Percentage of infants born to HIV-infected women who are provided with antiretrovirals to reduce the risk of HIV transmission during breastfeeding

Export Indicator

Percentage of infants born to HIV-infected women who are provided with antiretrovirals to reduce the risk of HIV transmission during breastfeeding
What it measures

This indicator measures progress in the prevention of mother-to-child transmission in breastfeeding populations by the provision of antiretroviral drugs to reduce the risk of HIV transmission during the breastfeeding period.

Rationale

The overall risk of PMTCT can be significantly reduced by providing antiretroviral drugs (as lifelong therapy or as prophylaxis) to the mother and by complementary practices related to safe delivery and appropriate infant feeding. In breastfeeding populations, antiretrovirals interventions to mothers or infants can specifically reduce the risk of transmission through breastfeeding and should be monitored.

Numerator

Number of infants born to HIV-infected women who, during the past 12 months, are breastfeeding and provided an antiretroviral intervention (i.e. maternal or infant ARVs) to reduce mother-to-child transmission through breastfeeding.

Denominator

Estimated number of infants born to HIV-infected women (HIV-exposed infants) who are breastfeeding during the past 12 months

Calculation

Numerator / Denominator

Method of measurement

The numerator is calculated from national programme records aggregated from facility registers.
Antiretroviral drug interventions to reduce HIV transmission through breastfeeding can be initiated shortly after delivery at facilities for labour and delivery if infants are 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.
In breastfeeding populations, antiretrovirals are recommended until one week after the cessation of breastfeeding. ARV coverage should be monitored throughout the duration. Currently, the proposed time point for a national indicator for ARV coverage during the breastfeeding is at or around 2-3 months to time it around the time of an infant's 6 week EID visit or DTP3 immunization visit and to capture the information at a time where loss to follow up may be minimal. The collection of this indicator is being field-tested and guidance may change in the future. Countries are encouraged to include the monitoring of ARV coverage during the breastfeeding period in their existing M&E system (please contact pmtctmoneval@who.int for further information).
The data for the numerator should be collected at the infant's 6 week EID visit or DTP3 immunization visit (2-3 months) and distinguished from ARV interventions given to prevent peripartum transmission. Data on whether maternal or infant antiretrovirals to reduce post-natal transmission were provided should be recorded for breastfeeding infants. HIV-infected pregnant women who are eligible for lifelong antiretroviral therapy and are receiving a treatment regimen and whose infants therefore benefit from the prophylactic effect of ART in reducing the risk of transmission through breastfeeding are also included in this indicator.
The denominator should represent the number of HIV-exposed infants who are breastfeeding. In settings where most exposed-infants would be breastfeeding, the estimated number of HIV-exposed infants could be a proxy for the denominator (with some adjustment of infant deaths before the time point for measurement if available). In other settings, where a sizable population of HIV-exposed infants may not be breastfeeding), it will be necessary to estimate the number of HIV-exposed infants who are breastfeeding.
Three methods for calculating the denominator can be considered:
• Counting at the time of labour and delivery: In settings where a high proportion of women give birth in health facilities, countries can estimate the denominator from only the labour and delivery register, by recording and counting the number of HIV exposed-infants whose initial feeding practice was breastfeeding, as a proxy for the denominator.
• Counting at postnatal or child health sites: In settings where a high proportion of women and children attend post-natal and child health sites, countries can count and aggregate the number of HIV-exposed infants who are breastfeeding recorded at postnatal or child health clinics if the exposure status of the child is likely to be known (e.g. from postnatal registers or stand-alone or integrated HIV-exposed infant registers).
Estimated number of women needing PMTCT as a proxy: In settings where almost all HIV+ women are likely to be breastfeeding, the estimated number of HIV+ women giving birth (e.g. women needing PMTCT from Spectrum) can be reviewed as a proxy, adjusting for any estimated deaths, if data exists. This proxy can also be reviewed with data collected from facilities to get a better idea of what proportion of the population is being captured in the numerator.
All public, private and nongovernmental organization-run health facilities that provide antiretroviral drugs for PMTCT should be included.

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

Measurement frequency

Periodic

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

This indicator allows countries to monitor their coverage of antiretrovirals prophylaxis provided among HIV-exposed infants to reduce the risk of post-natal HIV transmission in breastfeeding populations during a specific time point.
This indicator does not capture whether the drugs were taken or for how long, so it is not possible to determine adherence to the regimen or whether the regimen was completed.
Ideally, it is important to assess antiretroviral coverage throughout the breastfeeding period, but in many settings there is significant loss to follow-up after the 6 -week visit so it is difficult to get an accurate estimate of antiretroviral coverage at a later time point. In breastfeeding populations, effort should be made to ensure antiretroviral coverage during the breastfeeding period beyond 6 weeks or DTP3 as captured by this indicator.

Additional considerations: Countries that have mechanisms for giving antiretroviral drugs to HIV positive breastfeeding women or HIV-exposed infants during the postnatal period at Countries should periodically review data to assess whether ARV prophylaxis for the recommended full duration (until cessation of breastfeeding) was taken.

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 breastfeeding ARV prophylaxis regimen vis-à-vis the maternal ARV regimen.

Further information

Other references: PMTCT M&E Core Indicator #7