Child and Reproductive Health

Research Programmes: Maternal, Child and Reproductive Health | HIV/AIDS and Tuberculosis

  • Duration:
    09/2017 - 08/2019
  • Coordinator:
    Denise Naniche
  • Funded by:
    PEPFAR, Centers for Disease Control and Prevention

Measuring community prevalence among HIV exposed children in rural Southern Mozambique


Mozambique’s national prevention of mother to child transmission of HIV (PMTCT) program was established in 2002 and rapidly expanded. In June 2013, the Ministry of Health launched WHO Option B+, which offers antiretroviral treatment for life to all HIV positive pregnant women. By the end of 2014, 742 health units were offering B+ out of 1272 health facilities offering PMTCT services.

In light of these efforts, Mozambique has achieved a rapid reduction in new child HIV infections, from 27,000 in 2009 to 12,000 in 2013. UNAIDS estimates that the country’s MTCT rate has decreased from 26% in 2009 to 12% in 2013. However, reliable measures of final MTCT rates after breastfeeding cessation are not available. Obtaining this information is challenging due to low retention in the PMTCT cascade. Also, though prolonged breastfeeding is common in Mozambique, we have no reliable information on duration of breastfeeding among HIV-exposed infants and children. 

In order to begin assessing the impact of PMTCT efforts to date and obtain baseline information for further improvement of PMTCT programs, a programmatic evaluation to measure community HIV prevalence among HIV-exposed children after cessation of breastfeeding is urgently needed in Mozambique.


The main objective of the METRO study is to estimate the prevalence of HIV in exposed children under 4 years of age in the community, after cessation of breastfeeding, in Southern rural Mozambique in the period between 2012 and 2016.

More specifically, the project aims:

  • To describe characteristics linked with child HIV exposure and HIV vertical transmission
  • To estimate the duration of breastfeeding in the population of Manhiça district and to describe demographic, health, economic, and socio-cultural, characteristics of breastfeeding women
  • To estimate mortality among HIV-positive mothers and HIV-exposed children

The project takes place within a demographic surveillance platform in Manhiça and offers testing and counseling to women and their children, identifying children exposed to HIV 48 months or younger.


The results obtained from this study will provide baseline data at subnational level that can later be used to estimate trends; and also used to initiate the elimination of mother-to-child transmission (EMTCT) pre-validation process according to WHO criteria. Furthermore it will be used to inform planning of national PMTCT program activities including potential community outreach programs, among other applications.  

Total funding

300,000 USD