Investing in an HIV-Free Generation: A Cost Analysis to Strengthen Equity and Sustainability of PMTCT Services in Zimbabwe
1
Global, Public Health and Family Medicine, University of Zimbabwe, Harare, Zimbabwe
2
University of Zimbabwe, Harare, Zimbabwe
3
National Blood Service Zimbabwe, Harare, Zimbabwe
4
AIDS and TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
The elimination of Mother-to-Child Transmission of HIV (eMTCT) is a global health priority and a key to advancing gender equity and child survival. In Zimbabwe, progress is threatened by health system constrains which risk exacerbating inequities in access. This study aimed to provide policymakers with precise data on the resources required to deliver PMTCT and the consequences of system failure, to inform strategies doe sustainable, equitable scale-up.
METHODS:
A cross-sectional Time-Driven Activity-Based Costing (TDABC) analysis was conducted across ten health facilities in Zimbabwe, from clinics up to central hospitals. Data were collected on personnel, medicines and consumables, space and equipment, laboratory, and overheads. Process maps for PMTCT pathways were developed, and time equations were used to calculate unit costs per mother-baby pair. A counterfactual analysis estimated the long-term treatment costs if prevention fails.
RESULTS:
The full provider cost of guiding a mother-baby pair through the PMTCT cascade was $549. This investment is profoundly cost-saving as the first-year paediatric ART ($450.56) cost over twice maternal ART ($209.30), with lifetime treatment costs rising to $5210.78 for maternal seroconversion and $9 526.18 for infant infection. Every dollar invested in PMTCT averts $17 in future treatment costs. Key cost drivers were laboratory tests (42%) and medicines (28%). Costs were lowest at primary clinics ($160.84), suggesting that decentralised, community-based care is the most efficient model.However, deviations from guidelines due to stockouts and workload were common, creating inefficiencies and potentially compromising care quality.
CONCLUSIONS:
PMTCT is a clinically effective, foundational investment for sustainable health systems and intergenerational equity. To achieve eMTCT, Zimbabwe must decentralize services to primary care, strengthen supply chains for essential commodities for reliable and equitable service delivery and align national testing algorithms with rel-world reource constraints. These findings provide an evidence-based roadmap to support strategic investment in PMTCT for universal health coverage.
The elimination of Mother-to-Child Transmission of HIV (eMTCT) is a global health priority and a key to advancing gender equity and child survival. In Zimbabwe, progress is threatened by health system constrains which risk exacerbating inequities in access. This study aimed to provide policymakers with precise data on the resources required to deliver PMTCT and the consequences of system failure, to inform strategies doe sustainable, equitable scale-up.
METHODS:
A cross-sectional Time-Driven Activity-Based Costing (TDABC) analysis was conducted across ten health facilities in Zimbabwe, from clinics up to central hospitals. Data were collected on personnel, medicines and consumables, space and equipment, laboratory, and overheads. Process maps for PMTCT pathways were developed, and time equations were used to calculate unit costs per mother-baby pair. A counterfactual analysis estimated the long-term treatment costs if prevention fails.
RESULTS:
The full provider cost of guiding a mother-baby pair through the PMTCT cascade was $549. This investment is profoundly cost-saving as the first-year paediatric ART ($450.56) cost over twice maternal ART ($209.30), with lifetime treatment costs rising to $5210.78 for maternal seroconversion and $9 526.18 for infant infection. Every dollar invested in PMTCT averts $17 in future treatment costs. Key cost drivers were laboratory tests (42%) and medicines (28%). Costs were lowest at primary clinics ($160.84), suggesting that decentralised, community-based care is the most efficient model.However, deviations from guidelines due to stockouts and workload were common, creating inefficiencies and potentially compromising care quality.
CONCLUSIONS:
PMTCT is a clinically effective, foundational investment for sustainable health systems and intergenerational equity. To achieve eMTCT, Zimbabwe must decentralize services to primary care, strengthen supply chains for essential commodities for reliable and equitable service delivery and align national testing algorithms with rel-world reource constraints. These findings provide an evidence-based roadmap to support strategic investment in PMTCT for universal health coverage.
| eISSN: | 2654-1459 |
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