HIV testing in pregnant women
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— either as lifelong therapy or as prophylaxis—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: programme records, such as antenatal care registers or labour and delivery registers. Some people pick up several months of antiretroviral medicine at one visit. If the duration of the medicine picked up covers the last month of the reporting period, these people should still be counted as receiving antiretroviral therapy (as opposed to having stopped treatment).
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 or more frequently, depending on a country’s monitoring needs
- Known (positive) HIV infection at antenatal clinic entry.
- Tested HIV-positive at first antenatal care during current pregnancy, labour and/or delivery. This excludes women who already knew their HIV-positive status prior to current pregnancy.
- Tested HIV- negative at first antenatal care during current pregnancy, labour and/or delivery. This should be based on the latest test result in the case of repeat testing.
The sum of the above three counts should equal the number of women tested for HIV. The total identified HIV-positive women should equal the sum of known HIV-positive women at their first antenatal clinic entry plus those who tested HIV-positive at antenatal care during pregnancy, labour and/or delivery.
- Pregnant women who inject drugs.
Look at trends over time: if disaggregated data is available by region, see whether any lower performing areas can be identified. Review if data are available on the percentage of antenatal care attendees who know their status, including those with previously confirmed HIV status and those tested and the percentage of labour and delivery attendees who know their status.
This indicator enables a country to monitor trends in HIV testing among pregnant women. The points at which dropouts 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 also does not capture the number of women who received pre-test counselling.
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...).