Percent of infants of HIV-positive mothers receiving ARVs for PMTCT at birth
The percentage of infants born to HIV-positive pregnant women in the last 12 months who were started on Cotrimoxizole (CTX) prophylaxis within two months of birth for preventing mother-to-child transmission (MTCT) of HIV. Depending on the country and setting, antiretroviral (ARV) drugs can be given to HIV-exposed infants shortly after delivery, at facilities for labor and delivery, at outpatient postnatal care and child clinics for infants born at home and brought to the facility, or at HIV care and treatment and other sites (WHO/UNICEF/UNAIDS, 2011). For more background and guidelines on CTX pophylaxis, see WHO (2006) and for further details on calculation and interpretation of the indicator, see PEPFAR (2009); WHO/UNICEF/UNAIDS (2011); UNAIDS (2008); WHO et al., (2006).
Indicator is calculated as:
(Number of infants born to HIV-infected women during the past 12 months who received ARV prophylaxis within two months of birth to reduce MTCT / Estimated total number of live births to pregnant HIV-infected women in the past 12 months) x 100
Data for the numerator can be aggregated from the appropriate facility registers, which can include integrated maternal and child health registers, registers on the follow-up of HIV-exposed infants or pre–ARV therapy registers (WHO et al., 2006). The register used may vary depending on the country context, for example, where HIV-exposed infants are followed up in the HIV care and treatment setting, countries may aggregate information either from a pre–ARV therapy register adapted for follow-up of HIV exposed infants or from a separate register for HIV-exposed infants. Infants covered by ARVs (either to the mother or infant) during the breastfeeding period who also received the postpartum 1-4 week prophylaxis should be counted only once, in the category for “postpartum breastfeeding period prophylaxis” (WHO/UNICEF/UNAIDS, 2011).
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. 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 antenatal clinics (PEPFAR, 2009). For additional information on estimates of HIV prevalence and the use of Spectrum refer to UNAIDS/WHO (2010). The indicator can be disaggregated by timing of postpartum intervention, type of regimen used, and type of health care or HIV service facility.
For the numerator, program or facility records; For the denominator, antenatal care surveillance, surveys in combination with demographic data or estimation models such as Spectrum.
This indicator allows countries to monitor progress in the early follow-up of HIV-exposed infants by measuring provision of CTX in line with international guidelines (WHO, 2006). The risk for 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 and use of safe delivery practices and recommended infant feeding (WHO/UNICEF/UNAIDS, 2011). CTX prophylaxis is a simple and cost-effective intervention to prevent Pneumocystis jirovecipneumonia (PCP) among HIV-exposed and HIV-infected infants. PCP is the leading cause of serious respiratory disease among young HIV-infected infants in resource limited countries and often occurs before HIV infection can be diagnosed. Because diagnosing HIV infection among young infants is difficult, all infants born to women living with HIV should receive CTX prophylaxis starting at 4 to 6 weeks after birth and continuing until HIV infection has been excluded and the infant is no longer at risk of acquiring HIV through breastfeeding.
A low value of the indicator can signal whether exposed-infants are not attending facilities within 2 months (WHO/UNICEF/UNAIDS, 2011) or potential bottlenecks in the system, including poor management of CTX supplies in country, poor data collection, and inadequate distribution systems (PEPFAR, 2009). Countries may also wish to document provision of CTX for HIV-exposed infants older than 2 months as a way to monitor overall progress of the program, identify existing challenges with early initiation of CTX, and to monitor usage for procurement needs. Data can also be used as a proxy for the number of exposed infants who are seen at a facility within 2 months of birth. If disaggregated by regimen, this indicator can monitor increased access to more efficacious ARV regimens for reducing MTCT in countries that are scaling up newer regimen categories.
The indicator captures only those infants who are brought in for HIV-exposed infant follow-up services within two months of birth. It does not measure actual coverage of CTX prophylaxis for HIV-exposed infants as some infants may have been started on treatment after 2 months (PEPFAR, 2009). Inappropriate management of supplies can negatively affect the value of the indicator and significantly reduce access to CTX for HIV-exposed infants. Countries should ensure appropriate systems and tools, particularly tools for a logistics management and information system (LMIS, USAID/DELIVER, 2009), are in place to adequately procure, distribute, and manage supplies at facility, district and central levels. There is a risk of double-counting when antiretroviral drugs are provided during more than one visit or at different health facilities. Countries should establish data collection and reporting systems to minimize double-counting (WHO/UNICEF/UNAIDS, 2011).
access, newborn (NB), HIV/AIDS
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, 2010, Prevention of Mother-To-Child Transmission of HIV (PMTCT): Technical Guidance Note for Global Fund HIV Proposals, Geneva: UNAIDS.
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
USAID/DELIVER, 2009, Turning The Digital Corner: Essential Questions For Planning For A Computerized Logistics Management Information System, Washington, D.C.: USAID. https://www.psmtoolbox.org/wp-content/uploads/2017/11/Turn_Digi_Corn.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/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. 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.
WHO, 2006, Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults: Recommendations for a public health approach. Geneva, World Health Organization, http://www.who.int/hiv/pub/guidelines/ctxguidelines.pdf