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Jacob N, Rice B, Heekes A, Johnson LF, Brinkmann S, Kufa T, Boulle A. Can routine antenatal data be used to assess HIV antiretroviral therapy coverage among pregnant women? Evaluating the validity of different data sources in the Western Cape, South Africa. PLoS One 2024; 19:e0291844. [PMID: 38635753 PMCID: PMC11025901 DOI: 10.1371/journal.pone.0291844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Accurate measurement of antenatal antiretroviral treatment (ART) coverage in pregnancy is imperative in tracking progress towards elimination of vertical HIV transmission. In the Western Cape, South Africa, public-sector individual-level routine data are consolidated from multiple sources, enabling the description of temporal changes in population-wide antenatal antiretroviral coverage. We evaluated the validity of different methods for measuring ART coverage among pregnant women. METHODS We compared self-reported ART data from a 2014 antenatal survey with laboratory assay data from a sub-sample within the survey population. Thereafter, we conducted a retrospective cohort analysis of all pregnancies consolidated in the Provincial Health Data Centre (PHDC) from January 2011 to December 2020. Evidence of antenatal and HIV care from electronic platforms were linked using a unique patient identifier. ART coverage estimates were triangulated with available antenatal survey estimates, aggregated programmatic data from registers recorded in the District Health Information System (DHIS) and Thembisa modelling estimates. RESULTS Self-reported ART in the 2014 sentinel antenatal survey (n = 1434) had high sensitivity (83.5%), specificity (94.5%) and agreement (k = 0.8) with the gold standard of laboratory analysis of ART. Based on linked routine data, ART coverage by the time of delivery in mothers of live births increased from 67.4% in 2011 to 94.7% by 2019. This pattern of increasing antenatal ART coverage was also seen in the DHIS data, and estimated by the Thembisa model, but was less consistent in the antenatal survey data. CONCLUSION This study is the first in a high-burden HIV setting to compare sentinel ART surveillance data with consolidated individuated administrative data. Although self-report in survey conditions showed high validity, more recent data sources based on self-report and medical records may be uncertain with increasing ART coverage over time. Linked individuated data may offer a promising option for ART coverage estimation with greater granularity and efficiency.
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Affiliation(s)
- Nisha Jacob
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Brian Rice
- University of Sheffield, Sheffield, United Kingdom
| | - Alexa Heekes
- School of Public Health, University of Cape Town, Cape Town, South Africa
- Western Cape Government: Health and Wellness, Cape Town, South Africa
| | - Leigh F. Johnson
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | - Tendesayi Kufa
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Andrew Boulle
- School of Public Health, University of Cape Town, Cape Town, South Africa
- Western Cape Government: Health and Wellness, Cape Town, South Africa
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Abraha A, Myléus A, Byass P, Kahsay A, Kinsman J. The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study. AIDS Care 2019; 31:1271-1281. [PMID: 30957540 DOI: 10.1080/09540121.2019.1601670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.
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Affiliation(s)
- Atakelti Abraha
- a Tigray Health Bureau , Tigray , Ethiopia.,b Ethiopian Health Insurance Agency , Addis Ababa , Ethiopia
| | - Anna Myléus
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Peter Byass
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden.,d Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen , Aberdeen , UK.,e MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
| | | | - John Kinsman
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden.,g Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet , Stockholm , Sweden
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Mirkuzie AH. Implementation and outcomes of guideline revisions for the prevention of mother-to-child HIV transmission in Mother Support Programme, Addis Ababa, Ethiopia. PLoS One 2018; 13:e0198438. [PMID: 29927946 PMCID: PMC6013243 DOI: 10.1371/journal.pone.0198438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 05/20/2018] [Indexed: 11/19/2022] Open
Abstract
About 40% of the new HIV infections in Ethiopia are among children < 15 years of age. The great majority of these infections occur through Mother-to-child HIV transmission (MTCT). For prevention of MTCT, the national guidelines has been revised to incorporate scientific advances in HIV prevention, treatment and care. Since 2005, the country has been implementing a peer mentor programme called Mother Support Group (MSG), which provides psychosocial and adherence support for HIV positive mothers. This study examined implementation of PMTCT guidelines revisions and outcomes of HIV exposed babies in the MSG in Addis Ababa. Retrospective routine data were collected between 2005 and August 2013 from seven randomly selected primary health facilities. Odds ratios and 95% confidence intervals were calculated using logistic regression models. Several guidelines revisions were made between 2001 and 2013 in HIV testing approaches, prophylactic antiretroviral options, infant feeding recommendations and infant HIV testing algorithms. Revisions on the CD4 thresholds were associated with a significant increase in the proportion of women initiating antiretroviral treatment from 0 in 2005 to 62% in 2013. Revisions in infant feeding recommendations led to a 92.3% reported practice of exclusive breastfeeding in 2013 compared to 60.9% in 2005. Two and four percent of the HIV exposed babies were HIV positive by six and 18 months respectively. Not receiving prophylactic ART and receiving mixed feeding were independent predictors for babies having an HIV positive antibody test at 18 months. The rate of HIV status disclosure increased significantly year by year. Over the years, the PMTCT recommendations have moved from having a solo focus on PMTCT to holistic and inclusive approaches emphasizing survival beyond HIV prevention. The data reflect favourable outcomes of HIV exposed babies in terms of averted MTCT though serious gaps in data quality remain. For successful implementation of Option-B plus, the identified gaps in the MSG need to be addressed.
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Affiliation(s)
- Alemnesh H. Mirkuzie
- Ethiopian Public Health Institute, National Data Management Center, Addis Ababa, Ethiopia
- * E-mail:
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Joshi RK, Mehendale SM. Can we replace HIV sentinel surveillance platform with prevention of parent-to-child transmission (PPTCT) program data to assess HIV burden and trends in India? Trans R Soc Trop Med Hyg 2017; 110:393-9. [PMID: 27496513 DOI: 10.1093/trstmh/trw045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 06/15/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Estimates of HIV burden in India are based on HIV sentinel surveillance (HSS), which has limitations such as insufficient sample size for district level analysis and ethical concerns. We analysed prevention of parent-to-child transmission (PPTCT) program data, for its suitability for HIV surveillance in India. METHODS Correlation and differences in ante-natal clinic (ANC) attendees' HIV prevalence from the last four rounds of HSS (2007-2012) and PPTCT data for the corresponding years were analysed at national, state and district levels. Sensitivity and region wise analysis were also done. RESULTS The PPTCT program covered a higher number of districts and ANC attendees than HSS. Correlation of HIV prevalence from PPTCT data with HSS was high (0.99) at national level, moderate (0.66-0.86) at state level, and low (0.43-0.62) at district level. HIV prevalence levels from HSS were generally higher than those from PPTCT data. As the coverage of PPTCT program and HSS improved, the differences between HIV prevalence from these two data sources increased. Sensitivity analysis showed significant differences in ANC attendees' HIV prevalence from HSS and PPTCT, even among districts with high HIV test uptake level in PPTCT program. CONCLUSIONS PPTCT program data can be utilised for HIV surveillance in India as it has better coverage and will avoid ethical issues and expenditures related to HSS.
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Affiliation(s)
- Rajneesh K Joshi
- Department of Epidemiology and Biostatistics, National AIDS Research Institute (ICMR), 73, 'G'-Block MIDC Bhosari, Pune - 411026, Maharashtra, India Faculty of Health and Biomedical Sciences, Symbiosis International University , Pune, Maharashtra, India
| | - Sanjay M Mehendale
- National Institute of Epidemiology, R 127, 3rd Avenue, TNHB, Ayapakkam, Chennai, Tamil Nadu - 600077, India
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Filade TE, Dareng EO, Olawande T, Fagbohun TA, Adebayo AO, Adebamowo CA. Attitude to Human Papillomavirus Deoxyribonucleic Acid-Based Cervical Cancer Screening in Antenatal Care in Nigeria: A Qualitative Study. Front Public Health 2017; 5:226. [PMID: 28932735 PMCID: PMC5592338 DOI: 10.3389/fpubh.2017.00226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) deoxyribonucleic acid (DNA)-based testing is increasingly used for cervical cancer screening in developed countries, but the best approach to utilizing it in low- and middle-income countries (LMIC) is unclear. Incorporation of HPV DNA-based testing into routine antenatal care (ANC) is a potential yet poorly explored strategy for cervical cancer screening in LMIC. We explored the attitude of health care workers and pregnant women to the incorporation of HPV DNA-based tests into routine ANC in Nigeria. METHODS We conducted nine focus group discussions with 82 pregnant women and 13 in-depth interviews with obstetricians and midwives at four health care facilities in Abuja, Nigeria. We used qualitative content analysis to analyze the data and the theory of planned behavior as a theoretical framework to examine the responses. RESULTS Pregnant women expressed a favorable attitude toward HPV DNA testing for cervical cancer screening as part of routine ANC. Acceptability of this approach was motivated by the expected benefits from early detection and treatment of cervical cancer. The factors most commonly cited as likely to influence acceptability and uptake of HPV DNA-based tests are recommendations by their care providers and mandating testing as part of ANC services. Discussants mentioned lack of awareness and affordability as factors that may inhibit uptake of HPV DNA-based cervical cancer screening. Midwives expressed concerns about the safety of sampling procedure in pregnancy, while obstetricians fully support the integration of HPV DNA-based testing into routine ANC. CONCLUSION Our results show that incorporating HPV DN-based cervical cancer screening into routine ANC is acceptable to pregnant women and health care providers. Making the test affordable and educating health care workers on its efficacy and safety if performed during ANC will enhance their willingness to recommend it and increase its uptake.
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Affiliation(s)
| | - Eileen O Dareng
- Institute of Human Virology, Abuja, Nigeria.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Amos O Adebayo
- Department of Obstetrics and Gynaecology, Asokoro District Hospital, Abuja, Nigeria
| | - Clement A Adebamowo
- Institute of Human Virology, Abuja, Nigeria.,Institute of Human Virology and Greenebaum Comprehensive Cancer Centre, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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Barbieri MM, Von Linsingen R, Sbalqueiro RL, Tristão EG. Vertical mother-to-child HIV transmission in babies born in a tertiary hospital in southern Brazil. J Matern Fetal Neonatal Med 2017; 31:2000-2006. [PMID: 28532195 DOI: 10.1080/14767058.2017.1333102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Programs for the elimination of mother-to-child transmission of human immunodeficiency virus (HIV) are essentially focused on prevention actions that occur during prenatal care. This study aimed to evaluate the mother-to-child vertical transmission (MCVT) rate, and identify its possible causes, in a sample of pregnant women with HIV. MATERIALS AND METHODS This was a retrospective and descriptive study. The sample was composed of HIV-positive pregnant women who delivered a live infant in the maternity ward at the hospital of the Federal University of Parana in Brazil, between January 2007 and December 2012. RESULTS The calculated MCVT rate in this study was 5.1%. Comparisons between MCVT cases and control pregnant women with HIV but without MCVT showed that the highest risk factors for MCVT were: the detection of HIV infection status only at delivery; non-attendance to high risk prenatal care; unknown viral load; and late onset of highly active antiretroviral therapy (HAART). CONCLUSIONS Our results corroborate the assertion that viral replication control is essential for HAART, and that adherence to therapy is essential for such control. Factors that influence adherence to the use of antiretroviral therapy (ART) must be identified, and medical, psychological, or social assistance must be properly provided to these mothers.
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Affiliation(s)
- Manoela Muller Barbieri
- a Department of Gynecology and Obstetrics - Infectious Diseases in Gynecology and Obstetrics Sector , Federal University of Paraná , Curitiba , Brazil
| | - Renate Von Linsingen
- a Department of Gynecology and Obstetrics - Infectious Diseases in Gynecology and Obstetrics Sector , Federal University of Paraná , Curitiba , Brazil
| | - Renato Luiz Sbalqueiro
- a Department of Gynecology and Obstetrics - Infectious Diseases in Gynecology and Obstetrics Sector , Federal University of Paraná , Curitiba , Brazil
| | - Edson Gomes Tristão
- a Department of Gynecology and Obstetrics - Infectious Diseases in Gynecology and Obstetrics Sector , Federal University of Paraná , Curitiba , Brazil
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Billong SC, Dee J, Fokam J, Nguefack-Tsague G, Ekali GL, Fodjo R, Temgoua ES, Billong EJ, Sosso SM, Mosoko JJ, Monebenimp F, Ndjolo A, Bissek ACZK, Bolu O, Elat JBN. Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure. BMC Infect Dis 2017; 17:3. [PMID: 28049451 PMCID: PMC5209823 DOI: 10.1186/s12879-016-2119-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background In low-income countries (LICs), HIV sentinel surveillance surveys (HIV-SSS) are recommended in between two demographic and health surveys, due to low-cost than the latter. Using the classical unlinked anonymous testing (UAT), HIV-SSS among pregnant women raised certain ethical and financial challenges. We therefore aimed at evaluating how to use prevention of mother-to-child transmission of HIV (PMTCT) routine data as an alternative approach for HIV-SSS in LICs. Methods A survey conducted through 2012 among first antenatal-care attendees (ANC1) in the ten regions of Cameroon. HIV testing was performed at PMTCT clinics as-per the national serial algorithm (rapid test), and PMTCT site laboratory (PMTCT-SL) performances were evaluated by comparison with results of the national reference laboratory (NRL), determined as the reference standard. Results Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (49 · 3% aged 15–24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 81 · 2%, ranging from 58 · 8% (South region) to 100% (West region); thus implying that 18 · 8% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 99 · 3%, without significant disparity across sites. At population-level, this implies that every year in Cameroon, ~2,500 HIV-infected women are wrongly declared seronegative, while ~1,000 are wrongly declared seropositive. Only 44 · 4% (16/36) of evaluated laboratories reached the quality target of 80%. Conclusions The study identified weaknesses in routine PMTCT HIV testing. As Cameroon transitions to using routine PMTCT data for HIV-SSS among pregnant women, there is need in optimizing quality system to ensure robust routine HIV testing for programmatic and surveillance purposes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2119-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Serge C Billong
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon. .,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon. .,Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
| | - Jacob Dee
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, USA
| | - Joseph Fokam
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon. .,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon. .,Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon. .,Chair of Virology, Department of Experimental Medicine and Surgery, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Georges Nguefack-Tsague
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon
| | - Gabriel L Ekali
- Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Raoul Fodjo
- Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Edith S Temgoua
- Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon
| | | | - Samuel M Sosso
- Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon
| | - Jembia J Mosoko
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Cameroon Country Office, Yaoundé, Cameroon
| | - Francisca Monebenimp
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon
| | - Alexis Ndjolo
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon.,Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon
| | - Anne-Cecile Z-K Bissek
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon.,Division of Operational Health Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Omotayo Bolu
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Cameroon Country Office, Yaoundé, Cameroon
| | - Jean-Bosco N Elat
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon.,Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
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Balisanga H, Mutagoma M, Remera E, Kayitesi C, Kayirangwa E, Dee J, Malamba S, Boer KR, Hedt-Gauthier B, Umugwaneza P, Nsanzimana S. HIV surveillance in Rwanda: readiness assessment to transition from antenatal care-based to prevention of mother-to-child transmission program-based HIV surveillance. Int J Infect Dis 2016; 52:62-67. [PMID: 27616035 DOI: 10.1016/j.ijid.2016.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In 2013, the World Health Organization (WHO) recommended that for efficiency and ethical considerations, transitioning from antenatal clinic-based surveillance to prevention of mother-to-child transmission (PMTCT)-based routine data should be investigated. An assessment of the readiness for this transition was carried out in Rwanda in 2011 and 2013. METHODS This assessment applied the WHO recommended method. Individual HIV rapid testing at site was compared to antenatal surveillance results at all existing 30 sites, involving 13 292 women. In addition, PMTCT HIV testing quality assurance and PMTCT routine data quality were assessed at 27 out of the 30 sites. RESULTS All sentinel sites provided PMTCT services and had a high uptake of HIV testing (more than 90%). At all sites, PMTCT data were recorded in longitudinal and standardized antenatal clinic registers. Twenty-six out of 27 sites had HIV result completeness above 90%. A positive percentage agreement of 97.5% and negative percentage agreement of 99.9% were observed between routine PMTCT and sero-surveillance HIV test results. Of 27 sites, 25 scored more than 80% in all phases of HIV testing quality assurance. CONCLUSIONS According to WHO standards, Rwanda antenatal care HIV sero-surveillance is ready to transition to PMTCT-based sero-surveillance.
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Affiliation(s)
- Helene Balisanga
- Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda.
| | | | - Eric Remera
- Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda
| | - Catherine Kayitesi
- Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda
| | - Eugenie Kayirangwa
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA
| | - Jacob Dee
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA
| | - Samuel Malamba
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA
| | - Kimberly R Boer
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sabin Nsanzimana
- Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda
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Gonese E, Mushavi A, Mungati M, Mhangara M, Dzangare J, Mugurungi O, Dee J, Kilmarx PH, Shambira G, Tshimanga MT, Hargrove J. Is Zimbabwe ready to transition from anonymous unlinked sero-surveillance to using prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance?: results of PMTCT utility study, 2012. BMC Infect Dis 2016; 16:97. [PMID: 26923185 PMCID: PMC4770682 DOI: 10.1186/s12879-016-1425-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/10/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prevention of mother-to-child transmission of HIV (PMTCT) programs collect socio-demographic and HIV testing information similar to that collected by unlinked anonymous testing sero-surveillance (UAT) in antenatal settings. Zimbabwe evaluated the utility of PMTCT data in replacing UAT. METHODS A UAT dataset was created by capturing socio-demographic, testing practices from the woman's booking-card and testing remnant blood at a laboratory from 1 June to 30 September 2012. PMTCT data were collected retrospectively from ANC registers. UAT and PMTCT data were linked by bar-code labels that were temporarily affixed to the ANC register. A questionnaire was used to obtain facility-level data at 53 sites. RESULTS Pooled HIV prevalence was 15.8 % (95 % CI 15.3-16.4) among 17,349 women sampled by UAT, and 16.3 % (95 % CI 15.8 %-16.9 %) among 17,150 women in PMTCT datasets for 53 sites. Pooled national percent-positive agreement (PPA) was 91.2 %, and percent-negative agreement (PNA) was 98.7 % for 16,782 women with matched UAT and PMTCT data. Based on UAT methods, overall median prevalence was 12.9 % (Range 4.0 %-19.4 %) among acceptors and refusers of HIV test in PMTCT compared to 12.5 % ((Range 3.4 %-19.5 %) among acceptors in ANC registers. There were variations in prevalence by site. CONCLUSION Although, there is no statistical difference between pooled HIV prevalence in UAT compared to PMTCT program, the overall PPA of 91.2 % and PNA of 98.7 % fall below World Health Organisation (WHO) benchmarks of 97.6 % and 99.6 % respectively. Zimbabwe will need to strengthen quality assurance (QA) of rapid HIV testing and data collection practices. Sites with good performance should be prioritised for transitioning.
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Affiliation(s)
- E Gonese
- Centers for Disease Control and Prevention, 38 Nelson Mandela Rd, Box 3088, Harare, Zimbabwe.
| | - A Mushavi
- Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe.
| | - M Mungati
- Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe.
| | - M Mhangara
- Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe.
| | - J Dzangare
- Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe.
| | - O Mugurungi
- Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe.
| | - J Dee
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA.
| | - P H Kilmarx
- National Institute of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
| | - G Shambira
- Department of Community Medicine, University of Zimbabwe, Parirenyatwa Hospital, Mazoe Street, Harare, Zimbabwe.
| | - M T Tshimanga
- Department of Community Medicine, University of Zimbabwe, Parirenyatwa Hospital, Mazoe Street, Harare, Zimbabwe.
| | - J Hargrove
- South Africa Centre for Epidemiological Modelling and Analysis, Stellenbosch University, 19 Jonkershoek Road, Stellenbosch, 7602, South Africa.
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