In The Lancet HIV, Beth A Tippett Barr and colleagues present national estimates of early mother-to-child transmission (MTCT) of HIV and factors associated with early MTCT from the National Evaluation of Malawi’s Prevention of MTCT Program (NEMAPP) for the period 2014–16. Among HIV-exposed infants aged 4–12 weeks, the MTCT rate was 3·7% (95% CI 2·3–6·0) and consistent across all four subnational regions. A somewhat lower prevalence was observed among infants aged 4–7 weeks than among those aged 8–12 weeks (2·9% vs 5·2%; p=0·07). As expected, the mother’s antiretroviral therapy (ART) status during pregnancy was strongly associated with MTCT prevalence: it was 2·3% (95% CI 1·3–4·0) among those who were on ART during pregnancy compared with 19·6% (14·3–26·3) among those who were not on ART (p<0·0001