Preventing vertical transmission of HIV
Export Indicator
Progress in preventing vertical transmission of HIV during pregnancy and delivery by providing antiretroviral medicine.
This indicator allows countries to monitor the coverage of initiation of antiretroviral medicines among pregnant women living with HIV to reduce the risk of transmitting HIV to infants during pregnancy and delivery and breastfeeding. Since the indicator usually measures the antiretroviral medicines dispensed and not those consumed, adherence to the regimen cannot be determined in most cases.
Providing antiretroviral medicines to a woman living with HIV - either before conception or during pregnancy and during breastfeeding - can significantly reduce the risk of vertical transmission. This intervention is most effective if antiretroviral medicine is provided before conception and carefully adhered to throughout breastfeeding. This indicator can be used to: (a) track progress towards global and national goals of eliminating vertical transmission, (b) inform policy and strategic planning; (c) contribute to advocacy efforts; and (d) leverage resources for accelerating scale-up.
Number of pregnant women living with HIV who delivered during the past 12 months and received antiretroviral medicines to reduce the risk of vertical transmission of HIV. Global reports summarizing the coverage of antiretroviral medicine for preventing vertical transmission will exclude women who received single-dose nevirapine, since it is considered a suboptimal regimen. However, the country should report the number of women who only received single-dose nevirapine.
This count should include all women who delivered in the past 12 months, regardless of which year they started on antiretroviral medicines.
Estimated number of women living with HIV who delivered within the past 12 months
Numerator/denominator
For the numerator. National programme records aggregated from programme monitoring tools, such as patient registries and summary reporting forms.
For the denominator. Estimation models such as Spectrum or antenatal clinic surveillance surveys combined with demographic data and appropriate adjustments related to the coverage of antenatal clinic surveys.
Annually or more frequently, depending on a country’s monitoring needs
- The numerator should be disaggregated across the regimens described below.
- Newly initiated on antiretroviral therapy during the current pregnancy.
- Already receiving antiretroviral therapy before the current pregnancy.
- Other (please specify regimen).
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Categories |
Further clarification |
Common examples |
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The first two options include women receiving lifelong antiretroviral therapy
(including Option B+):
1. Newly initiating treatment during the current pregnancy.
2. Already receiving treatment before the pregnancy.
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A three-drug regimen intended to provide antiretroviral therapy for life:
1. Number of pregnant women living with HIV identified in the reporting period newly initiating lifelong antiretroviral therapy. 2. Number of pregnant women living with HIV who were already receiving antiretroviral therapy at their first antenatal clinic visit. If a woman initiates lifelong antiretroviral therapy during labour, she would be counted in Category 1.
If the number of women receiving antiretroviral therapy is not available by the timing of when they started, the number can be included in the cell entitled “total number of pregnant women receiving lifelong antiretroviral therapy”.
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Standard national treatment regimen, for
example:
■ TDF + 3TC + EFV.
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3. If another regimen that does not include lifelong therapy was provided, please enter the other regimen (using one of the options below) and the number of women receiving that alternative regimen. |
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Maternal triple antiretroviral medicine
prophylaxis (prophylaxis component of World Health Organization (WHO) Option B during pregnancy and delivery)
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A three-drug regimen provided for prophylaxis of vertical transmission started during pregnancy—or as late as during labour or delivery—with the intention of stopping at the end of the breastfeeding period (or stopping at delivery, if not breastfeeding).
If a woman is receiving triple antiretroviral medicines for the first time at labour or delivery, then she should still be counted in this category if the facility is implementing Option B.
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■ TDF + 3TC + EFV. ■ AZT + 3TC + EFV. ■ AZT + 3TC + LPV/r. |
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Maternal AZT (prophylaxis component
of WHO Option A during pregnancy and delivery)
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A prophylactic regimen that uses AZT (or another nucleoside reverse-transcriptase inhibitor (NRTI)) started as early as 14 weeks—or as late as during labour or delivery— to prevent HIV transmission.
If a woman is receiving antiretroviral medicines for the first time at labour or delivery, then she should still be counted in this category if the facility is implementing Option A.
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■ AZT at any point before labour + intrapartum NVP. ■ AZT at any point before labour + intrapartum NVP + 7-day postpartum tail of AZT + 3TC. |
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Single-dose nevirapine to the mother during pregnancy or delivery
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Count this if nevirapine is the only regimen provided to a pregnant woman living with HIV during pregnancy, labour or delivery. Do not count as single-dose nevirapine if: ■ Nevirapine is provided as part of Option A during pregnancy. ■ A pregnant woman living with HIV initiates Option A, B or B+ at labour and delivery. |
■ Single-dose nevirapine for mother only at onset of labour. ■ Single-dose nevirapine + 7-day AZT + 3TC tail only. ■ Single-dose nevirapine for mother at onset of labour and single-dose nevirapine for baby only. |
Two methods can be used to estimate the denominator: an estimation model, such as Spectrum, using the output: the number of pregnant women needing services for preventing vertical transmission. This indicator is calculated as births to women living with HIV
Or, if Spectrum estimates are not available, by multiplying the number of women giving birth in the past 12 months (which can be obtained from estimates of the central statistics office, United Nations Population Division or pregnancy registration systems with complete data) by the most recent national estimate of HIV prevalence among pregnant women (which can be derived from HIV sentinel surveillance in antenatal clinic and appropriate adjustments related to coverage of antenatal clinic surveys).
To ensure comparability, the Spectrum output will be used for the denominator for global analysis.
Countries are encouraged to track and report the number of women receiving treatment by the timing of ART initiation so that the impact of antiretroviral medicines on vertical transmission of HIV can be modelled (see indicator 2.2 on MTCT rate). The numerator should be deduplicated to remove women attending multiple clinics over the course of pregnancy.
The prevention of vertical transmission is a rapidly evolving programme area, and methods for monitoring coverage of this service are likewise evolving. To access information, please consult the following:
Publications on vertical transmission of HIV. Geneva: World Health Organization; c2020 https://www.who.int/reproductivehealth/congenital-syphilis/emtc-gvac/en/
Consolidated HIV strategic information guidelines: Driving impact through programme monitoring and management. Geneva: World Health Organization, 2020 (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).
Related Indicators
VT.4 ART coverage in pregnant women, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).
PMTCT_ART, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf).