2016 indicator reference guide at-risk infants tested for hiv
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This document defines the indicator "Percentage of infants born to HIV-positive women who had a virologic HIV test done within 12 months of birth". It provides details on the numerator, denominator, and disaggregation categories for this indicator, which measures how many exposed infants receive early testing to determine their HIV status. Early diagnosis is critical to ensure untreated infants receive necessary treatment. The document also describes how to calculate and interpret this indicator, and what types of PEPFAR support can be counted.
2016 indicator reference guide at-risk infants tested for hiv
- 1. 18 Prevention Services October 2015 Prevention of Mother-to-Child Transmission (PMTCT)/Pediatrics Indicator code: PMTCT_EID 1 Percentage of infants born to HIV-positive women who had a virologic HIV test done within 12 months of birth Purpose: This indicator measures the extent to which infants born to HIV-positive women receive virologic testing to determine their HIV status within the first 12 months of life. Early diagnosis of infants who acquired HIV during pregnancy, delivery or in the early postpartum period is critical as infants have an increased risk of mortality if they go undiagnosed and untreated. NGI Mapping: C4.1 .D continuing slightly modified indicator, limited effect on trend analysis PEPFAR Support Target/Result Type: Both Direct Service Delivery (DSD) and Technical Assistance-Service Delivery Improvement (TA- SDI) targets and results should be reported to HQ Numerator: 1 Number of infants who had a virologic HIV test within 12 months of birth during the reporting period Denominator: 1 Number of HIV-positive pregnant women identified in the reporting period (including known HIV-positive women at entry into PMTCT) Disaggregation(s): 1 Infants who received a virologic test within 2 months of birth Infants who received their first virologic HIV test between 2 and 12 months of age Infants with a positive virologic test result within 2 months of birth Infants with a positive virologic test result within 2 and 12 months of birth Data Source: Lab databases, patient records, service outlet log books, HIV-exposed infant registers or other auditable source documentation at PEPFAR supported facilities. Data Collection Frequency: Data should be collected continuously at the facility level and aggregated in time for PEPFAR reporting cycles. Data should be reviewed regularly for the purposes of program management, to monitor progress towards achieving targets, and to identify and correct any data quality issues. Method of Measurement: A virologic test is a test used for HIV diagnosis in infants up to 18 months of age. The most commonly used form of virologic testing is HIV DNA PCR on dried blood spots (DBS). Tests used for clinical monitoring of children on ART, such as viral load quantification, should not be included here. Infants tested should be counted once, even if they have had more than one virologic test done during the reporting period. Explanation of Numerator: The numerator is calculated from PEPFAR-supported lab databases or program records. Only infants who have received a virologic test by 12 months of birth should be counted and reported. The numerator is calculated as follows: The number of infants who received a virologic test within 12 months of birth The numerator is disaggregated as follows: The number of infants who received a test within 2 months of birth The number of infants who received a virologic test for the first time between 2 and 12 months of age The number of infants with a positive virologic test result within 12 months of birth Explanation of Denominator: Number of HIV-positive pregnant women identified during the reporting period (include known HIV-positive at entry). This number serves as a proxy for the number of infants born to HIV-positive women. This denominator calculates a coverage estimate of PEPFAR contribution to early infant diagnosis in PEPFAR-supported countries. If a national level
- 2. 19 coverage is desired, then the national estimate of HIV-positive pregnant women should be used as the denominator. By using the number of the HIV-positive pregnant women identified in the reporting period as the denominator, this indicator is harmonized and comparable with the PEPFAR PMTCT ARVs/ART indicator. This is a facility-based denominator and not representative of the population. Interpretation: WHO recommends that national programs establish the capacity to conduct early virologic testing for HIV exposed infants at 4-6 weeks, or as soon as possible thereafter, to guide clinical decision-making at the earliest possible stage. Disaggregating this data by age provides a way for programs to track progress towards earlier testing of HIV-exposed infants and therefore earlier identification of HIV-infected infants who should then be initiated on treatment as soon as possible. This indicator allows countries to monitor progress in reaching HIV-exposed infants with early infant testing as a critical service that enables early identification of positive infants and reinforces the importance of exclusive breastfeeding and maternal ARVs during the breastfeeding period for those with an initial negative result. Since many countries do not have a unique patient identifier system for testing infants, and infants may receive more than one virologic test according to national testing algorithms, countries may have difficulty distinguishing between an initial virologic test and any subsequent virologic tests the infant receives (e.g., confirmatory virologic test in infant with an initial positive virologic result, second virologic test in infant with an initial negative virologic result). As a result, the data should be closely reviewed for double counting and efforts to deduplicate for reporting purposes should be made. Double counting will overestimate the number of infants receiving a virologic test and in some instances, may more accurately reflect the number of virologic tests conducted. The indicator does not measure the quality of testing or the system in place for testing. A low value of the indicator could, however, signal potential bottlenecks in the system, including poor management of HIV testing supply in country, poor data collection, and sample transportation issues, etc. PEPFAR Support: DSD: Individuals will be counted as receiving direct service delivery support from PEPFAR when BOTH of the below conditions are met: Provision of key staff or commodities AND frequent, at least quarterly, support to improve the quality of services. TA-SDI: Individuals will be counted as supported through TA-SDI when the point of service delivery receives support from PEPFAR that meets the second criterion only: Frequent, at least quarterly support to improve the quality of services. 1. PEPFAR is directly interacting with the patient or beneficiary in response to their health (physical, psychological, etc.) care needs by providing key staff and/or essential commodities for routine service delivery. For infants receiving PMTCT/HEI services, this includes procurement of critical commodities such as test kits, lab commodities, or ARVs, or funding for salaries of HCW. Staff who are responsible for the completeness and quality of routine patient records (paper or electronic) can be counted here; however, staff who exclusively fulfill MOH and donor reporting requirements cannot be counted. AND/OR 2. PEPFAR provides an established presence at and/or routinized, frequent (at least quarterly) support to those services at the point of service delivery. For PMTCT/HEI services, this ongoing support for service delivery improvement can include: training of PMTCT service providers, clinical mentoring and supportive supervision of
- 3. 20 PMTCT service sites, infrastructure/renovation of facilities, support of PMTCT service data collection, reporting, data quality, QI/QA of PMTCT services support, ARV consumption forecasting and supply management, support of lab clinical monitoring of patients, supporting patient follow-up/retention, support of mother mentoring programs. Additional References: HIV-P15. The Global Fund to Fight AIDS, Tuberculosis and Malaria Monitoring and Evaluation Toolkit 4th Edition. November 2011. (http://www.theglobalfund.org/en/me/documents/toolkit/) 3.2. Global AIDS Progress Reporting 2013: Construction of Core indicators for monitoring the 2011 UN Political Declaration on HIV/AIDS (http://www.unaids.org/en/media/unaids/contentassets/documents/document/2013/GARPR_2013_guidelines_en.p df) Refer to the PMTCT/Peds Treatment TWG with further inquiries.