HIV testing in pregnant women
Export Indicator
Coverage of the first step in the prevention of vertical transmission cascade. High coverage enables early initiation of care and treatment for HIV-positive mothers. The total number of identified HIV-positive women provides the facility-specific number of pregnant women with HIV to start a facility-based prevention of vertical transmission cascade.
The risk of vertical transmission can be reduced significantly by: (a) providing antiretroviral medicines for the mother during pregnancy and delivery; (b) supplying antiretroviral prophylaxis for the infant and antiretroviral medicines for the mother or child during breastfeeding (if applicable); (c) instigating safe delivery practices and safer infant feeding.
Data will be used in the following ways: (a) to track progress towards global and national goals of eliminating vertical transmission; (b) to inform policy and strategic planning; (c) to contribute to advocacy efforts; and (d) to leverage resources for accelerated scale-up. It will help measure trends in coverage of antiretroviral prophylaxis and treatment, and when disaggregated by regimen type, will assess progress in implementing more effective regimens and antiretroviral therapy.
Number of pregnant women attending antenatal clinics and/or giving birth at a facility who were tested for HIV during pregnancy, at labour and/or delivery, or those who already knew they were HIV-positive at the first antenatal care visit.
Population-based denominator: Number of pregnant women giving birth in the past 12 months.
Programme-based denominator: Number of pregnant women who attended an antenatal clinic or gave birth at a facility in the past 12 months.
Numerator/denominator
Numerator: programme records, such as antenatal care registers or labour and delivery registers.
Population-based denominator: estimates from central statistics office, UN Population Division or vital statistics.
Facility-based denominator: programme records, such as antenatal care registers or labour and delivery registers
Annual
- Known (positive) HIV infection at first antenatal care visit (i.e. before their current pregnancy).
- Tested positive for HIV at first antenatal care visit during their current pregnancy, labour and/or delivery. This excludes women who already knew their HIV-positive status before their current pregnancy.
- Tested negative for HIV at first antenatal care visit during their current pregnancy, labour and/or delivery. This should be based on the latest test result in the case of repeat testing.
These three counts sum to the number of women with HIV status ascertained in their current pregnancy. The number of women known to be living with HIV at their first antenatal care entry plus the number of women who tested positive for HIV for the first time during antenatal care during their current pregnancy (whether in antenatal care or during labour and/or delivery) represents the total number of women identified as living with HIV.
If data are available, an additional disaggregation for pregnant women who inject drugs is recommended at the national level.
None.
This indicator enables a country to monitor trends in HIV testing among pregnant women. The points at which dropouts may occur during the testing and counselling process—and the reasons why they occur—are not captured by this indicator. This indicator does not measure the quality of the testing or counselling. It does not capture the number of women who received pre-test counselling.
Within the Spectrum platform to estimate the national epidemic and other testing- and treatment-related GAM indicators, counts of pregnant women living with HIV recorded in antenatal clinics are also used to validate and align with entries for women who received prevention for vertical transmission. Specifically, in principle, for every year with data:
- the number of women newly identified as living with HIV during their current pregnancy is expected to equal or be greater than the number of women who started lifelong antiretroviral therapy for prevention of vertical transmission (whether early or late in the current pregnancy);
- the number of women already known to be living with HIV before their current pregnancy (before their first antenatal care visit) is expected to equal or be greater than the number of women on antiretroviral therapy for prevention of vertical transmission since before their current pregnancy.
If the number of women living with HIV is greater than the respective subset of entries for antiretroviral therapy and prevention of vertical transmission, this is accepted if explained by dropout. In contrast, if the number of HIV-positive entries is below the respective subset of entries for antiretroviral therapy and prevention of vertical transmission, this indicates a problem in either set of entries and must be reconciled for Spectrum to produce a valid estimate of coverage of prevention of vertical transmission.
Criteria for assessing the quality and national adequate antenatal care attendance and HIV testing data are detailed in the Guide for Updating Spectrum HIV Estimates.
Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis. Second edition. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/handle/10665/259517/9789241513272-eng...).