Antiretroviral therapy coverage among HIV-infected pregnant women for PMTCT (%)

Percent

In the absence of any preventative interventions, infants born to and breastfed by HIV-infected women have roughly a one-in-three chance of acquiring infection themselves. This can happen during pregnancy, during labour and delivery or after delivery through breastfeeding. The risk of mother-to-child transmission can be significantly reduced through the complementary approaches of antiretroviral regimens for the mother with or without prophylaxis to the infant, implementation of safe delivery practices and use of safer infant feeding practices. The purpose of this indicator is to assess progress in preventing mother-to-child transmission of HIV (PMTCT).

The percentage of HIV-infected pregnant women who received antiretroviral medicines to reduce the risk of mother-to-child transmission, among the estimated number of HIV-infected pregnant women.   Numerator: Number of HIV-infected pregnant women who received antiretroviral medicines to reduce the risk of mother-to-child transmission in the last 12 months Denominator: Estimated number of HIV-infected pregnant women in the last 12 months

Numerator There are four general antiretroviral categories that HIV-infected women can receive for the prevention of mother-to-child transmission (PMTCT): a) Single-dose Nevirapine only b) Prophylactic regimens using a combination of two antiretroviral drugs c) Prophylactic regimens using a combination of three antiretroviral drugs d) Antiretroviral therapy for HIV-infected pregnant women eligible for treatment HIV-infected women receiving any antiretroviral therapy, including specifically for prophylaxis, meet the definition for the numerator. Countries should report the total number of HIV-infected pregnant women who were provided with any antiretrovirals as the numerator. Countries can compile data for the numerator from patient registers at antenatal clinics, delivery and care sites, and post-partum care and HIV service sites.  This should be disaggregated by regimen type.  Women receiving antiretroviral drugs in both the private sector and the public sector should be included in the numerator where data for both are available.   Denominator The denominator is generated by estimating the number of HIV-infected women who were pregnant in the last 12 months. This is based on surveillance data from antenatal clinics. Two methods are possible for generating the estimate for the denominator: 1. Estimates generated by a projection model such as Spectrum (see Epidemiological software and tools, 2009); or 2. Multiplying: (a) the total number of women who gave birth in the last 12 months, which can be obtained from the Central Statistics Office estimates of births or estimates from the UN Population Division, by (b) the most recent national estimate of HIV prevalence in pregnant women, which can be derived from HIV sentinel surveillance antenatal clinic estimates. (UNAIDS/WHO, 2010)

Outcome

Estimating the numerator The number of pregnant women living with HIV receiving antiretrovirals for PMTCT is based on national programme data aggregated from facilities or other service delivery sites and as reported by the country.   Estimating the denominator The number of pregnant women living with HIV who need antiretroviral medicine for PMTCT is estimated using standardized statistical modelling based on UNAIDS/WHO methods that consider various epidemic and demographic parameters and national programme coverage of antiretroviral therapy in the country (such as HIV prevalence among women of reproductive age, effect of HIV on fertility and antiretroviral therapy coverage). These statistical modelling procedures are used to derive a comprehensive population-based estimate of the number of all pregnant women living with HIV who need antiretrovirals for PMTCT in the country.   Estimating the coverage of antiretrovirals for PMTCT The coverage of antiretrovirals for PMTCT is calculated by dividing the number of pregnant women living with HIV who received antiretrovirals for PMTCT of HIV by the estimated number of pregnant women living with HIV who need antiretrovirals for PMTCT in the country. Estimates of coverage are based on the standardized estimates of pregnant women living with HIV who need antiretrovirals for PMTCT derived using UNAIDS/WHO methods. Point estimates are given for countries with a generalized epidemic, these estimates are presented here. Point estimates and ranges for countries with a generalized epidemic, and ranges for countries with a concentrated epidemic are available in the report "Towards universal access - Scaling up priority HIV/AIDS interventions in the health sector". (WHO/UNAIDS/UNICEF, 2009)   Predominant type of statistics: predicted

N/A

Annual

In 2006, international guidelines were updated to recommend more efficacious regimens for prevention of mother-to-child transmission, and countries may be at different phases in adopting the newer recommendations. In some countries, large numbers of pregnant women do not have access to antenatal clinic services or choose not to make use of them. Pregnant women living with HIV may be more or less likely to use antenatal clinic services (or public rather than private antenatal clinic services) than those who are not infected, particularly where antiretroviral therapy can be accessed via such services or where levels of stigma are particularly high. National estimates of HIV-infected pregnant women should be derived by adjusting surveillance data from antenatal clinic sentinel sites and other sources, taking into consideration characteristics such as rural/urban patterns of HIV prevalence that may affect the representation of surveillance sites. Methods for monitoring coverage of this service are therefore also evolving. To access the most current information available please consult: http://www.who.int/hiv/topics/mtct/guidelines/en/index.html   (UNAIDS, 2009)