Number of pregnant women with known HIV status (includes women who were tested for HIV and received their results

Export Indicator

Number of pregnant women with known HIV status (includes women who were tested for HIV and received their results
What it measures

GFATM: This indicator assesses efforts to identify the HIV serological status of pregnant women in the previous 12 months. Identification of a pregnant woman’s HIV serological status provides an entry point for other services for PMTCT and to tailor prevention, care and treatment to her needs.

This can be used in generalized epidemics, and also applies in countries with policies to identify the HIV status of all pregnant women. Countries with low-level or concentrated epidemics that do not have policies to identify the HIV status of all pregnant women should adapt the denominator on the basis of the target population of pregnant women whose HIV status is to be assessed, according to their national policy or strategy.

 

Rationale

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.
These data will be important to PEPFAR Headquarters, TWGs and USG country-level managers in order to:
• Identify progress toward the USG goal to reach 80% of pregnant women with HIV testing and counseling
• Determine PEPFAR and PEPFAR-funded partners’ performance in providing HIV testing to pregnant women
• Identify countries/ partners needing assistance with program implementation

Numerator

Number of pregnant women who were tested for HIV and know their results

GFATM: Number of pregnant women of known HIV status

Denominator

Number of new ANC and L&D clients

GFATM: Estimated number of pregnant women in the past 12 months

Calculation

NUmerator / Denominator

Method of measurement

The numerator is a composite of the following two data components:

The number of women with known (positive) HIV infection attending ANC for a new pregnancy over the last reporting period

The number of women attending ANC, L&D who were tested for HIV and received results (These should also be counted in indicator P11.1.D)

The numerator can be summed from categories a-d below:
a) Number of pregnant women who received an HIV test and result during ANC
b) Number of pregnant women attending L&D with unknown HIV status who were tested in the L&D and received results
c) Women with unknown HIV status attending postpartum services within 72 hours of delivery who were tested and received results
d) Pregnant women with known HIV infection attending ANC for a new pregnancy.

Explanation of Numerator:
The numerator is calculated using national and/or PEPFAR program records aggregated from facility registers in the ANC and L&D. In countries with high L&D attendance rates (>90%), data can be collected from L&D registers only.
Health facility registers should reflect known HIV infection among HIV-positive pregnant women coming to the ANC for a new pregnancy, such as through a code, circle, or other method, in order for them to receive subsequent PMTCT interventions.

Pregnant women with unknown status: women who were not tested during ANC or at L&D for this pregnancy or did not have documented proof of having been tested during ANC or at L&D for this pregnancy.

Pregnant women with known HIV-infection: women who were tested and confirmed HIV-positive at any point prior to the current pregnancy, who are attending ANC for a new pregnancy. Pregnant women with known HIV infection attending ANC for a new pregnancy do not need retesting if that is in line with the national guidelines on testing pregnant women and/or, as long as they bring documented proof of their positive status with them. However, these women do need subsequent PMTCT services, and so should be counted in the numerator.

In this case, documented proof may include (but is not limited to), a health card with HIV status noted in it, test results from another testing center, or any other document that denotes that the bearer of the document is HIV positive.

PEPFAR denominator:
The total number of new clients attending ANC and L&D services at USG-supported sites should be used as the denominator. This total will include the number of new clients who attend PMTCT services at USG-supported ANC sites and the number of women who present at L&D sites supported by USG with unknown status (as a proxy for those who have not attended ANC with PMTCT services). USG country team is to identify the best source of data for unduplicated individuals. If the country has high facility delivery rates (>90%), the L&D data may be used as the denominator, otherwise ANC data should be used.

Note: This indicator is meant to measure the number of pregnant women who know their HIV status and is not meant to provide programmatic guidance around the types of services that should accompany HIV testing (i.e. counseling). All HIV testing programs should be adhere to national or international standards. 
 
Disaggregation (Essential/Not reported): Known positives at entry; Number of new positives identified

GFATM: This is compiled from the number of women of unknown HIV serological status attending antenatal care, labour and delivery and postpartum services, who have been tested for HIV and know their results and women with known HIV infection attending antenatal care for a new pregnancy in the past 12 months.
The numerator is the sum of categories a–d below:

(a) pregnant women who have an HIV test and receive their result during antenatal care;
(b) pregnant women of unknown HIV serological status attending labour and delivery who were tested and received results;
(c) women of unknown HIV serological status attending postpartum services within 72 hours of delivery who were tested and received results; and
(d) pregnant women with known HIV infection attending antenatal care for a new pregnancy.

Pregnant (and postpartum) women of unknown serological status:
women who were not tested during antenatal care or at labour and delivery for this pregnancy or do not have documented proof of having been tested during this pregnancy.

(a)-(c) include all women who were tested and received results, irrespective of the HIV test result.
(d) includes women with previously known HIV positive status.

Pregnant women with known HIV infection: women who were tested and confirmed to be HIV-positive at any time before the current pregnancy, who are attending antenatal care for a new pregnancy.
These women do not need to be retested if there is documented proof of their positive status1, in line with national guidelines on testing pregnant women. These women do, however, need services for PMTCT and are counted in the numerator.

Disaggregation into:
(a) women with known (positive) HIV infection at antenatal care,
(b) women newly identified as HIV positive and
(c) women testing HIV negative.
The numerator is calculated from national programme records aggregated from facility registers for antenatal care, labour and delivery and postpartum care. In countries with high rates of facility attendance for labour and delivery, data can be collected from labour and delivery registers only, as the results of HIV testing will be available for most pregnant women from this one source. Health facility registers should record known HIV infection in pregnant women coming to antenatal care clinics for a new pregnancy, so that they receive services for PMTCT.

All public, private and nongovernmental organization-run health facilities that are providing testing and counseling for pregnant women should be included.

The denominator is derived from a population estimate of the number of pregnant women giving birth in the past 12 months. This can be obtained from estimates of births from the central statistics office or from the United Nations Population Division or pregnancy registration systems with complete data.

Measurement frequency

Periodic

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator enables the USG PEPFAR team to monitor trends and uptake in HIV testing among pregnant women at the National level

The points at which drop-outs occur during the testing and counseling process and the reasons why they occur are not captured by this indicator.
This indicator does not measure the quality of the testing or counseling. It also does not capture the number of women who received pre-test counseling.

There is a risk of double counting with this indicator, as a pregnant woman could be tested multiple times during ANC, L&D, or postpartum. This is particularly true where women get re-tested in different facilities, or where they come to the L&D without documentation of their test. While not feasible to avoid double counting entirely, countries should ensure a data collection and reporting system is in place to minimize it, such as using patient held and facility held ANC records to document that testing took place.

GFATM: This indicator makes it possible to monitor trends in HIV testing among women attending antenatal care. This indicator does not capture individual components of the testing process such as the number of women counseled, but not tested; or women who were tested and counseled, but did not receive their results. It is a measure neither of the quality of testing or counselling nor of the number of women who receive counselling before or after testing.

There is a risk for double-counting with this indicator, as a pregnant woman can be tested more than once during antenatal care, labour and delivery or postpartum care, particularly when women are retested in different facilities, when they come to antenatal care or labour and delivery services without documentation of their previous results or when they are re-tested after a previous negative test result during the pregnancy. While double-counting cannot be avoided entirely, countries should set up a data collection and reporting system to minimize it.

Not all categories will be applicable to or significant for all settings, e.g. women of unknown status tested within 72 hours postpartum. Countries may wish to revise their methods and allocate time and other resources for measuring the categories appropriate to their context.

Further information