Percent of all HIV positive pregnant women who received a complete course of ART prophylaxis
Number and percent of HIV-positive pregnant women who received a complete course of antiretroviral (ARV) prophylaxis to reduce risk of mother-to-child-transmission (MTCT) in the last 12 months. For recommendations on ARV prophylaxis regimens for reducing MTCT, see WHO (2009); and for more background on this indicator, see PEPFAR (2009); WHO/UNICEF/UNAIDS (2011);
WHO et al. (2006); and UNAIDS (2009).
This indicator is calculated as:
(Number of HIV-positive pregnant women who received ARV prophylaxis to reduce risk of MTCT / Total estimated number of pregnant HIV-positive women in the last 12 months) x 100
The numerator can be calculated by counting the number of HIV-positive pregnant women who received ARVs to reduce MTCT in the reporting period, by type of ARV regimen. Counting can take place where pregnant women receive HIV treatment, during antenatal care (ANC), labor and delivery care and during postpartum care (WHO/UNICEF/UNAIDS, 2011). Women receiving antiretroviral drugs in both the private sector and the public sector should be included in the numerator where data for both are available. Data should be collected continuously at the facility level and aggregated periodically, preferably monthly or quarterly.
Each ARV regimen category is mutually exclusive. If a woman switches regimens within one reporting period, she should be counted only once and the most recent regimen provided in the reporting period should be used for disaggregation (PEPFAR, 2009).
The numerator can be disaggregated by regimen type:
1. Single-dose nevirapine only
2. Prophylactic regimens using a combination of 2 ARVs
3. Prophylactic regimens using a combination of 3 ARVs
4. ART for HIV-positive pregnant women eligible for treatment
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: 1) using a projection model, such as Spectrum; or 2) by multiplying the total number of women who gave birth in the last 12 months × the most recent national estimate of HIV prevalence among pregnant women (PEPFAR, 2009). The total number of women who gave birth in the last 12 months can be obtained from estimates of births from central statistics offices or the estimates of the United Nations Population Division. The most recent national estimate of HIV prevalence among pregnant women can be derived from HIV sentinel surveillance data collected in ANC facilities. National estimates of HIV-infected pregnant women should take into consideration characteristics such as rural/urban patterns of HIV prevalence that may affect the representation of surveillance sites. For additional information on estimates of HIV prevalence and the use of Spectrum refer to UNAIDS/WHO (2010). The indicator can be disaggregated by whether the pregnant women was known positive at entry or newly tested positive, by the type of regimen used, and by the type of health care or HIV service facility used.
For the numerator: facility registers, patient records, and other program monitoring tools; For the denominator: ANC surveillance surveys in combination with demographic data or estimation models such as Spectrum.
This indicator measures the delivery and uptake of ARV prophylaxis by regimen type for the reduction of MTCT. In the absence of any preventive interventions, infants born to and breastfed by women living with HIV have about a one in three chance of acquiring HIV infection themselves (WHO et al., 2006). MTCT can happen during pregnancy, during labor and delivery or after delivery through breastfeeding. The risk of MTCT can be significantly reduced by the complementary approaches of providing ARV drugs (as treatment or as prophylaxis) for the mother with ARV prophylaxis for the infant in conjunction with safe delivery practices and recommended infant feeding practices (WHO, 2009). ARVs can be provided to HIV positive women during pregnancy, at labor, and shortly after delivery and can be provided through a number of sites and services, including ANC, labor and delivery, and postpartum care and treatment.
This indicator allows countries to monitor the coverage of ARVs given to HIV-positive pregnant women to reduce MTCT and the increased access to more efficacious ARV regimens for reducing MTCT in countries that are scaling up newer regimen categories (PEPFAR, 2009). Countries are encouraged to track and report on the actual or estimated percent distribution of the various regimens provided so that the impact of ARVs on MTCT can be modeled based on the efficacy of corresponding regimens. In 2006, international guidelines were updated to recommend more efficacious regimens for reducing MTCT, and countries may be at different phases in adopting the newer recommendations (UNAIDS, 2009).
The reduction of MTCT is a rapidly evolving programmatic area and some countries may not have a system in place yet to collect and report coverage of ARV provision for reducing MTCT by the various regimens. In some settings, large numbers of pregnant women do not have access to ANC services or choose not to use them. Pregnant women living with HIV may be less likely to use ANC services (or public rather than private ANC services) than those who are not infected, particularly where ARV therapy can be accessed through private services or where levels of stigma are particularly high (UNAIDS, 2009). The indicator excludes mother-infant pairs who only received infant prophylaxis, and, therefore, partial prophylaxis for the infant is not measured. The indicator measures ARVs dispensed and not ARVs consumed, thus it is not possible to determine adherence to the ARV regimen. Duplicate counting is possible for women with repeated visits and country program and facilities should establish data collection and reporting systems to minimize double-counting (WHO/UNICEF/UNAIDS, 2011).
newborn (NB), HIV/AIDS, safe motherhood (SM)
PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. http://www.pepfar.gov/documents/organization/81097.pdf
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.
UNAIDS/WHO, 2010, Future Tools for National Estimates and Epidemiological analyses: Technical Report And Recommendations, Joint United Nations Programme on HIV/AIDS (UNAIDS) Reference Group on Estimates, Modelling and Projections, London: Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London. http://www.epidem.org/sites/default/files/reports/Future%20Tools%20Report.pdf
WHO/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. Geneva: WHO.
WHO, 2009, New WHO recommendations: Preventing Mother-to-Child Transmission, Geneva: WHO. http://www.who.int/hiv/pub/mtct/mtct_key_mess.pdf
WHO, 2009, Rapid Advice: Use of antiretroviral drugs for treating pregnant women
and preventing HIV infection in infants, 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.
MEASURE Evaluation. 2018. Community-Based Indicators for HIV Programs. https://www.measureevaluation.org/community-based-indicators/indicators