Percentage of infants born to HIV-infected women who received an HIV test within 12 months [disaggregated by type/timing of testing (virological testing within 2 months, virological testing between 2 and 12 months or antibody testing between 9 and 12 mont

Export Indicator

Percentage of infants born to HIV-infected women who received an HIV test within 12 months, disaggregated by type/timing of testing (virological testing within 2 months, virological testing between 2 and 12 months or antibody testing between 9 and 12 mont
What it measures

This indicator measures the extent to which infants born to HIV-infected women are tested for HIV within the first 12 months of life.

Rationale

Determining the HIV status of children exposed to HIV during pregnancy, labour or breastfeeding is an important part of follow-up services in programmes for the prevention of mother-to-child HIV transmission (PMTCT). Infants infected with HIV during pregnancy, delivery or early postpartum often die before they are recognized as having HIV infection. HIV testing and counselling should therefore be recommended for all HIV-exposed infants or infants born to HIV-positive women as a routine component of follow-up care. WHO recommends that national programmes establish the capacity to provide early HIV virological testing of infants at 6 weeks, or as soon as possible thereafter, to guide clinical decision-making at the earliest possible stage. Where virological testing is unavailable, antibody testing at 9-12 months is recommended.

Numerator

Number of infants in the last 12 months who received an HIV test within 12 months of birth, disaggregated by:
infants who received virological testing in the first 2 months; and
infants who were tested either virologically between 2 and 12 months, or by antibody testing between 9 and 12 months.

Denominator

Estimated number of HIV-infected pregnant women giving birth in the last 12 months. This is a proxy measure for number of infants born to HIV-infected women.
 

Calculation

Number of infants in the last 12 months who received an HIV test
within 12 months of birth
------------------------------------------------------------------------------------------------------------------------- x 100
Estimated number of HIV-infected pregnant women giving birth in the last 12 months

Method of measurement

Data for the numerator should be aggregated from the appropriate facility registers, which could include integrated Maternal and Child Health (MCH) registers, HIV-exposed infant follow-up registers, or pre-ART registers. The register used may vary depending on the country context. For example, where HIV-exposed infant follow-up takes place in the HIV care and treatment setting, countries may aggregate information either from a pre-ART register adapted for HIV-exposed infant follow-up or in a separate HIV-exposed infant register.
 
Where feasible, infants born to known HIV-infected mothers (who were identified as HIV-infected through a PMTCT programme) should be included in the numerator. The number of infants who were tested, and not the number of HIV tests performed, should be counted, since many infants may be tested multiple times.
All service providers should be included: public, private, faith-based and NGO-led.
The denominator is generated by estimating the number of HIV-infected women who were pregnant in the last 12 months. This is based on HIV surveillance data from antenatal clinics, and estimates can be generated by:
using a projection model, such as Spectrum; or
multiplying:

The total number of women who gave birth in the last 12 months × The most recent national estimate of HIV prevalence in pregnant women
The total number of women who gave birth in the last 12 months can be obtained from the Central Statistics Office estimates of births or the UN Population Division estimates. The most recent national estimate of HIV prevalence in pregnant women can be derived from HIV sentinel surveillance data collected in antenatal clinics.
 

Measurement frequency

Continuously

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

This indicator allows countries to monitor progress in reaching HIV-exposed infants with early infant testing as a critical tool for providing appropriate follow-up care and treatment. While ideally the indicator captures infants born to known HIV-infected women, it may not be feasible in some settings to exclude infants who were tested for HIV using virological testing or antibody testing through provider-initiated testing, such as in paediatric wards, malnutrition centres, and other settings where infants may be identified as exposed or infected.
 
This indicator does not capture the number of children with a definitive diagnosis (i.e., either confirmed or excluded of HIV infection), nor does it measure whether appropriate follow-up services were provided to the child based on the interpretation of test results. The indicator does not measure the quality of testing or the system in place for testing. A low value of the indicator could, however, signal potential bottlenecks in the system, including poor management of HIV test supplies in country, poor data collection, and/or mismanagement of testing samples.
 

Further information