Percent of HIV-positive pregnant women who received antiretrovirals to reduce risk of mother-to-child-transmission

Export Indicator

This indicator measures the delivery and uptake of antiretroviral prophylaxis, by regimen type, for the prevention of mother-to-child-transmission (PMTCT). The risk of MTCT can be significantly reduced with the use of antiretrovirals for the mother, with
What it measures

This indicator measures the delivery and uptake of antiretroviral prophylaxis, by regimen type, for the prevention of mother-to-child-transmission (PMTCT). The risk of MTCT can be significantly reduced with the use of antiretrovirals for the mother, with or without prophylaxis to the infant.

The disaggregation by regimen type provides data used by SPECTRUM and other models and applications to determine the impact of PMTCT programs, by country. These data will be important to PEPFAR Headquarters, TWGs and USG country-level managers in order to:
• Identify progress toward the USG goal of reaching 80% of HIV-positive pregnant women and reducing transmission by 40%
• Determine the impact of national PMTCT programs
• Determine countries’ progress at implementing more efficacious PMTCT ARV programs
• Identify countries needing assistance to implement more efficacious regimens

Rationale
Numerator

Number of HIV-positive pregnant women who received antiretrovirals to reduce risk of mother-to-child-transmission

Denominator

Estimated number of pregnant HIV-positive women in the last 12 months

Note: The denominator will be incorporated into COPRs by PEPFAR Headquarters using SPECTRUM estimates. However, PEPFAR in country teams will have the opportunity to add an additional source of data.

Calculation

Numerator / Denominator

Method of measurement

The numerator can be generated by counting the number of HIV-positive pregnant women who received antiretrovirals to reduce MTCT in the reporting period, by regimen.  Explanation:
Numerator:
The number of HIV-positive pregnant women who received antiretrovirals to reduce MTCT is obtained from program monitoring records compiled from patient records and facility registers. ARVs can be provided to HIV-positive women during pregnancy, at labor, and shortly after delivery across a number of sites, including at ANC, L&D, and care and treatment.
Numerator data will be stratified by maternal regimen:
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 treatment1
Each ARV regimen category is mutually exclusive. ARVs can be provided to HIV-positive women at many sites including ANC, L&D and care & treatment. If a woman switches regimens within one reporting period, she should be counted only once. Count the most recent regimen provided to her in the reporting period. If Neverapine is given after AZT this will be counted as two-drug. HIV-positive women receiving any of the above regimen categories meet the definition of the numerator.
1The categories can be clarified as follows:
Categories Further clarification Examples
a) Single-dose nevirapine only One dose of nevirapine for mother given at or around birth Single-dose (SD) NVP
b) Prophylactic regimens using a combination of two ARV; A prophylactic regimen that uses more than one ARV drug for mothers to prevent HIV transmission and is started before labour and delivery AZT + SD NVP
AZT + SD NVP +7 day post-partum tail of AZT/3TC
AZT + 3TC
AZT + 3TC + SD NVP
c) Prophylactic regimens using a combination of three ARVs Highly active regimen for MTCT prophylaxis designed to fully suppress viral replication prior to and during delivery and for a variable duration post partum AZT + 3TC + NNRTI or
AZT + 3TC +PI or
AZT + 3TC + NRTI
d) ART for HIV-positive pregnant women eligible for treatment ART for HIV-positive pregnant women eligible for treatment
(estimate AZT + 3TC + NNRTI or
AZT + 3TC +PI or
AZT + 3TC + NRTI

Two methods for calculating the numerator can be used:

1) Low facility delivery settings:
Counting at point of ARV provision: In settings with low facility deliveries, data for the numerator should be compiled from patient registers based on where ARVs are dispensed and where the data is being recorded. For example, where ARV prophylaxis is provided in the ANC and ART is provided in the care and treatment unit, countries should aggregate data from the ANC/PMTCT register as well as the pre-ART or ART register. 
There is a risk of double counting in settings where ARVs are provided at different points in time and/or in different service units or health facilities (e.g. a woman received SD-NVP at post-test counseling and then received AZT at 28 weeks). Countries should ensure a data collection and reporting system is in place to minimize the potential for double counting.
2) High facility deliver settings:
Counting at the end-point of labor and delivery: In settings with high facility delivery rates (>90%), countries can aggregate the numerator entirely from the L&D register by counting the number of HIV-positive pregnant women who had received a specific ARV regimen by the time of delivery (e.g., a woman received SD-NVP and AZT during her pregnancy; at the time of delivery she would be recorded in the L&D register as having received AZT+SD-NVP during pregnancy and included in category #2). This may be the most reliable and accurate meth

Measurement frequency

Annual

Disaggregation

Condom type: N/A

Education: N/A

Gender: N/A

Geographic location: N/A

HIV status: N/A

Pregnancy status: N/A

Sector: N/A

Service Type: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator allows countries to monitor: 1) the coverage of antiretrovirals given to HIV-positive pregnant women to reduce the risk of HIV transmission to the child; and 2) increased access to more efficacious ARV regimens for PMTCT in countries that are scaling up newer regimen categories. One weakness of this indicator is the exclusion of mother-infant pairs who only received infant prophylaxis. Therefore, partial prophylaxis for the infant only is not measured. The indicator measures ARVs dispensed and not ARVs consumed, thus it is not possible to determine adherence to the ARV regimen.

Further information