Additional considerations: Countries may wish to also monitor the week of pregnancy that each woman is tested. Preventing congenital syphilis requires testing early in pregnancy, as stillbirth may occur in the second trimester. Knowing that women are being tested late in pregnancy will indicate either that women are not accessing ANC early or that testing is not occurring early in pregnancy.
Programmes that test pregnant women for syphilis and those that test pregnant women for HIV should work together to enhance the effectiveness of their individual programme work.

Data utilization: Global: Examine trends over time to assess progress towards target levels of testing coverage required for elimination of mother-to-child transmission of syphilis. Knowledge of testing policies and practices should be used to assist with interpretation of trends in coverage.
Local: Data can be used to identify clinics not fully implementing national policy.

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".

This indicator permits comparison of trends of the quantity of TC services delivered and the strength of scaling up TC services over time.

This indicator will provide information on the number of times T&C occurred, and not necessarily the number of people who received T&C services unless countries have a mechanism to avoid double-counting of repeat testers.

The indicator does not provide information on whether those who were tested were adequately referred to and receiving follow-up services to benefit from knowing their status.

Data utilization:
To know the number of tests conducted in the country, can compare with previous years to look at trends while considering the percentage of the population that may have already been tested recently. It can be useful to explore any patterns in testing, for example whether there were more tests conducted in a particular
season or month when there were campaigns, or whether many more people are being tested in particular health facilities or in the communities.

Additional considerations for countries
In some countries, a significant proportion of testing and counselling services are provided by community-based organizations or unregistered organizations, which often may not be included as part of national statistics. These organizations should be encouraged to register with national authorities so all data on testing and counselling could be reflected in the national statistics.

This indicator permits comparison of trends of the quantity of TC services delivered and the strength of scaling up TC services over time.

This indicator will provide information on the number of times T&C occurred, and not necessarily the number of people who received T&C services unless countries have a mechanism to avoid double-counting of repeat testers.

The indicator does not provide information on whether those who were tested were adequately referred to and receiving follow-up services to benefit from knowing their status.

Data utilization:
To know the number of tests conducted in the country, can compare with previous years to look at trends while considering the percentage of the population that may have already been tested recently. It can be useful to explore any patterns in testing, for example whether there were more tests conducted in a particular
season or month when there were campaigns, or whether many more people are being tested in particular health facilities or in the communities.

Additional considerations for countries
In some countries, a significant proportion of testing and counselling services are provided by community-based organizations or unregistered organizations, which often may not be included as part of national statistics. These organizations should be encouraged to register with national authorities so all data on testing and counselling could be reflected in the national statistics.

This indicator permits comparison of trends of the quantity of TC services delivered and the strength of scaling up TC services over time.
This indicator may provide information on the number of times T&C occurred, and not necessarily the number of people who received T&C services unless countries have a mechanism to avoid double-counting of repeat testers.
The indicator does not provide information on whether those who were tested were adequately referred to and receiving follow-up services to benefit from knowing their status.

Data utilization:
To know the number of tests conducted in the country, can compare with previous years to look at trends while considering the percentage of the population that may have already been tested recently. It can be useful to explore any patterns in testing, for example whether there were more tests conducted in a particular
season or month when there were campaigns, or whether many more people are being tested in particular health facilities or in the communities.

Additional considerations for countries
In some countries, a significant proportion of testing and counselling services are provided by community-based organizations or unregistered organizations, which often may not be included as part of national statistics. These organizations should be encouraged to register with national authorities so all data on testing and counselling could be reflected in the national statistics.

This indicator is intended to monitor availability of TC services as countries continue to expand TC. It does not intend to capture quality of TC services provided.

To look at progress in the number of health facilities which provide testing and counselling. Analyzing the data geographically and by type of health facilities, and triangulating it with population data, can provide insight into where there is a need to increase availability of TC services.

It is recommended that every health facility has the capacity to offer testing and counselling in generalized epidemics. In low-level and concentrated epidemics, the goal may not be to have TC services available in every facility.

This indicator is intended to monitor availability of TC services as countries continue to expand TC. It does not intend to capture quality of TC services provided.

To look at progress in the number of health facilities which provide testing and counselling. Analyzing the data geographically and by type of health facilities, and triangulating it with population data, can provide insight into where there is a need to increase availability of TC services.

It is recommended that every health facility has the capacity to offer testing and counselling in generalized epidemics. In low-level and concentrated epidemics, the goal may not be to have TC services available in every facility.

This indicator allows countries to monitor their coverage of antiretrovirals prophylaxis provided among HIV-exposed infants to reduce the risk of post-natal HIV transmission in breastfeeding populations during a specific time point.
This indicator does not capture whether the drugs were taken or for how long, so it is not possible to determine adherence to the regimen or whether the regimen was completed.
Ideally, it is important to assess antiretroviral coverage throughout the breastfeeding period, but in many settings there is significant loss to follow-up after the 6 -week visit so it is difficult to get an accurate estimate of antiretroviral coverage at a later time point. In breastfeeding populations, effort should be made to ensure antiretroviral coverage during the breastfeeding period beyond 6 weeks or DTP3 as captured by this indicator.

Additional considerations: Countries that have mechanisms for giving antiretroviral drugs to HIV positive breastfeeding women or HIV-exposed infants during the postnatal period at Countries should periodically review data to assess whether ARV prophylaxis for the recommended full duration (until cessation of breastfeeding) was taken.

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 breastfeeding ARV prophylaxis regimen vis-à-vis the maternal ARV regimen.

Other references: PMTCT M&E Core Indicator #7

The strength of this indicator is that it enables countries to monitor the extent to which HIV-infected pregnant women are receiving an intervention that is critical for accessing ART for their own health.
It does not capture whether HIV-infected pregnant women who were eligible for ART actually received it.
Although each category is mutually exclusive, there is a risk of double counting this indicator where HIV-infected pregnant women have been assessed both clinically and immunologically, as well as where women are assessed in different units or in a different facility. Countries should ensure systems are in place to minimize the risk of double counting.
This indicator does not capture women who may have been identified HIV-positive at labour and delivery and subsequently assessed for ART eligibility.

Further information:
Monitoring and Evaluating the Prevention of Mother-to-Child Transmission of HIV: A guide for national programmes. Towards the Elimination of Mother-to-Child Transmission, 2011. Available at: http://www.who.int/hiv/pub/me/en/index.html.

Additional considerations:
It is recommended that countries disaggregate by eligibility status for additional information on national trends in the percentage of pregnant women who are eligible for ART.
In settings where HIV-infected pregnant women are referred out to another health facility or another service unit within the same health facility, health providers should make an effort to document referrals made and services received for these women in the ANC/PMTCT register for better patient tracking and monitoring of
HIV-infected pregnant women.

Data utilization: The goal would be to aim for 100%; once 100% is reached routinely, this indicator may become obsolete. Explore further information on disaggregated data on whether eligibility was assessed through clinical staging or CD4 tests and any data available on how long it takes to receive a CD4 test result in various places.

This indicator allows countries to monitor efforts at increasing testing of male partners of pregnant women attending ANC services. It does not measure whether the male partner received his result or any follow-up services.
The indicator does not take into account ANC clients that have more than one partner or that may change partners over time. It also may not include partners that received HIV testing at non-ANC settings and which are not linked to ANC (e.g. general VCT or provider initiated testing).
Not all sites may be collecting data on male partner testing or routinely aggregating and reporting the data. Measuring this indicator may require additional investment and resources to revise data collection tools and summary reporting forms.

Additional considerations:
Although testing male partners is an important tool for increasing male involvement and preventing infection during pregnancy, it is also a critical entry point into ongoing and family focused care for the man. Health providers should ensure and document that appropriate follow-up services are provided to all male partners who
test HIV-positive, as part of a comprehensive care and treatment programme.

Data utilization: Interpret based on country context and applicability. Discuss how to increase
coverage.

Other references: PMTCT Additional Indicator # A-3

This indicator reflects new evidence of the need for a greater focus on wealth dimensions of vulnerability and the fact that that targeting on the basis of extreme poverty in high prevalence contexts ensures good coverage of poor households affected by HIV and AIDS . Proxy indicators of AIDS affectedness (such as “chronic illness’) have often been poorly associated with HIV, have weak associations with adverse developmental outcomes, and have proven difficult to define in household questionnaires.

This indicator demonstrates changing levels of economic support for the poorest households. In high prevalence contexts, in particular, the majority are likely to be HIV affected. The indicator also demonstrates changes in the composition of external support (e.g. cash, food, livelihoods) received by poor households.

The indicator does not measure directly economic support to HIV infected and affected households, which is difficult to establish during a survey, but implicitly suggests that households living in the bottom wealth quintile in high prevalence contexts are more likely to be negatively impacted by HIV and AIDS and in need of economic assistance. In order to keep measurement as simple as possible, the indicator does not attempt to identify the different sources of support to households but this should be partly captured in National AIDS Spending Assessments (NASA).

The collection of data through population-based surveys, particularly DHS and MICS, means that the indicator does not capture the status of people living outside of households such as street children, children in institutions and internally displaced populations. Separate surveys are needed to track coverage for such vulnerable populations.

For further information, please consult the following website:
o http://www.unicef.org/aids/index_documents.html