Percent of pregnant women who were counseled and tested for HIV and know their results
The percentage of pregnant women attending antenatal care (ANC), labor & delivery (L&D), and postpartum care services (PPC), plus women with known HIV infection attending ANC for a new pregnancy, who received testing and counseling for HIV in the last 12 months and who know their HIV test results.
The numerator can be summed from categories a-d below (PEPFAR, 2009):
- Number of pregnant women who received an HIV test and result during ANC
- Number of pregnant women attending L&D with unknown HIV status who were
- tested in the L&D and received results
- Women with unknown HIV status attending postpartum services within 72 hours of delivery who were tested and received results
- Pregnant women with known HIV infection attending ANC for a new pregnancy.
The denominator is generated through a population estimate of the number of pregnant women giving birth in the last 12 months, which can be obtained from the Central Statistics Office estimates of births or the UN Population Division estimates. In countries with low-level and concentrated epidemics where policies to identify the HIV status of all pregnant women do not exist, the denominator should be adapted to the target population of pregnant women whose HIV status should be assessed (UNAIDS, 2008). For additional information on this and closely related indicators, see UNAIDS, (2008); PEPFAR (2009), UNAIDS, (2010); WHO/UNICEF/UNAIDS, (2011); WHO et al., (2006); USAID/CORE, 2004).
Indicator is calculated as:
(Number of pregnant women receiving HIV testing and counseling who know their HIV test results/Total estimated number of pregnant women in the last 12 months. ) x 100
Data to construct the numerator should come from national program records aggregated from facility registers in ANC, L&D, and postpartum services. Health facility registers should include data on known HIV infection among HIV-infected pregnant women accessing ANC services for a new pregnancy in order for them to receive subsequent prevention of mother-to-child transmission (PMTCT) services. All service providers should be included (public, private, non-governmental and community-based) and data should be collected continuously at the facility and community levels.
If targeting and/or linking to inequity, classify outlets where counseling is taking place by location (poor/not poor) and disaggregate by area served. Exit interviews can be conducted with clients to determine client’s poverty status.
For the numerator: ANC and L&D registers; HIV testing and counseling registers; HIV TOOLS: reporting forms. For the denominator: published estimates (e.g., estimates from the UN Population Division)
This indicator measures the percentage of pregnant women who were tested and counseled for HIV in the last 12 months and who received their HIV test results. This indicator reflects one goal of PMTCT, which is to increase the number of pregnant women who know their HIV status. Identification of a pregnant woman’s HIV status is the key entry point into PMTCT services and other HIV care and treatment services (PEPFAR, 2009). Mother-to-child transmission (MTCT) of HIV infection can occur during pregnancy, labor and delivery, or during breastfeeding. Receiving HIV testing and counseling services as early as possible during pregnancy enables HIV-positive pregnant women to benefit from HIV services and to access interventions for reducing HIV transmission to their infants. The risk of MTCT can be reduced by a range of interventions, including provision of antiretroviral prophylaxis given to women during pregnancy and labor and to the infant in the first weeks of life; obstetrical interventions; and either complete avoidance of breastfeeding or early postpartum exclusive breastfeeding where safe and affordable breast milk substitutes are not feasible (WHO/UNICEF, 2003). For more background and international recommendations on infant feeding and PMTCT, see the technical area in this database on Women’s Nutrition and HIV.
This indicator enables a country to monitor trends in HIV testing among pregnant women and women receiving postpartum services who may require antiretroviral (ARV) drugs to prevent mother-to-child transmission of HIV. In addition, it provides a good measure of how effectively HIV testing and counseling services are being provided to pregnant women and women receiving postpartum services.
The indicator does not capture points at which drop-outs occur during the testing and counseling process; the reasons why drop-outs occur; the number of women who received pre-test counseling; nor the quality of HIV testing and counseling services. There is a risk for double counting women in the numerator since a pregnant woman can be tested more than once while receiving ANC, L&D, or postpartum services. This is particularly true where women are re-tested in different facilities, or where they come to the L&D without documentation of their HIV test result. While it may not be feasible to avoid double counting entirely, countries should take measures to minimize double counting, such as through the use of patient-held records that document, among other services, that HIV testing was done (UNAIDS, 2008).
newborn (NB), HIV/AIDS, integration
The availability of ARVs which can prevent the transmission of HIV from mother to child increase the value that voluntary counseling and testing (VCT) could have for pregnant women. Yet many women refuse testing and treatment. Health workers must recognize that VCT entails significant risks for women which may include partner violence and ostracism. Applying strict standards of confidentiality and privacy to VCT, as well as to the treatment phase (if one is required), is necessary to ensure that pregnant women will have enough trust in their own safety to risk being tested. The lack of treatment options for the mother herself remains a serious obstacle to PMTCT.
PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. http://pdf.usaid.gov/pdf_docs/Pcaac330.pdf
UNAIDS, 2008, Core Indicators for National AIDS Programmes: Guidance and Specifications for Additional Recommended Indicators, Geneva: UNAIDS. http://data.unaids.org/pub/BaseDocument/2009/20090305_additionalrecommendedindicators_finalprintversio_en.pdf
UNAIDS, 2010, Prevention of Mother-To-Child Transmission of HIV (PMTCT): Technical Guidance Note for Global Fund HIV Proposals, Geneva: UNAIDS. http://www.who.int/hiv/pub/toolkits/PMTCT_Technical_guidance_GlobalFundR10_May2010.pdf
USAID/CORE, 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/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. Geneva: WHO. http://www.who.int/hiv/data/UA2011_indicator_guide_en.pdf
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. http://www.hivpolicy.org/Library/HPP000485.pdf
WHO/UNICEF, 2003, Global Strategy for Infant and Young Child Feeding, Geneva: WHO. http://whqlibdoc.who.int/publications/2003/9241562218.pdf