Abstract
BackgroundIn Brazil, due to the rapid increase in programmes for the prevention of mother-to-child transmission (PMTCT), routine programme data are widely available. The objective of this study was to assess the utility of programmatic data to replace HIV surveillance based on the antenatal care (ANC) surveillance survey (SS).MethodsWe analysed ANC SS data from 219 maternity service clinics. PMTCT variables were extracted from the ANC SS data collection form, which allowed us to capture and compare the ANC SS data and PMTCT HIV test results for each pregnant woman who completed the ANC SS. Both the PMTCT programme and the ANC SS tested for HIV using sequential ELISA and western blot for confirmation. We assessed the completeness (% missing) of the PMTC data included in the ANC SS.ResultsOf the 36,713 pregnant women who had ANC SS HIV tests performed, 30,588 also underwent PMTCT HIV testing. The HIV prevalence rate from routine PMTCT testing was 0.36%, compared to 0.38% from the ANC SS testing (relative difference −0.05%; absolute difference −0.02%). The relative difference in prevalence rates between pregnant women in northern Brazil and pregnant women central-west Brazil was −0.98 and 0.66, respectively. Of the 29,856 women who had HIV test results from both the PMTCT and ANC SS, the positive percent agreement of the PMTCT versus the surveillance test was 84.1% (95% confidence interval [CI]: 74.8–91.0), and the negative percent agreement was 99.9% (95% CI: 99.9–100.0). The PMTCT HIV testing uptake was 86.4%. The ANC SS HIV prevalence was 0.33% among PMTCT non-refusers and 0.59% among refusers, with a percent bias of −10.80% and a differential prevalence ratio of 0.56. Syphilis and HIV testing results were complete in 98% and 97.6% of PMTCT reports, respectively. The reported HIV status for the women at clinic entry was missing.ConclusionsAlthough there were consistent HIV prevalence estimates from the PMTCT data and the ANC SS, the overall positive percent agreement of 84.1% falls below the World Health Organization benchmark of 94.7%. Therefore, Brazil must continue to reinforce data collection practices and ensure the quality of recently introduced rapid HIV testing before replacing the PMTCT data with surveillance techniques. However, some regions with better results could be prioritized to pilot the use of PMTCT data for surveillance.
Highlights
In Brazil, due to the rapid increase in programmes for the prevention of mother-to-child transmission (PMTCT), routine programme data are widely available
PMTCT variables were collected through a specific form, and the results of the antenatal care (ANC) surveillance survey (SS) indicate that the Human immunodeficiency virus (HIV) national prevalence rate has remained stable, at approximately 0.4%, the testing of pregnant women has increased from 52% [3] to 86.6% [2]
Because study participants were present in both the PMTCT and ANC SS groups, we considered them dependent samples
Summary
In Brazil, due to the rapid increase in programmes for the prevention of mother-to-child transmission (PMTCT), routine programme data are widely available. [2,3,4,5,6,7,8] Data from these surveys are used to monitor HIV trends in pregnancy and are applied as a proxy to estimate the prevalence of HIV among adults in the general population [9]. In Brazil, each antenatal (ANC) HIV surveillance survey (SS) tested parturient women tested for HIV [3, 5,6,7], except in 2006, during which time the HIV prevalence was calculated from routinely collected data at facilities at the local level [4]. PMTCT variables were collected through a specific form, and the results of the ANC SS indicate that the HIV national prevalence rate has remained stable, at approximately 0.4%, the testing of pregnant women has increased from 52% [3] to 86.6% [2]
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