DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results

Jack Hyyombo Tambwe Kokolomami

doi:10.11648/j.cajph.20180405.13

Abstract

Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen's Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 - 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.

Highlights

In 2013, the HIV prevalence in the general population of the Democratic Republic of Congo (DRC) was 1.2% [1]
The Antenatal Clinics (ANC) and AUT-sentinel surveillance (SS) data were available for 26,301 pregnant women, collected at 60 sentinel sites, while data from Prevention of Mother-To-Child Transmission (PMTCT) routine testing were available for 12,291women
For example, Subsequent to assessing the five criteria proposed by the World Health Organization (WHO), some researchers have shown that some countries were ready to transit from ANC-SS data to the routine PMTCT data, for HIV surveillance purpose [8]

Summary

Introduction

In 2013, the HIV prevalence in the general population of the Democratic Republic of Congo (DRC) was 1.2% [1]. PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results. Since 2003, the HIV epidemic sentinel surveillance field activities are organized every two years, the protocol calls for a yearly collection of data. The DRC could only be interested in the current WHO recommendations to use as far as possible routine HIV screening data, including and especially those from the prevention of mother-to-child transmission of HIV programs (PMTCT), for purposes of HIV surveillance. Before transitioning from ANC AUT-SS data based surveillance to the one using routine testing on PMTCT program data, it should be assessed whether the country is ready to do this. The WHO recommends to evaluate five criteria of the database and the quality of the PMTCT program data for this assessment [7].

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Results

Conclusion