This indicator allows countries to monitor the coverage of antiretrovirals regimens dispensed or initiated among HIV-infected infants to reduce the risk of maternal HIV transmission. If disaggregated, this indicator can monitor increased access to more efficacious ARV regimens for PMTCT in countries that are scaling up newer
regimen categories.
The indicator measures the extent to which ARVs were dispensed for infants as prophylaxis. It does not capture whether the ARVs were consumed; thus it is not possible to determine adherence to the ARV regimen, nor whether ARV regimens were completed.

Additional considerations:
Countries that have developed mechanisms for reaching HIV-exposed infants at the community level with ARVs will want to ensure a system of data collection is in place for reporting infants receiving ARV regimens at the community level.

Data utilization: Compare the indicator value with coverage of the maternal ARV regimen (Indicator I-10) and discuss what the data may mean in the country context. Some countries may want to explore further and do a linked review of the infant ARV prophylaxis regimen vis-à-vis the maternal ARV regimen can be assessed.

Other references: PMTCT M&E Core Indicator #6

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.

Other references: PMTCT M&E Core Indicator #3

OST sites should be readily available and valid since they are typically licensed by the relevant authorities. However, the number of sites does not indicate the number of slots that may be available.
Obtaining subgroup population size estimates will be difficult and add extra uncertainty.

Additional considerations: Please refer to the WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (http://www.who.int/hiv/topics/idu/en/index.html) for a complete set of globally agreed indicators for people who inject drugs.

Data utilization: Get an idea of the availability of OST sites and trends over time in relation to the population size of opiate injectors in the country. Also try to analyse data based on geographical location of the OST sites and geographical distribution and population density of people who inject opioid drugs in the country. If possible, try to interpret this indicator considering information available on the number of OST slots in various sites. Try to assess whether sufficient OSTs are available for the number and distribution of opiate injectors in the country.

Other references: WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (http://www.who.int/hiv/pub/idu/idu_target_setting_guide.pdf)

Many NSPs are not "official" and therefore not counted among national program data.

Additional considerations:
Needle and syringe programmes (NSPs) are any programmes that include access to clean equipment and safe disposal through fixed or mobile exchange programmes and/or through pharmacies where equipment is available free of charge. In many countries pharmacy sales of injecting equipment are an important and sometimes the most significant source of clean injecting equipment accessible to drug users. However, pharmacies that sell needles and syringes are typically not counted in a retrievable database as part of a public health or harm reduction programme. If they are available, they should be counted and highlighted, if possible. Pharmacies that distribute needles and syringes free of cost typically do maintain records of needles distributed as part of the programme and should be included.
Please refer to the WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (http://www.who.int/hiv/topics/idu/en/index.html) for a proposed complete set of globally agreed indicators for people who inject drugs.

Data utilization: Get an idea of the availability of NSP sites, and trends over time. Also try to analyse data based on geographical location of the NSP sites and geographical distribution and population density of people who inject drugs in the country. Try to assess whether sufficient NSPs are available for the number and distribution of people who inject drugs in the country.

Other References: WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users ( http://www.who.int/hiv/topics/idu/en/index.html )

Number of people on OST should be readily available and valid since they are typically licensed by the relevant authorities.

Additional considerations
Please refer to the WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users ( http://www.who.int/hiv/topics/idu/en/index.html ) for a proposed complete set of globally agreed indicators for IDUs.

Data utilization: Try to assess whether sufficient OSTs are available for the number and distribution of people who are dependent on opiods in the country.

Other References: WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users ( http://www.who.int/hiv/topics/idu/en/index.html )

Strengths: Requiring testing by both tests enhances specificity of the reported numbers of positive tests. In addition, requiring testing by both tests will increase the likelihood of identifying active disease.
Weaknesses: Requiring testing by both tests increases the difficulty of acquiring data for this indicator.

Additional considerations: Quality assurance and quality control should be an integral part of syphilis testing to ensure reliable results.

Data utilization: Look at trends in comparable groups over time. Compare with data on trends of syphilis and HIV where available.

Strengths: Requiring testing by both tests enhances specificity of the reported numbers of positive tests. In addition, requiring testing by both tests will increase the likelihood of identifying active disease.
Weaknesses: Requiring testing by both tests increases the difficulty of acquiring data for this indicator.

Additional considerations
Quality assurance and quality control should be an integral part of syphilis testing to ensure reliable results.

Data utilization
Look at trends in comparable groups over time. Compare with data on trends of syphilis and HIV where available.

Strengths: Data on treatment of syphilis in antenatal care attendees is often routinely monitored in health facilities.

Weaknesses: Collection of treatment data may require collaboration with MCH programmes to ensure that it is available at a national level.

Additional considerations:
For purposes of this indicator, documentation of a single dose of penicillin is sufficient. Treatment of a pregnant woman positive for syphilis with a single injection of 2.4 mU benzathine penicillin prior to 24 weeks gestational age is sufficient to prevent transmission of syphilis from mother to infant. However, three injections spaced at weekly intervals are recommended to treat latent syphilis and prevent tertiary syphilis in the mother.

Data utilization:
Global/regional/local: Estimate programme effectiveness in reducing syphilis-associated perinatal morbidity and mortality.
Local: Identify areas in need of assistance with programme implementation or additional resources.
All levels: Knowledge of treatment policies and practices should be used to assist with interpretation of trends in treatment.

Other References: Recommended indicator in "National-Level Monitoring of the Achievement of Universal Access to Reproductive Health: Conceptual and practical considerations and related indicators"; recommended indicator in "Methods for Surveillance and Monitoring of Congenital Syphilis Elimination within Existing Systems".

Strengths: Data on syphilis positivity in pregnant women are available in most countries through routine health system reporting.
Weaknesses: Differences in test type used or changes in testing practices may affect data. Knowledge of testing practices within the country (e.g., proportion of treponemal vs. non-treponemal testing used) should be used to assist with interpretation of disease trends.

Additional considerations: • Countries are encouraged to use unique identifiers or registers that separate first and subsequent tests so that the data reflect syphilis true prevalence or incidence rather than test positivity.
• Since most countries will have data from a variety of test types, sub-analysis (disaggregation) in 15 to 24 year old women may increase the likelihood that test positivity reflects recent infection.

Data utilization: Global/regional: Estimate perinatal mortality and morbidity caused by syphilis that could be averted with effective programmes to eliminate MTCT of syphilis. Identify areas at greatest need of comprehensive congenital syphilis prevention interventions.
Local: Follow trends over time to assess changes in burden of disease and STI prevention programme needs.
All levels: Compare data on trends of syphilis and HIV to look for early warning of increased risk of HIV transmission.

Other References: Recommended indicator in "National-Level Monitoring of the Achievement of Universal Access to Reproductive Health: Conceptual and practical considerations and related indicators" and "Methods for Surveillance and Monitoring of Congenital Syphilis Elimination within Existing Systems".