Abstract
BackgroundIn the absence of reliable data, antenatal HIV surveillance has been used to monitor the HIV epidemic since the late 1980s. Currently, routine data from Prevention of Mother-to-child HIV transmission (PMTCT) programmes are increasingly available. Evaluating whether the PMTCT programme reports provide comparable HIV prevalence estimates with the antenatal surveillance reports is important. In this study, we compared HIV prevalence estimates from routine PMTCT programme and antenatal surveillance in Addis Ababa with the aim to come up with evidence based recommendation.MethodsSummary data were collected from PMTCT programmes and antenatal surveillance reports within the catchment of Addis Ababa. The PMTCT programme data were obtained from routine monthly reports from 2004 to 2009 and from published antenatal HIV surveillance reports from 2003 to 2009. Data were analysed using descriptive statistics.ResultsIn Addis Ababa, PMTCT sites had increased from six in 2004 to 54 in 2009. The site expansion was accompanied by an increased number of women testing. There were marked increases in the rate of HIV testing following the introduction of routine opt-out HIV testing approach. Paralleling these increases, the HIV prevalence showed a steady decline from 10.0% in 2004 to 4.5% in 2009. There were five antenatal surveillance sites from 2003 to 2007 in Addis Ababa and they increased to seven by 2009. Four rounds of surveillance data from five sites showed a declining trend in HIV prevalence over the years. The overall antenatal surveillance data also showed that the HIV prevalence among antenatal attendees had declined from 12.4% in 2003 to 5.5% in 2009. The HIV prevalence estimates from PMTCT programme were 6.2% and 4.5% and from antenatal surveillance 6.1 and 5.5% in 2008 and 2009 respectively.ConclusionsThere were consistent HIV prevalence estimates from PMTCT programme and from antenatal surveillance reports. Both data sources showed a marked decline in HIV prevalence among antenatal care attendees in Addis Ababa. This study concludes that the routine data from the PMTCT programmes in Addis Ababa provides comparable HIV prevalence estimates with antenatal HIV surveillance data and could be used for monitoring trends.
Highlights
In the absence of reliable data, antenatal Human immunodeficiency virus (HIV) surveillance has been used to monitor the HIV epidemic since the late 1980s
Prabhu et al have done an economic evaluation in Zanzibar to estimate incremental costs of antenatal surveillance using routine Prevention of mother-to-child HIV transmission (PMTCT) programme data and reported that routine Prevention of Mother-to-child HIV transmission (PMTCT) report provides considerable cost saving compared to antenatal surveillance [8]
The PMTCT reports In Addis Ababa, as the number of facilities providing PMTCT services increased from six in 2004 to 54 in 2009, the number of women receiving HIV testing showed a year by year increase (Table 1)
Summary
In the absence of reliable data, antenatal HIV surveillance has been used to monitor the HIV epidemic since the late 1980s. Evaluating whether the PMTCT programme reports provide comparable HIV prevalence estimates with the antenatal surveillance reports is important. We compared HIV prevalence estimates from routine PMTCT programme and antenatal surveillance in Addis Ababa with the aim to come up with evidence based recommendation. From an ethical point of view, the antenatal surveillance does not offer direct individual level benefits to the women since the test is anonymous and unlinked. Prabhu et al have done an economic evaluation in Zanzibar to estimate incremental costs of antenatal surveillance using routine Prevention of mother-to-child HIV transmission (PMTCT) programme data and reported that routine PMTCT report provides considerable cost saving compared to antenatal surveillance [8]
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