This indicator allows countries to monitor progress in providing early HIV virological testing to HIV-exposed infants two months or younger, which is critical for appropriate follow-up care and treatment. Limiting the age to two months or younger also eliminates the potential for repeat tests for the same infant, which can lead to double counting. The only three fields needed for this indicator—date of sample collection, age at collection (actual or calculated based on the date of birth) and results—are systematically entered into central early infant diagnosis testing databases at testing laboratories.
Because of the small number of testing laboratories and the electronic format of testing databases, this indicator should not have a heavy collection burden. The data quality of the laboratories is generally high, resulting in a robust indicator. The indicator does not capture the number of children with a definitive diagnosis of HIV infection or measure whether appropriate follow-up services were provided to the child based on interpretation of the test results. It also does not measure the quality of testing or the system in place for testing. A low value of the indicator could, however, signal systemic weaknesses, including poor country-level management of supplies of HIV virological test kits, poor data collection, poor follow-up and mismanagement of testing samples.
Disaggregation by test results cannot be used as a proxy for overall mother-to-child transmission rates. If either the overall national early infant diagnosis coverage or the early infant diagnosis testing coverage in the first two months of life is low, low positivity rates among the infants tested will not necessarily mean programme success, since this sample does not include many other infants who are likely positive.
Although early virological testing is a critical intervention for identifying infants living with HIV, countries should also strengthen the quality of followup of HIV-exposed infants and train health providers to recognize the signs and symptoms of early HIV infection among exposed infants, especially if access to virological testing is limited. Inappropriate management of supplies can negatively affect the value of the indicator and significantly reduce access to HIV testing for the infants born to women living with HIV. Countries should ensure that appropriate systems and tools, especially tools for logistics management information systems, are in place to procure, distribute and manage supplies at the facility, district and central levels.
The numerator for this indicator is a subset of the United States Government MER indicator on PMTCT Early Infant Diagnosis (PMTCT_EID). The MER indicator is disaggregated to include the number of children with an HIV outcome between 0 and 2 months and 2 and 12 months. The GAM indicator described here includes only those diagnoses by two months of age, and it uses a denominator of births to women living with HIV, including those women who were not in the PMTCT programme.