Percentage of pregnant women who know their HIV status (tested for HIV and received their results - during pregnancy, during labour and delivery, and during the post-partum period (<72 hours), including those with previously known HIV status)

Export Indicator

Percentage of pregnant women who know their HIV status (tested for HIV and received their results - during pregnancy, during labour and delivery, and during the post-partum period (<72 hours), including those with previously known HIV status)
What it measures

This indicator assesses efforts to identify the HIV serological status of pregnant women in the previous 12 months.

Rationale

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.

Numerator

Number of pregnant women of known HIV status.
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.
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 may not need to be retested if there is documented proof of their positive status , and in line with national guidelines on testing pregnant women. These women do, however, need services for PMTCT and are counted in the numerator.
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.

The numerator is the sum of categories a–c below:
(a-1) pregnant women who have an HIV test and receive their result during antenatal care;
(a-2) pregnant women with known HIV infection attending antenatal care for a new pregnancy;
(b) pregnant women of unknown HIV serological status attending labour and delivery who were tested and received results; and
(c) women of unknown HIV serological status attending postpartum services within 72 hours of delivery who were tested and received results.
Categories a-1, b and c include all women who were tested and received results, irrespective of the HIV test result. Category a-2 includes women with previously known HIV-positive status.

Data reported from facilities may be disaggregated 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 remainder).
See below for Disaggregation for Global Reporting.

Denominator

Estimated number of pregnant women in the past 12 months

Calculation

Numerator / Denominator

Method of measurement

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 counselling 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.

Disaggregation:
Pregnancy stages: ANC, L&D, postpartum
Receipt of results: tested, tested and received results
HIV serostatus: number HIV+

Data Quality Control and Notes for the Reporting Tool:

Double Reporting: There is a risk of double counting with this indicator, as a pregnant woman can be tested a few 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.
Please do not add all the number of women tested from ANC and L&D to get the total number of women tested. We are interested in knowing the number of women tested, and not the total number of tests (i.e. if a women is tested at ANC and again at L&D, try to only count her once). It is important to include those with previously known HIV infection in the numerator – even if they do not receive an HIV test, their HIV infection is identified for subsequent PMTCT interventions.
Number tested, as well as tested and received results: If available, please report the number of pregnant women tested, as well as the number of pregnant women tested and received results (latter should not exceed the former).
If your data collection system does not currently separate those with known and unknown HIV status and you are unable to provide the specific disaggregated data, please review the data available, and derive the best data for the number of pregnant women whose HIV status has been identified during pregnancy, L&D, or during the post-partum period within 72 hours.
Please provide any details that would help to interpret your data in the Comment section.
Please comment on the source of your denominator.

Measurement frequency
Disaggregation

HIV status: HIV positive, HIV negative

Service Type: Antenatal Care, Labour & Delivery, Postpartum

Explanation of the numerator

The numerator is the sum of categories a–c below:
(a-1) pregnant women who have an HIV test and receive their result during antenatal care;
(a-2) pregnant women with known HIV infection attending antenatal care for a new pregnancy;
(b) pregnant women of unknown HIV serological status attending labour and delivery who were tested and received results; and
(c) women of unknown HIV serological status attending postpartum services within 72 hours of delivery who were tested and received results.
Categories a-1, b and c include all women who were tested and received results, irrespective of the HIV test result. Category a-2 includes women with previously known HIV-positive status.

Data reported from facilities may be disaggregated 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 remainder).
See below for Disaggregation for Global Reporting.

Explanation of the denominator
Strengths and weaknesses

This indicator enables a country to monitor trends in HIV testing among pregnant women. The points at which drop-outs occur during the testing and counselling process and the reasons why they occur are not captured by this indicator.

This indicator does not measure the quality of the testing or counselling. It also does not capture the number of women who received pre-test counselling.

Additional considerations for countries:
Health facility registers should reflect known HIV infection among HIV-infected pregnant women coming to the ANC for a new pregnancy (even if they are not tested at that site), such as through a code, circle, or other method, in order for them to receive subsequent PMTCT interventions.
Not all categories will be applicable or significant to all settings (e.g. women of unknown status tested within 72 hours postpartum). Countries may want to prioritize investment of resources (revision of tools, time, money) for measuring the categories that are appropriate to their country context.
It may be important for programme managers to use additional sub-national and facility level indicators to measure trends and progress in the testing and counselling process, such as uptake of testing and receipt of results.
It is also important to know the number of women whose HIV status has been identified at each service, i.e. % ANC attendees whose HIV status is known; % L&D attendees whose HIV status is known, etc.
This indicator could be triangulated and validated using population-based surveys, such as the DHS, which generally occurs every five years, or the AIDS Indicator Survey, a population-based survey that can be done on a more periodic basis.

Data utilization: Look at trends over time. If disaggregated data is available by region, see whether any lower performing areas can be identified. Review if data is available on % of ANC attendees who know their status (including those with previously confirmed HIV status and those tested) and % of L&D attendees who know their status.

Further information

Other references: PMTCT M&E Core Indicator #3