Percentage of infants born to HIV-infected women provided with antiretroviral (ARV) prophylaxis to reduce the risk of early mother-to-child transmission in the first 6 weeks (i.e. early postpartum transmission around 6 weeks of age)

Export Indicator

Percentage of infants born to HIV-infected women provided with antiretroviral (ARV) prophylaxis to reduce the risk of early mother-to-child transmission in the first 6 weeks (i.e. early postpartum transmission around 6 weeks of age)
What it measures

Progress in the prevention of early postpartum mother-to-child transmission by the provision of antiretroviral prophylaxis for HIV-exposed infants

Rationale

The risk for mother-to-child transmission can be significantly reduced by the complementary approaches of providing antiretroviral drugs (as treatment or as prophylaxis) for the mother during pregnancy and delivery, with antiretroviral prophylaxis for the infant, and antiretrovirals to the mother or child during breastfeeding (if breastfeeding), and use of safe delivery practices and safer infant feeding.

Numerator

Number of infants born to HIV-infected women during the past 12 months who received antiretroviral prophylaxis to reduce early mother-to- child transmission (i.e. early postpartum, in the first 6 weeks).

Denominator

Estimated number of live births to pregnant HIV-infected women in the past 12 months

Calculation

Numerator / Denominator

Method of measurement

The numerator is calculated from national programme records aggregated from facility registers.
Antiretroviral drugs can be given to HIV-exposed infants shortly after delivery, at facilities for labour and delivery for infants born at facilities, at outpatient postnatal care or child clinics for infants born at home and brought to the facility, or at HIV care and treatment or other sites, depending on the country.
Three methods for calculating the numerator can be considered:
• Counting at the point of antiretroviral drug provision: In settings with low facility delivery rates, data for the numerator should be compiled from the sites where antiretroviral drugs are dispensed and where the data are recorded. 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.
• Counting around time of delivery: In settings where a high proportion of women give birth in health facilities, countries can estimate the numerator from only the labour and delivery register by counting the number of HIV-exposed infants who received a specific antiretroviral drug regimen before discharge from the labour and delivery ward. This may be the most reliable and accurate method for calculating this indicator in settings with a high proportion of facility deliveries and low follow-up, as the corresponding antiretroviral drug regimen dispensed is counted at the time of provision to the infant.
• Counting at postnatal or child health sites: Countries can also count and aggregate the number of HIV-exposed infants who received antiretroviral prophylaxis recorded at postnatal or child health clinics if attendance is high and the exposure status of the child is likely to be known (e.g. from postnatal registers, stand-alone registers or integrated HIV-exposed infant registers).
All public, private and nongovernmental organization-run health facilities that provide antiretroviral drugs to HIV-exposed infants for the prevention of mother-to-child transmission of HIV should be included.

Two methods can be used to estimate the denominator:
• a projection model, such as that provided by Spectrum software; use the output “number of pregnant woman needing prevention of mother-to-child transmission of HIV” as a proxy; or
• multiply the number of women who gave birth in the past 12 months (which can be obtained from estimates by central statistics office or the United Nations Population Division or pregnancy registration systems with complete data) by the most recent national estimate of HIV prevalence in pregnant women (which can be derived from HIV sentinel surveillance in antenatal care clinics), if Spectrum projections are unavailable.
• If there are data on the number of live births, they should be adjusted to derive a better proxy.

Data Quality Control and Notes for the Tool:
Please provide any comments that would help us interpret the data.

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

This indicator allows countries to monitor the coverage of antiretrovirals regimens dispensed or initiated among HIV-infected infants to reduce the risk of maternal HIV transmission. If disaggregated, this indicator can monitor increased access to more efficacious ARV regimens for PMTCT in countries that are scaling up newer
regimen categories.
The indicator measures the extent to which ARVs were dispensed for infants as prophylaxis. It does not capture whether the ARVs were consumed; thus it is not possible to determine adherence to the ARV regimen, nor whether ARV regimens were completed.

Additional considerations:
Countries that have developed mechanisms for reaching HIV-exposed infants at the community level with ARVs will want to ensure a system of data collection is in place for reporting infants receiving ARV regimens at the community level.

Data utilization: Compare the indicator value with coverage of the maternal ARV regimen (Indicator I-10) and discuss what the data may mean in the country context. Some countries may want to explore further and do a linked review of the infant ARV prophylaxis regimen vis-à-vis the maternal ARV regimen can be assessed.

Further information

Other references: PMTCT M&E Core Indicator #6