Data to construct the numerator should come from national program 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 prevention of mother-to-child transmission (PMTCT) services. All service providers should be included (public, private, non-governmental and community-based) and data should be collected continuously at the facility and community levels.

Data Source(s):

For the numerator: ANC and L&D registers; HIV testing and counseling registers; HIV TOOLS: reporting forms. For the denominator: published estimates (e.g., estimates from the UN Population Division)

Purpose:

This indicator measures the percentage of pregnant women who were tested and counseled for HIV in the last 12 months and who received their HIV test results. This indicator reflects one goal of PMTCT, which is to increase the number of pregnant women who know their HIV status. Identification of a pregnant woman’s HIV status is the key entry point into PMTCT services and other HIV care and treatment services (PEPFAR, 2009). Mother-to-child transmission (MTCT) of HIV infection can occur during pregnancy, labor and delivery, or during breastfeeding. Receiving HIV testing and counseling 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. The risk of MTCT can be reduced by a range of interventions, including provision of antiretroviral prophylaxis given to women during pregnancy and labor and to the infant in the first weeks of life; obstetrical interventions; and either complete avoidance of breastfeeding or early postpartum exclusive breastfeeding where safe and affordable breast milk substitutes are not feasible (WHO/UNICEF, 2003). For more background and international recommendations on infant feeding and PMTCT, see the technical area in this database on Women’s Nutrition and HIV.

Issue(s):

The indicator does not capture points at which drop-outs occur during the testing and counseling process; the reasons why drop-outs occur; the number of women who received pre-test counseling; nor the quality of HIV testing and counseling 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 (UNAIDS, 2008).

Gender Implications:

The availability of ARVs which can prevent the transmission of HIV from mother to child increase the value that voluntary counseling and testing (VCT) could have for pregnant women. Yet many women refuse testing and treatment. Health workers must recognize that VCT entails significant risks for women which may include partner violence and ostracism. Applying strict standards of confidentiality and privacy to VCT, as well as to the treatment phase (if one is required), is necessary to ensure that pregnant women will have enough trust in their own safety to risk being tested. The lack of treatment options for the mother herself remains a serious obstacle to PMTCT.

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR.  http://pdf.usaid.gov/pdf_docs/Pcaac330.pdf