Percentage of pregnant women who were tested for HIV and who know their results [disaggregated by service type (Antenatal Care, Labour & Delivery, Postpartum)]

Export Indicator

Percentage of pregnant women who were tested for HIV and who know their results, disaggregated by service type (Antenatal Care (ANC); Labour & Delivery (L&D); Postpartum).  
What it measures

This indicator measures the percentage of pregnant women who were tested for HIV in the last 12 months and who received their HIV test results.

Rationale

Mother-to-child transmission (MTCT) of HIV infection can occur during pregnancy, labour and delivery or during breastfeeding. The risk of MTCT can be reduced by a range of interventions, including provision of antiretroviral prophylaxis given to women during pregnancy and labour and to the infant in the first weeks of life; obstetrical interventions, including elective caesarean delivery; and complete avoidance of breastfeeding.
Receiving HIV testing and counselling services as early as possible during pregnancy enables HIV-positive pregnant women to benefit from HIV services and to access interventions for reducing HIV transmission to their infants.

Numerator

The number of women attending antenatal care, labour & delivery, and postpartum services who were tested for HIV and received their result, plus women with known HIV infection attending ANC for a new pregnancy in the last 12 months.

Denominator

Estimated number of pregnant women in the last 12 months.
 
 

Calculation

[Pregnant women who received an HIV test and result during ANC] + [Pregnant women attending L&D with unknown HIV status who were tested for HIV in the L&D facility and received their result] + [Women with unknown HIV status attending postpartum services within 72 hours of delivery who were tested for HIV and received their result] + [Pregnant women with known HIV infection attending ANC for a new pregnancy]
--------------------------------------------------------------------------------------------------------------------------------------- x 100
Estimated number or pregnant women in the last 12 months

Method of measurement

The numerator is the sum of categories a-d:
pregnant women who received an HIV test and result during ANC;
pregnant women attending L&D with unknown HIV status who were tested for HIV in the L&D facility and received their result;
women with unknown HIV status attending postpartum services within 72 hours of delivery who were tested for HIV and received their result;
pregnant women with known HIV infection attending ANC for a new pregnancy.
 
Pregnant (and postpartum) women with unknown status are women who were not tested during ANC or L&D for this pregnancy or did not have documented proof of having been tested during ANC or L&D for this pregnancy.
Pregnant women with known HIV-infection are 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 to be re-tested but do need subsequent PMTCT services, and are counted in the numerator.
Data to construct the numerator should come from national programme records aggregated from facility registers in ANC, L&D, and postpartum services. Health facility registers should include data on known HIV infection among HIV-infected pregnant women accessing ANC services for a new pregnancy in order for them to receive subsequent PMTCT services. All service providers should be included: public, private, faith-based and NGO-led.
Not all categories are 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 for measuring the categories that are appropriate to their country context.
The denominator is generated through a population estimate of the number of pregnant women giving birth in the last 12 months, which can be obtained from the Central Statistics Office estimates of births or the UN Population Division estimates.
In countries with low-level and concentrated epidemics where policies to identify the HIV status of all pregnant women do not exist, the denominator should be adapted to the target population of pregnant women whose HIV status should be assessed.

Measurement frequency

Continuously

Disaggregation

Service Type: Antenatal Care, Labour & Delivery, Postpartum

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator enables a country to monitor trends in HIV testing among pregnant women and women receiving postpartum services who may require ARV drugs to prevent mother-to-child transmission of HIV. This indicator provides a good measure of how effectively HIV testing and counselling services are being provided to pregnant women and women receiving postpartum services. However, it does not capture the points at which drop-outs occur during the testing and counselling process; the reasons why drop-outs occur; the number of women who received pre-test counselling; nor the quality of HIV testing or counselling services.
 
There is a risk for double counting women in the numerator since a pregnant woman can be tested more than once while receiving ANC, L&D, or postpartum services. This is particularly true where women are re-tested in different facilities, or where they come to the L&D without documentation of their HIV test result. While it may not be feasible to avoid double counting entirely, countries should take measures to minimize double counting such as through the use of patient-held records that document, among other services, that HIV testing was done.
 

Further information