HIV prevalence among pregnant women 15-24 years old

HIV prevalence among pregnant women 15-24 years old

HIV prevalence among pregnant women 15-24 years old

The percentage of pregnant women aged 15 to 24 years who are tested for HIV during an antenatal care (ANC) visit and have positive test results.  For background on this and closely related indicators, see UNAIDS, 2010.

Indicator is calculated as:

(Number of antenatal clinic attendees (aged 15–24 years)  tested whose HIV test results are positive/ Total number of antenatal clinic attendees (aged 15–24 years) tested  for their HIV infection status ) x 100

Data Requirement(s):

This indicator is calculated using data from pregnant women attending antenatal clinics in HIV sentinel surveillance sites in the capital city and other urban and rural areas.  To supplement data from antenatal clinics, an increasing number of countries are implementing HIV testing as part of the population-based survey. Wherever available, the results of the survey should be included in the report submitted with this indicator. Data can be disaggregated by age subgroupings (15-19 and 20-24), by type of sentinel ANC site (i.e. public, private, non-governmental, community-based) and by urban/rural location.

HIV sentinel surveillance data collection based on WHO guidance (UNAIDS, 2009).

This indicator is used to assess progress towards reducing HIV infection.  In countries with a generalized (heterosexually driven) epidemic, national estimates of HIV prevalence are based on data generated by surveillance systems that focus on pregnant women (who by definition had unprotected sex) who attend a selected number of sentinel antenatal clinics, and in an increasing number of countries, on nationally representative serosurveys (WHO, 2011). The percentage of pregnant women of all ages who test positive for HIV, including those with already confirmed HIV infection, is a closely related indicator that is also used in monitoring programs to reduce mother-to-child transmission (MTCT) of HIV (UNAIDS, 2010).  PEPFAR uses the estimated number of pregnant HIV-positive women in the last 12 months as the denominator for calculating the percentage of HIV-positive pregnant women who received antiretrovirals to reduce MTCT (see PEPFAR (2009) for more details on the calculation of these estimates).

Since the highest rates of new HIV infections typically occur in young adults, UNAIDS (2009) employs an indicator for the prevalence of HIV among all young people aged 15 to 24. At young ages, trends in HIV prevalence are a better indication of recent changes in HIV incidence and risk behavior. Thus, reductions in HIV incidence associated with genuine behavior change should first become detectable in HIV prevalence figures for 15–19-year-olds (UNAIDS, 2009). Where available, parallel behavioral surveillance survey data should be used to support interpretation of trends in HIV prevalence. In countries where the age at which young people first have sexual intercourse is late and/or levels of contraception use are high, HIV prevalence among pregnant women of 15–24 years of age will differ from that among all women in the age group. This indicator, which uses data from ANC sentinel sites, gives a fairly good estimate of relatively recent trends in HIV infection in locations where the epidemic is heterosexually driven.

HIV prevalence for any specified age is the difference between the cumulative numbers of people that have become infected with HIV up to this age minus the number who have died, expressed as a percentage of the total number alive at this age. At older ages, changes in HIV prevalence are slow to reflect changes in the rate of new infections (HIV incidence) because the average duration of infection is long. Therefore, declines in HIV prevalence can reflect saturation of infection among those individuals who are most vulnerable and rising mortality rather than behavior change (UNAIDS, 2009).

As a sentinel indicator, this estimated measure is designed for assessing trends at regional, country and district levels and cannot be effectively used for monitoring or evaluating individual programs and interventions.  This indicator is less reliable a gauge of concentrated HIV-epidemic trends in locations where most infections remain temporarily confined to most-at-risk populations (MARP).  PEPFAR (2009), UNAIDS (2009) and WHO/UNICEF/UNAIDS (2011) recommend using an indicator for HIV prevalence specific to these MARP, which is also included in this technical area of the database.

newborn (NB), HIV/AIDS, adolescent, safe motherhood (SM)

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR.

UNAIDS, 2009, Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on Construction of Core Indicators, Geneva: UNAIDS

UNAIDS, 2010, Prevention of Mother-To-Child Transmission of HIV (PMTCT): Technical Guidance Note for Global Fund HIV Proposals, Geneva: UNAIDS.

WHO, 2011 World Health Statistics 2011: Indicator compendium, Geneva, WHO.

WHO, UNAIDS, The Global Fund, CDC, USAID, UNICEF, MEASURE Evaluation, US Dept. of State: OGAC, 2006, Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis, and Malaria, Geneva: WHO.