Background Despite substantial global progress in HIV prevention and treatment, mother-to-child transmission (MTCT) of HIV remains a major public health challenge in sub-Saharan Africa, which accounts for approximately 65% of the world’s 39.9 million people living with HIV. Vertical transmission rates vary substantially across regions and over time. We conducted a systematic review and meta-analysis to estimate the overall, temporal, regional, and country level prevalence of HIV MTCT in sub-Saharan Africa. Methods This research was conducted between June 2024 and May 2025, in accordance with PRISMA guidelines and a protocol registered in PROSPERO (CRD42025637989). We systematically searched six databases (MEDLINE, Embase, PubMed, ScienceDirect, Web of Science, and the Cochrane Library) for articles published in English or French. We included cross-sectional, cohort, and case-control studies involving HIV-positive pregnant women aged ≥18 years that reported MTCT prevalence. Two reviewers independently screened, extracted data, and assessed study quality (Joanna Briggs Institute and Newcastle-Ottawa Scale). Pooled prevalence and 95% CI were calculated using a random-effects model in STATA 17. Heterogeneity (I 2 ), subgroup analyses (by period, region, country), sensitivity analysis, and funnel plots for publication bias were performed. Results From 5,848 records, 48 studies (86,376 mothers; 2,875,104 infants) across 15 countries were included. The pooled MTCT prevalence was 7.0% (95% CI 5.2–9.4%; I 2 = 99.1%). Temporal trends showed a decline from 26.0% (1993–2000) to 8.0% (2001–2010) and 5.0% (2011–2023). Regionally, West Africa had the highest prevalence (12.1%; 95% CI 6.5–21.6%), Southern Africa had the lowest (4.7%; 95% CI 2.6–8.1%). Approximately 9% of HIV-exposed infants were infected by 24–48 months, 6% were infected by 24 months after enrolment, and 7% tested positive at their first HIV test conducted between 1 and 12 weeks of age. Conclusion Although MTCT rates have declined, the current 7.0% remains above the WHO target (<5%) with noted significant regional and national disparities. However, this rate should be interpreted cautiously due to the extremely high heterogeneity (I 2 = 99.1%) knowing it’s a directional synthesis of available evidence rather than a precise population-level figure.
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