{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:58:41Z","timestamp":1792457921458,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Eliminating vertical HIV transmission remains a major public health priority, particularly in sub\u2010Saharan Africa (SSA), which accounted for 83% of global paediatric HIV acquistions in 2024. Despite expanded antiretroviral therapy (ART) coverage, gaps in maternal ART access, retention and HIV acquisition during pregnancy and breastfeeding continue to drive paediatric HIV acquisitions. Long\u2010acting injectable (LAI) lenacapavir pre\u2010exposure prophylaxis (PrEP) may reduce paediatric HIV acquisitions\u00a0by preventing maternal HIV acquisition. We evaluated drivers of vertical transmission in SSA and assessed the impact and cost\u2010effectiveness of LAI lenacapavir PrEP among pregnant and breastfeeding women (PBW) without HIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using 2025 UNAIDS estimates, Spectrum AIM and Naomi model outputs, we decomposed vertical HIV transmission pathways by maternal HIV acquisition timing and ART status. We modelled universal and geographically targeted rollout strategies using district\u2010level HIV incidence thresholds among women aged 15\u201349 years (\u22650.7%, \u22650.5% and \u22650.3%). Base\u2010case assumptions included 65% uptake, 70% retention over 2.2 years, drug costs of US$40 per person\u2010year plus a US$17 loading dose and service delivery costs of US$50 per person\u2010year. Upper\u2010bound scenarios and deterministic sensitivity analyses evaluated implementation uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2024, an estimated 98,000 new paediatric HIV acquisitions occurred in SSA. Lack of maternal ART access accounted for 46% of vertical transmissions, while ART discontinuation during pregnancy or breastfeeding contributed 19%. Maternal HIV acquisition during pregnancy or breastfeeding accounted for 25% of paediatric HIV acquisitions, reaching 59% in South Africa and 46% in Zambia. Under base\u2010case assumptions, universal LAI lenacapavir PrEP rollout averted approximately 56,100 HIV acquisitions at a net cost of US$85,200 per HIV acqusition\u00a0averted. Geographic targeting at \u22650.7% incidence was more cost\u2010effective, averting approximately 8450 acquisitions at a net cost of US$8530 per acquisition averted. Retention and service delivery costs were the primary determinants of cost\u2010effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gaps in maternal ART access and retention remain the dominant drivers of vertical HIV transmission in SSA, while maternal HIV acquisition contributes substantially in high\u2010incidence settings. Targeted LAI lenacapavir PrEP rollout among PBW without HIV could reduce maternal and paediatric HIV acquistions more efficiently than universal rollout, although outcomes remain highly sensitive to implementation conditions. LAI lenacapavir PrEP should complement strengthened maternal ART programmes, not replace them.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70127","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:19:30Z","timestamp":1781875170000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Drivers of Vertical HIV Transmission in Sub\u2010Saharan Africa and the Impact and Cost\u2010Effectiveness of Targeted and Universal Lenacapavir Pre\u2010Exposure Prophylaxis"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7105-9120","authenticated-orcid":false,"given":"Anna","family":"Yakusik","sequence":"first","affiliation":[{"name":"Data and Evidence Department Joint United Nations Programme on HIV\/AIDS  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalene K.","family":"Walters","sequence":"additional","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis, School of Public Health Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Mattur","sequence":"additional","affiliation":[{"name":"Sustainability Department Joint United Nations Programme on HIV\/AIDS  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savvy","family":"Brar","sequence":"additional","affiliation":[{"name":"Division of Data Analytics, Planning and Monitoring UNICEF  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2354-4580","authenticated-orcid":false,"given":"Leigh F.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Centre for Integrated Data and Epidemiological Research School of Public Health University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0439-381X","authenticated-orcid":false,"given":"Gesine","family":"Meyer\u2010Rath","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"The South African Department of Science and Innovation\/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA)  Stellenbosch South Africa"},{"name":"Department of Global Health Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise","family":"Jamieson","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Wits Health Consortium University of the Witwatersrand  Johannesburg South Africa"},{"name":"SACEMA Stellenbosch University  Stellenbosch South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Mushavi","sequence":"additional","affiliation":[{"name":"Ministry of Health and Child Care  Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Stover","sequence":"additional","affiliation":[{"name":"Center for Modelling Planning, and Policy Analysis Avenir Health  Glastonbury Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Mahy","sequence":"additional","affiliation":[{"name":"Data and Evidence Department Joint United Nations Programme on HIV\/AIDS  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Transforming Vision Into Reality: The 2024 Global Alliance Progress Report on Ending AIDS in Children by 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