Abstract
BackgroundOpt-out HIV testing is offered at 70% of antenatal care (ANC) clinics in Mozambique through the prevention of mother-to-child transmission (PMTCT) program. If routine data from this program were of sufficient quality, their heightened coverage and continuous availability could complement or even replace biannual sentinel serosurveys that currently serve as the primary HIV surveillance system in Mozambique.MethodsWe assessed the efficacy of routine HIV testing data from prevention of mother-to-child transmission programs for estimating the prevalence of HIV infection among pregnant women. The PMTCT program uses sequential point-of-care rapid tests conducted on site while ANC surveillance surveys use dried blood spots tested sequentially for HIV-1/2 antibodies at a central laboratory. We compared matched routine PMTCT and ANC surveillance test results collected during 2007 and 2009 ANC surveillance surveys from 36 sentinel sites.ResultsAfter excluding 659 women without PMTCT data, including 83 who refused rapid testing, test results from a total of 20,563 women were available. Pooling the data from both years indicated HIV prevalence from routine PMTCT testing was 14.4% versus 15.2% from surveillance testing (relative difference -5.1%; absolute difference -0.78%). Positive percent agreement (PPA) of PMTCT versus surveillance tests was 88.5% (95% Confidence Interval [CI]: 85.7-91.3%), with 19 sites having PPA below 90%; Negative percent agreement (NPA) was 98.9% (CI: 98.5-99.2%). No significant difference was found among three regions (North, Center and South), however both PPA and NPA were significantly higher in 2009 than 2007 (p < 0.05).ConclusionsWe found low PPA of PMTCT test results compared to surveillance data which is indicative either of testing errors or data reporting problems. Nonetheless, PPA improved significantly from 2007 to 2009, a possible positive trend that should be investigated further. Although use of PMTCT test results would not dramatically change HIV prevalence estimates among pregnant women, the impact of site-level differences on surveillance models should be evaluated before these data are used to replace or complement ANC surveillance surveys.
Highlights
Opt-out HIV testing is offered at 70% of antenatal care (ANC) clinics in Mozambique through the prevention of mother-to-child transmission (PMTCT) program
Those who refuse to give blood for syphilis testing are ineligible for the survey, those refusing syphilis testing or ANC surveillance could still participate in PMTCT HIV testing
The median Positive percent agreement (PPA) across all 36 surveillance sites was 88.8% (Interquartile Range [Inter-quartile range (IQR)]: 83.1-93.0%, minimum 63.8%, maximum 100.0%); Nineteen sites had a PPA below 90% (See Additional file 1: Table S1, which shows site-level measures of agreement)
Summary
Opt-out HIV testing is offered at 70% of antenatal care (ANC) clinics in Mozambique through the prevention of mother-to-child transmission (PMTCT) program. Antenatal care HIV surveillance was restricted to one site in the capital city until the end of the civil war in 1992, but expanded rapidly in the late nineties, reaching 36 sites located in both urban and rural areas and in all 11 provinces by 2001. These surveys are currently conducted every two years and as of 2007 have been based on centralized Enzyme-Linked Immunosorbent Assay (ELISA) testing of dried blood spot (DBS) specimens for presence of HIV antibodies prepared from leftover blood from routine syphilis tests. If routine HIV test data from the PMTCT program can provide reliable estimates of HIV prevalence in pregnant women, these data could supplement or replace traditional ANC serosurveys, at lower cost and potentially with greater frequency, coverage and precision
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