Percent of HIV positive pregnant women who received appropriate treatment in labor, according to PMTCT recommendations
The percentage of pregnant women who are HIV-positive and who received appropriate treatment during labor and delivery according to recommendations for preventing mother-to-child transmission (PMTCT) of HIV during the reporting period.
This indicator is calculated as:
(Number of HIV-positive pregnant women who received appropriate treatment during labor, according to PMTCT recommendations / Total number HIV-positive pregnant women who received labor and delivery care during the reporting period) x 100
WHO et al., (2008) recommendations for PMTCT during labor and delivery include ‘Standard Precautions,’ which reduce the risk of transmission of blood-borne pathogens from the patient to the health care worker, and the following general precautions for women with HIV or unknown HIV status:
- Minimize vaginal examinations.
- Avoid prolonged labor.
- Avoid premature rupture of membranes.
- Avoid unnecessary trauma during delivery.
Specific interventions for PMTCT include:
- A woman of unknown HIV status at labor should be offered HIV testing, counseling, and, if HIV-positive, antiretroviral therapy or prophylaxis during for PMTCT.
- Administer or continue ARV therapy or prophylaxis during labor.
- Avoid routine episiotomy.
- Minimize the use of forceps or vacuum extractors.
- Minimize the risk of postpartum hemorrhage.
- Minimize transfusions and use safe blood transfusion practices.
- Consider benefits and risks of elective caesarean section for PMTCT.
Review of labor and delivery facility records for women’s HIV status and test results and records for care received, ideally from public, private, and non-governmental facilities. Where the Baseline Assessment Tools for Preventing Mother-to-child Transmission (PMTCT) of HIV (FHI, 2003), are being used to monitor care during labor and delivery, the data can be used for these facilities and programs. Data should be collected continuously and aggregated periodically for the purposes of program management, review, and district and country-level reporting. Data can be disaggregated by type of facilities, districts, and urban/rural location.
Labor and delivery facility registers; patient records; monitoring surveys, such as the FHI PMTCT assessment tool (FHI, 2003).
This indicator provides information on whether labor and delivery facilities are fully implementing practices for HIV infected women that meet the standard obstetric practices set forth by national or international standards. Evaluators can examine trends over time in the numbers of HIV-positive women presenting at labor and delivery facilities and the percentage of these women who are receiving the recommended quality of care. Additionally, the indicator can be used to identify areas of need and prioritize investments in resources, staffing, and PMTCT training.
Presently, women account for nearly half of all people living with HIV and 76 percent of young people (15-24 years) living with HIV are female (UNFPA 2011). Infants of women with HIV can become infected during pregnancy, labor and delivery, and through breastfeeding. Children account for more than ten percent of all new HIV infections and most of these are through mother-to-child transmission (IATT, 2007). Many countries have programs for PMTCT and are scaling up efforts to provide comprehensive prevention, care and support for women, children and their families. For further technical guidance on interventions and indicators for PMTCT, see USAID/CORE Group (2004); UNAIDS (2010); WHO (2010).
Lack of accuracy and quality control in record keeping at labor and delivery centers can impact the validity of this indicator. Missing information in records and registers may signal suboptimal care. In some settings, large numbers of pregnant women do not have access to labor and delivery services or choose not to use them. Pregnant women living with HIV may be less likely to use these services (or public rather than private services) than those who are not infected, particularly where levels of stigma associated with HIV are particularly high.
quality, integration, newborn (NB), HIV/AIDS, safe motherhood (SM)
Family Health International (FHI), 2003, Baseline Assessment Tools for Preventing Mother-to-child Transmission (PMTCT) of HIV, Arlington, VA: FHI, Institute for HIV/AIDS, http://pdf.usaid.gov/pdf_docs/pnadf776.pdf
Interagency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and their Children, 2007, Guidance on the Global Scale-up of the Prevention of Mother-to-Child Transmission of HIV, Geneva, WHO.
USAID, CORE Group, 2004, Maternal and Newborn Standards and Indicators Compendium, Washington, DC: USAID https://www.mchip.net/sites/default/files/Maternal_and_Newborn_Standards_and_Indicators_Compendium_2004.pdf
WHO, 2009, New WHO recommendations: Preventing Mother-to-Child Transmission, Geneva: WHO. http://www.who.int/hiv/pub/mtct/mtct_key_mess.pdf
WHO, 2010, PMTCT Strategic Vision 2010–2015: Preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals, Geneva: WHO. http://www.who.int/hiv/pub/mtct/strategic_vision/en/index.html
WHO/CDC/USHHS/GAP, 2008, Prevention of Mother-to-Child Transmission of HIV: Generic training package draft participant manual, Washington, DC: USHHS.
WHO, UNFPA, UNICEF, AMDD , 2010, Monitoring Emergency Obstetric Care: A Handbook, Geneva: WHO. http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf