(PMTCT_STAT_NAT / SUBNAT) Percentage of pregnant women with known HIV status
The risk of mother-to-child transmission (MTCT) can be significantly reduced by providing ARVs to the mother during pregnancy, delivery and (if applicable) breastfeeding. This indicator provides information on coverage of the first step in the prevention of mother-tochild transmission (PMTCT) cascade. High coverage enables early initiation of care and treatment for HIV-positive mothers. The total number of identified HIV-positive women provides the facility-specific number of pregnant women with HIV to start a facility-based PMTCT cascade.
This indicator is harmonized with GARPR indicators 3.4 (https://aidsreportingtool.unaids.org/static/docs/GARPR_Guidelines_2016_E...).
Number of pregnant women attending antenatal clinics (ANC) and/or had a facility based delivery and were tested for HIV during pregnancy, or already knew they were HIV positive
Number of pregnant women who attended ANC or had a facility-based delivery in the past 12 months
For the numerator and denominator: The data source is ANC, PMTCT and L&D program monitoring tools, such as patient registers and summary reporting forms.
Numerator: Count all women who were enrolled in ANC during the 12-month reporting period whose HIV status is known positive, or who received an HIV test result (positive or negative) during ANC. Reconcile with all women in the L&D register who whose date of delivery was in the 12 months reporting period and whose HIV status at L&D was known positive, or who received an HIV test result (positive or negative) at ANC or L&D to avoid double counting.
The numerator is a composite of the following two data components:
1) The number of women with known (positive) HIV infection attending ANC for a new pregnancy over the last reporting period
2) The number of women attending ANC, L&D who were tested for HIV and received results
The numerator can be summed from categories a-d below:
a) Number of pregnant women with unknown HIV status attending ANC who received an HIV test and result during the current pregnancy
b) Pregnant women with known HIV infection attending ANC for a newpregnancy
c) Number of pregnant women with unknown HIV status attending L&D who received an HIV test and result during their current pregnancy
d) Women with unknown HIV status attending postpartum services within 72 hours of delivery who were tested for the first time in the current pregnancy and received results.
A “status” is defined as a confirmed test result from a test during this pregnancy (either positive or negative) or already known HIV infection at antenatal clinic entry. An indeterminate test result should not be counted or reported as a part of this indicator.
For the denominator: Count all women who were enrolled in ANC during the 12-month reporting period OR delivered at the facility (recorded in the L&D register), reconciling the latter with the former using the ANC No. to avoid double counting.
As per global guidance (see GARPR indicator 3.4, link above), it is expected that the national program can reconcile information collected from ANC with L&D records. However in MER 2.0 the PEPFAR indicator for PMTCT_ART has been simplified to collect information only at antenatal care (ANC) sites to better align with 2016 WHO Consolidated ARV guidelines, reduce burden on data collection, and improve data quality. Therefore in reporting this indicator PEPFAR operating units should 1) utilize the national system whether it is able avoid double counting or not and are not expected to collect or report this information through a separate system 2) if it this is not possible to report individuals from both ANC and L&D, please include an explanation in the narrative whether the data is from ANC, L&D and/or both.
Pregnant women’s HIV status should be counted only once per pregnancy. This may be difficult if national guidelines recommend testing a pregnant woman more than once during a pregnancy or if a woman seroconverts during her pregnancy and has multiple tests.
Disaggregated data is required. This indicator should be disaggregated by:
- HIV status/test results:
o Known HIV infection at antenatal clinic entry (Known Positive)
o Tested HIV positive at ANC during current pregnancy (Newly tested positive)
o Tested HIV negative at ANC during current pregnancy (Newly tested negative)
To adequately plan the PMTCT program, these numbers are needed from both the National and subnational level. The subnational level is considered that in which the country team has prioritized their program (PSNU; District, province etc). This data should be entered for all SNUs, regardless of PEPFAR funding supporting these geographical area; so that the total of the subnational number should equal the total number of National number.
This data should be entered by the country team at both National and subnational level. Narratives should include the methodology used for National and subnational data.
Narratives should include information on how National and SNU estimates have been derived for both results and targets.
Host country teams often set targets by OU, and SNU level to plan their programs (please describe the target setting process that the host country employs in the narratives). Targets should aligned with the START free, STAY free, AIDS-free super-FAST TRACK initiative. If the host country does not develop targets for this indicator, then for planning purposes, data should be entered that includes MOH results from the previous reporting with the PEPFAR planned targets (at the least) should constitute the host country targets.