Percentage of infants born to HIV-infected women who are started on cotrimoxazole prophylaxis within two months of birth

Export Indicator

Percentage of infants born to HIV-infected women initiated on cotrimoxazole prophylaxis within two months of birth.  
What it measures

This indicator measures the provision and coverage of co-trimoxazole prophylaxis for HIV-exposed infants in line with international guidelines . Co-trimoxazole prophylaxis is a simple, cost-effective intervention to prevent Pneumocystis carinii pneumonia in HIV-infected infants. This infection is the leading cause of serious respiratory disease in these infants in resource-constrained countries and often occurs before HIV infection can be diagnosed.

Rationale

Owing to resource and logistical constraints in diagnosing HIV infection in young infants, all infants born to HIV-infected women should receive cotrimoxazole prophylaxis, starting 4–6 weeks after birth and continuing until HIV infection has been excluded and the infant is no longer at risk of acquiring HIV through breastfeeding.

Countries may also wish to document the provision of co-trimoxazole for HIV-exposed infants older than 2 months in order to monitor the overall progress of the programme, to identify challenges in early initiation of cotrimoxazole and to monitor consumption of drug stocks from the point of view of procurement. Inappropriate management of supplies can negatively affect the value of the indicator and significantly reduce the access of HIV-exposed infants to cotrimoxazole. Countries should ensure that they have appropriate systems and tools, particularly for logistics management and information systems, in order to procure, distribute and manage supplies adequately at facility, district and central levels.

 

Numerator

Number of infants born to HIV-infected women in the last 12 months started on cotrimoxazole prophylaxis within two months of birth.
 

Denominator

Estimated number of HIV-infected pregnant women giving birth in the last 12 months. This is a proxy measure for the number of infants born to HIV-infected women.
 

Calculation

Number of infants born to HIV-infected women in the last 12 months who are
started on cotrimoxazole prophylaxis within two months of birth
------------------------------------------------------------------------------------------------------------------- x 100
Estimated number of HIV-infected pregnant women giving birth in the last 12 months

Method of measurement

Data for the numerator should be aggregated from the appropriate facility registers, which could include integrated Maternal and Child Health (MCH) registers, HIV-exposed infant follow-up registers, or pre-ART registers. The register used may vary depending on the country context. For example, where HIV-exposed infant follow-up takes place in the HIV care and treatment setting, countries may aggregate information either from a pre-ART register adapted for HIV-exposed infant follow-up or in a separate HIV-exposed infant register.
 
The denominator is generated by estimating the number of HIV-infected women who were pregnant in the last 12 months. This is based on HIV surveillance data from antenatal clinics, and estimates can be generated by:
using a projection model, such as Spectrum; or
multiplying:

The total number of women who gave birth in the last 12 months × The most recent national estimate of HIV prevalence in pregnant women
The total number of women who gave birth in the last 12 months can be obtained from the Central Statistics Office estimates of births or the UN Population Division estimates. The most recent national estimate of HIV prevalence in pregnant women can be derived from HIV sentinel surveillance data collected in antenatal clinics.

GFATM: The numerator is calculated from national programme records aggregated from facility registers. Data should be aggregated from the appropriate facility registers, such as a stand-alone or integrated HIV-exposed infant register. The register used may depend on where services are offered. For example, where HIV-exposed infants are followed by health workers in HIV care and treatment facilities, countries could aggregate information from a register based at that site. All public, private and nongovernmental organization-run health facilities that provide co-trimoxazole prophylaxis for HIV-exposed infants should be included.

Two methods can be used to estimate the denominator:

(a) a projection model such as that provided by Spectrum software; use the output “number of pregnant woman needing prevention of mother-to-child transmission of HIV” as a proxy; or
(b) multiply the total number of women who gave birth in the past 12 months (which can be obtained from central statistics offices or the United Nations Population Division or pregnancy registration systems with complete data) by the most recent national estimate of HIV prevalence in pregnant women (which can be derived from HIV sentinel surveillance in antenatal care clinic), if Spectrum projections are unavailable.

If there are data on the number of live births, they should be adjusted to derive a better proxy.

WHO: The numerator is calculated from national programme records aggregated from facility registers. Data should be aggregated from the appropriate facility registers, such as a stand-alone or integrated HIV-exposed infant register. The register used may depend on where services are offered. For example, where HIV-exposed infants are followed by health workers in HIV care and treatment facilities, countries could aggregate information from a register based at that site. All public, private and nongovernmental organization-run health facilities that provide co-trimoxazole prophylaxis for HIV-exposed infants should be included. Two methods can be used to estimate the denominator: (a) a projection model such as that provided by Spectrum software; use the output “number of pregnant woman needing prevention of mother-to-child transmission of HIV” as a proxy; or (b) multiply the total number of women who gave birth in the past 12 months (which can be obtained from central statistics offices or the United Nations Population Division or pregnancy registration systems with complete data) by the most recent national estimate of HIV prevalence in pregnant women17 (which can be derived from HIV sentinel surveillance in antenatal care clinic), if Spectrum projections are unavailable. If there are data on the number of live births, they should be adjusted to derive a better proxy.

Data Quality Control and Notes for the Reporting Tool: National Representativeness: If this indicator is obtained from a sub-set of facilities, comments should be added regarding the representativeness. Triangulation Options: pharmacy registers 

Measurement frequency

Continuously

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator allows countries to monitor progress in the early follow-up of exposed infants by measuring provision of cotrimoxazole in line with international guidelines. It can also be used as a proxy indicator for early follow-up visits of exposed infants within the recommended first 4-6 weeks of life. The indicator captures only those infants who return for HIV-exposed infant follow-up services within two months of birth. It does not measure actual coverage of cotrimoxazole prophylaxis for HIV-exposed infants as some infants may have been started on treatment after 2 months. A low value of the indicator could signal potential bottlenecks in the system, including poor management of CTX supplies in country, poor data collection, and inadequate distribution systems.

Additional considerations:
Countries may also wish to document provision of CTX for HIV-exposed infants older than 2 months as a way to monitor overall progress of the programme, identify existing challenges with early initiation of CTX, and to monitor
consumption for procurement needs.
Inappropriate management of supplies can negatively affect the value of the indicator and significantly reduce access to CTX for HIV-exposed infants. Countries should ensure appropriate systems and tools, particularly tools for
LMIS, are in place to adequately procure, distribute, and manage supplies at facility, district and central levels.

Data utilization:
Data can also be reviewed as an indication of the number of exposed infants who are seen at a facility within 2 months of birth. If indicator value is low, explore reasons why (e.g. whether exposed-infants are not attending facilities within 2 months, or if there are stock-outs of CTX, etc.).
 

Further information