Eliminating Parent-to-Child HIV Transmission in Rural Sindh: A Case Series from a Low-resource Setting at CDC HIV Treatment Centre, Nawab Shah

Background: Preventing parent to child transmission of HIV remains a priority in resource limited settings. We report outcomes of 29 HIV positive women managed at the CDC HIV Treatment Centre, Peoples Medical College Hospital Nawab shah, Shaheed Benazir Abad. All women delivered while maternal viral load was undetectable or not detected. Parent-to-child transmission of HIV remains a health challenge in rural districts of Pakistan where access to viral load monitoring, consistent antiretroviral therapy (ART), and structured delivery services is often limited. This case series documents outcomes from a rural ART Centre in Sindh. Methods: This is a descriptive case series of consecutive pregnant women who received antenatal care, ART, and delivery care at the treatment center. Interventions included maternal ART, viral load monitoring, adherence support, infant prophylaxis, early infant diagnosis, and feeding counselling. Primary outcome was infant HIV status. Secondary outcomes included mode of delivery, maternal adherence, and programmatic lessons. From January 2024 to December 2025, 29 HIV-positive pregnant women were enrolled at the CDC HIV Treatment Centre, Peoples Medical College Hospital, Nawab shah. All mothers were provided ART and monitored for viral load suppression before delivery. Infant HIV testing was conducted at 6 weeks, 9 months, and 16 months using viral load testing. Results: Between the study period, 29 HIV positive women delivered under care at the center with maternal viral load reported as negative or not detected at the time of delivery. All 29 infants were HIV negative on early infant diagnosis. No case of vertical transmission was detected. All 29 mothers achieved undetectable viral load at the time of delivery. Each infant received prophylaxis according to national protocols. All infants tested HIV-negative at 6 weeks, 9 months, and 16 months. There were no cases of loss to follow-up or infant mortality related to HIV. Conclusions: In this rural setting, a focused PMTCT program achieved zero detected vertical transmissions among 29 consecutive deliveries where mothers had undetectable viral load at delivery. These results show that standard PMTCT interventions can be effective when delivered consistently, even with limited resources. This research is all based on rural area Pakistan in Sindh province. This case series demonstrates that complete prevention of parent-to-child transmission of HIV is possible in a low-resource rural setting when viral suppression and structured follow-up are ensured. The findings provide a practical model for replication in Pakistan and similar contexts.