Preventing the mother-to-child transmission of HIV

Export Indicator

Percentage of pregnant women living with HIV who received antiretroviral medicine to reduce the risk of mother-to-child transmission of HIV
What it measures
Progress in preventing mother-to-child transmission of HIV during pregnancy and delivery by providing antiretroviral medicine
 
This indicator allows countries to monitor the coverage of provision of antiretroviral medicines to pregnant women living with HIV to reduce the risk of transmitting HIV to infants during pregnancy and delivery. When disaggregated by regimen, it can show increased access to more effective antiretroviral regimens for pregnant women living with HIV. Since the indicator usually measures the antiretroviral medicines dispensed and not those consumed, adherence to the regimen cannot be determined in most cases.
Rationale
Providing antiretroviral medicines (as lifelong therapy or as prophylaxis) for the mother during pregnancy and delivery can significantly reduce the risk of mother-to-child transmission. This entails antiretroviral medicine prophylaxis for the infant and antiretroviral medicines for the mother or child if breastfeeding and using safe delivery practices and safer infant feeding. The data will be used to track progress towards global and national goals of eliminating mother-to-child transmission; to inform policy and strategic planning; for advocacy; and for leveraging resources for accelerating scale-up. It will help measure the trends in the coverage of antiretroviral medicine prophylaxis and treatment and, when disaggregated by regimen type, will also assess progress in implementing more effective antiretroviral therapy regimens.
Numerator

Number of pregnant women living with HIV who delivered during the past 12 months and received antiretroviral medicines to reduce the risk of the mother-to-child transmission of HIV. Global reports summarizing the coverage of antiretroviral medicine for preventing mother-to-child transmission will exclude women who received single-dose nevirapine, since it is considered a suboptimal regimen. However, the country should report the number of women who only received single-dose nevirapine.

Denominator

Estimated number of women living with HIV who delivered within the past 12 months

Calculation

Numerator/denominator

 

 

Method of measurement
For the numerator. National programme records aggregated from programme monitoring tools, such as patient registries and summary reporting forms.
 
For the denominator. Estimation models such as Spectrum or antenatal clinic surveillance surveys combined with demographic data and appropriate adjustments related to the coverage of antenatal clinic surveys.
Measurement frequency

Annually or more frequently, depending on a country’s monitoring needs

Disaggregation
  • Cities and other administrative areas of importance.
  • The numerator should be disaggregated across the six general regimens described below.
Additional information requested
Please provide city-specific data for this indicator. Space has been created in the data entry sheet to provide information for the capital city as well as one or two other key cities of high epidemiological relevance: for example, those that have the highest HIV burden or have committed to ending AIDS by 2030.
Explanation of the numerator

The numerator should be disaggregated by the six categories below (WHO recommends the first three regimens) for pregnant women living with HIV for preventing mother-to-child transmission. Each woman should only be counted once in one of the six cells:

 
1. Newly initiated on antiretroviral therapy during the current pregnancy.
 
2. Already receiving antiretroviral therapy before the current pregnancy.
 
3. Maternal triple antiretroviral medicine prophylaxis (prophylaxis component of WHO option B).
 
4. Maternal AZT (prophylaxis component during pregnancy and delivery of WHO option A).
 
5. Single-dose nevirapine (with or without tail) only.
 
6. Other (please comment: for example, specify regimen, uncategorized, etc.).
 
The numerator must match the values included in Spectrum or an automated query will be sent requesting that the team make the values consistent. 
 
 

Categories

Further clarification

Common examples

The first two options include women receiving lifelong antiretroviral therapy (including option B+)

1. Newly initiating treatment during the current pregnancy.

2. Already receiving treatment before the pregnancy

A three-drug regimen intended to provide antiretroviral therapy for life:

1. Number of pregnant women living with HIV identified in the reporting period newly initiating lifelong antiretroviral therapy.

2. Number of pregnant women living with HIV identified in the reporting period who were already receiving antiretroviral therapy at their first antenatal clinic visit.

If a woman initiates lifelong antiretroviral therapy during labour, she would be counted in category 1.

If the number of women receiving antiretroviral therapy is not available by the timing of when they started, the number can be included in the cell entitled total number of pregnant women receiving lifelong antiretroviral therapy.

Standard national treatment regimen, for example:

■ TDF + 3TC + EFV

■ TDF + 3TC + DTG

 

3. Maternal triple antiretroviral medicine prophylaxis (prophylaxis component of WHO option B during pregnancy and delivery)

A three-drug regimen provided for prophylaxis of mother-to-child transmission started during pregnancy or as late as during labour or delivery with the intention of stopping at the end of the breastfeeding period (or stopping at delivery if not breastfeeding).

If a woman is receiving triple antiretroviral medicines for the first time at labour or delivery, then she should still be counted in this category if the facility is implementing option B.

■ TDF + 3TC + DTG

■  TDF + 3TC + EFV

■ AZT + 3TC + EFV

■ AZT + 3TC + LPV/r

4. Maternal AZT (prophylaxis component of WHO option A during pregnancy and delivery)

A prophylactic regimen that uses AZT (or another nucleoside reverse-transcriptase inhibitor (NRTI)) started as early as 14 weeks or as late as during labour or delivery to prevent HIV transmission.

If a woman is receiving antiretroviral medicines for the first time at labour or delivery, then she should still be counted in this category if the facility is implementing option A.

■ AZT at any point before labour + intrapartum NVP

■ AZT at any point before labour + intrapartum NVP + 7-day postpartum tail of AZT + 3TC

5. Single-dose nevirapine to the mother during pregnancy or delivery

■ Count this if nevirapine is the only regimen provided to a pregnant woman living with HIV during pregnancy, labour or delivery

Do not count as single-dose nevirapine if:

■ Nevirapine is provided as part of option A during pregnancy.

or

■ A pregnant woman living with HIV initiates option A, B or B+ at labour and delivery

■ Single-dose nevirapine for mother only at onset of labour

■ Single-dose nevirapine + 7-day AZT + 3TC tail only

■ Single-dose nevirapine for mother at onset of labour and single-dose nevirapine for baby only

The numerator must match the values included in Spectrum or an automated query will be sent requesting that the team make the values consistent.

Global AIDS Monitoring

Spectrum

1. Newly initiates treatment during the current pregnancy

Option B+: antiretroviral therapy started during current pregnancy (this is split among women who started ART less than four weeks before delivery and women starting more than four weeks before delivery)

2. Already receiving treatment before the pregnancy

Option B+: antiretroviral therapy started before current pregnancy

3. Maternal triple antiretroviral medicine prophylaxis (prophylaxis component of WHO option B during pregnancy and delivery)

Option B: triple prophylaxis from 14 weeks

4. Maternal AZT (prophylaxis component of WHO option A during pregnancy and delivery)

Option A: maternal AZT

5. Single-dose nevirapine to the mother during pregnancy or delivery

Single-dose nevirapine

6. Other (usually limited to countries still providing maternal AZT started late in the pregnancy)

Maternal AZT according to the 2006 WHO guidelines. Spectrum requires data on historical regimens. This category is maintained to describe the regimens provided in previous years.

 

Explanation of the denominator
Two methods can be used to estimate the denominator: an estimation model, such as Spectrum, using the output: the number of pregnant women needing services for preventing mother-to-child transmission; or, if Spectrum estimates are not available, by multiplying the number of women giving birth in the past 12 months (which can be obtained from estimates of the central statistics office, United Nations Population Division or pregnancy registration systems with complete data) by the most recent national estimate of HIV prevalence among pregnant women (which can be derived from HIV sentinel surveillance in antenatal clinic and appropriate adjustments related to coverage of antenatal clinic surveys).
 
 
Strengths and weaknesses

Countries are encouraged to track and report the number of women receiving the various treatment regimens so that the impact of antiretroviral medicines on mother-to-child transmission of HIV can be modelled based on their efficacy. If countries do not have a system for collecting and reporting this data, they should establish one. Efforts should be made to remove women captured twice in the reporting systems. A critical determinant of the effectiveness of mother-to-child transmission regimens is whether women have suppressed viral loads when their children are conceived. It is therefore essential for PMTCT registers to disaggregate by whether a woman was already on ART when she arrived for antenatal care.

Further information
The prevention of mother-to-child transmission is a rapidly evolving programme area, and methods for monitoring coverage of this service are likewise evolving. To access information, please consult the following.
 
WHO publications on mother-to-child transmission of HIV (http://www.who.int/hiv/pub/mtct/en).
 
WHO publications on HIV monitoring and evaluation (http://www.who.int/hiv/pub/me/en/index.html).