{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T02:01:59Z","timestamp":1784512919195,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Sustained maternal HIV viral-load (VL) suppression during breastfeeding is essential for eliminating vertical HIV transmission in Sub-Saharan Africa. Although vertical transmission prevention programmes have improved antiretroviral therapy coverage and peripartum outcomes, viral control may deteriorate after delivery. This decline may result from psychosocial stressors, fragmented mother\u2013infant services, and delayed return of results. This review examines post-delivery VL dynamics, breastfeeding-associated transmission risk, and the limitations of binary suppression thresholds. We suggest that post-delivery VL monitoring should be implemented as a rapid-action pathway. In this approach, detectable viraemia during breastfeeding should prompt a timely reassessment of adherence and repeat VL testing. Regimen review and additional measures to reduce the risks for both the mother and infant should be implemented where indicated. We also examine the individual, relational, structural, and health system determinants of post-delivery viraemia and lost to follow-up, including intimate partner violence. Finally, we highlight service delivery innovations that may improve maternal VL suppression and HIV-free infant survival rates.<\/jats:p>","DOI":"10.3390\/tropicalmed11070202","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:47:32Z","timestamp":1784508452000},"page":"202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimising Post-Delivery Viral Load Monitoring and HIV Care to Eliminate Breastfeeding-Associated HIV Transmission in Sub-Saharan Africa: A Review"],"prefix":"10.3390","volume":"11","author":[{"given":"Joycelyn A.","family":"Dame","sequence":"first","affiliation":[{"name":"Department of Child Health, University of Ghana Medical School, College of Health Sciences, Accra P.O. Box 4236, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4473-4298","authenticated-orcid":false,"given":"Yemah","family":"Bockarie","sequence":"additional","affiliation":[{"name":"Department of Child Health, Cape Coast Teaching Hospital, Cape Coast P.O. Box CT 136, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5123-7086","authenticated-orcid":false,"given":"Adraina N. M.","family":"Asante","sequence":"additional","affiliation":[{"name":"Department of Child Health, Greater Accra Regional Hospital, Accra P.O. Box GP 473, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6521-3400","authenticated-orcid":false,"given":"Anthony","family":"Enimil","sequence":"additional","affiliation":[{"name":"Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi P.O. Box 1934, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"ref_1","unstructured":"(2026, June 22). UNAIDS DATA 2024. Geneva: Joint United Nations Programme on HIV\/AIDS. Available online: https:\/\/www.unaids.org\/en\/resources\/documents\/2024\/2024_unaids_data."},{"key":"ref_2","unstructured":"World Health Organization (2026, June 12). Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240031593."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/QAI.0000000000002744","article-title":"Association of maternal viral load and CD4 count with perinatal HIV-1 transmission risk during breastfeeding in the PROMISE postpartum component","volume":"88","author":"Flynn","year":"2021","journal-title":"J. Acquir. 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