(PMTCT_EID) Percentage of infants born to HIV-positive women who received a first virologic HIV test (sample collected) by 12 months of age
This percentage is a proxy measure, relying on PMTCT_STAT_POS + HTS_TST_POS (Post ANC1: Pregnancy/L&D/BF) as a proxy denominator for total number of HEI. Reviewing infants with a first virologic test (N) against this proxy denominator should be done with caution; see assumptions and limitations in the data quality section below.
Number of infants who had a first virologic HIV test (sample collected) by 12 months of age during the reporting period
PMTCT_STAT_POS + HTS_TST_POS from the Post ANC1: Pregnancy/L&D/BF modality. (see PMTCT_STAT & HTS_TST reference sheets)
How to collect:
This indicator measures the extent to which HIV-exposed infants receive a first virologic HIV test to determine their HIV status by 12 months of age. The indicator is disaggregated by the age of the infant at the time of sample collection, specifically between birth and 2 months and between 2 and 12 months of age.
Only samples collected for the first virologic test for each HIV-exposed infant should be counted in this indicator, including dried blood spots (DBS) and samples collected for POC testing (e.g., Alere, Xpert). Even though there is ongoing exposure of infants to HIV (through breastfeeding), this indicator only measures access to a first test, and not access to all the recommended HIV tests throughout breastfeeding. HIV status of infants at the end of the breastfeeding period and the outcomes of the PMTCT program are measured in PMTCT_FO.
The positive results of HIV infant virologic testing are collected under the PMTCT_HEI_POS indicator. Please see the reference sheet for PMTCT_HEI_POS for more information. Implementing partners should report on all infants whose samples were collected for a first virologic test, even if no test result has been recorded in the patient record/register at the time of reporting.
This indicator should be collected from the clinical source (i.e., HIV-exposed infant registers or patient records) to ensure unduplicated patient counting. HIV-exposed infant registers should be used to count exposed infants and samples collected for virologic testing. (If available, information could come from electronic systems). If the standard report does not contain all the required information, individual patient files should be used. Additional supporting information for this indicator can be obtained from standard laboratory information systems (i.e., DNA PCR or POC/near POC log books or electronic systems) however, it will be important to ensure that repeat tests of the same sample or HIV-infected infants receiving a confirmatory virologic HIV test result are not counted twice.
A virologic test is a test used for HIV diagnosis in infants up to 18 months of age. The most commonly used form of virologic testing or nucleic acid testing (“NAT”) is HIV DNA PCR on dried blood spots (DBS) but this indicator also includes samples collected for POC testing. Three other types of testing should not be reported: 1) Serologic testing of children should not be reported in this indicator. (See HTS_TST for additional details). 2) Virologic tests conducted with the purpose of confirming the diagnosis of HIV, 3) Virologic tests used for clinical monitoring of children on ART, such as viral load quantification. Additionally, only the first sample collected should be counted for each infant, even if they have had more than one virologic test done.
The numerator is divided into first sample collected between birth and 2 months of age and first sample collected between 2 and 12 months of age. The 0-2 month and 2-12-month age periods are based on age at collection of sample, not on date of result return to the facility or caregiver. It is likely that at the time of reporting there will be samples that have been collected but for which no result is documented in the register or patient record.
Reporting level: Facility
How to review for data quality:
Infant testing coverage (PMTCT_EID / PMTCT_STAT_POS + HTS_TST_POS from the Post ANC1: Pregnancy/L&D/BF modality) is a proxy calculation, relying on PMTCT_STAT_POS + HTS_TST_POS from the Post ANC1: Pregnancy/L&D/BF modality as a proxy denominator for the total number of HIV exposed infants (HEI). Reviewing infants with a first virologic test (N) against these denominator results) should be done carefully—see assumptions and limitations below. Review of outlier percentages for testing coverage by age band is recommended (e.g., review high and low outliers for 0-≤2-month testing coverage disaggregate).
Assumption: the total number of HIV positive pregnant and breastfeeding women, and therefore HEI, does not significantly vary quarter by quarter. We would not expect all the women reported under PMTCT_STAT_POS to have given birth to the infants reported under PMTCT_EID. However, despite that time period mismatch, the assumption is that the total number of HIV positive women (estimated HEI) does not vary significantly quarter by quarter, so it is reasonable to compare infants tested to the STAT_POS & HTS_TST_POS PostANC1: Pregnancy/L&D/BF denominator from the same reporting time period.
See the PMTCT_HEI_POS indicator reference sheet for a description of considerations and limitations in calculating proxy positivity for HEI (PMTCT_HEI_POS / PMTCT_EID).
Reporting frequency: Quarterly
Disaggregate descriptions & definitions:
Infant Test by Age at Sample Collection: For the numerator to be calculated, implementing partners are required to report:
- Infants who had a first virologic test (sample collected) between birth and 2 months of age (0-≤2mo): Age at the time the sample is collected should be reported.
- Infants who had a first virologic test (sample collected) between 2 and 12 months of age: Age at the time the sample is collected should be reported.
The numerator is a measure of sample collection for virologic testing. Throughout the reference guide the term “received a first virologic test” specifically means “had a first sample collected for virologic testing.” Age refers to age at specimen collection
Calculated indicator, sum of: PMTCT_STAT POS: 1) Newly Tested Positive, 2) Known Positive at entry (see PMTCT_STAT reference sheet for more details) and HTS_TST_POS: Post ANC1: Pregnancy/L&D/BF modality (see HTS_TST reference sheet for more details)
Indicator changes (MER 2.0 v2.3 to v2.4): None
PEPFAR Support definition:
Standard definition of DSD and TA-SDI used.
Provision of key staff or commodities for PMTCT includes: commodities such as test kits, ARVs including infant prophylaxis, lab commodities, or funding for salaries of health care workers.
Ongoing support for PMTCT service delivery improvement includes: training of PMTCT service providers, clinical mentoring and supportive supervision of PTMCT service sites, infrastructure/renovation of facilities, support for PMTCT service data collection, reporting, data quality, QI/QA of PMTCT services support, ARV consumption forecasting and supply management, support of lab clinical monitoring of patients, supporting patient follow- up/retention, support of mother mentoring programs.
Guiding narrative questions:
- Provide context for low EID testing coverage by geographic area or partner/implementing mechanism, including any planned activities/remedial actions. For example, PMTCT_EID is lower than previous quarters due to a stock out of DBS reagent.
- Provide additional monitoring data related to: turn-around time of virologic test results back to the facility and results returned to caregiver.