Number of HIV-exposed infants receiving a virological test for HIV within two months of birth

Background

Infants born to mothers that are HIV-positive should be tested within four to six months of birth, per World Health Organization (WHO) recommendation, to ensure that antiretroviral therapy (ART) can be provided—ART has been shown to reduce risks of death by AIDS-related illness by 75 percent. Earlier initiation of ART in infants is effective in preventing death and disease progression, but about half of those infected perinatally, and a quarter infected through breastfeeding, will die before their first birthday without treatment. Identification of infants that are exposed to HIV is a crucial element of early infant diagnosis, but identifying infants exposed postnatally, for testing and services, has been proven to be a challenge. HIV DNA polymerase chain reaction testing on dried blood spots has significantly improved early infant diagnosis (EID) services. The WHO has recommended that EID be provided during the six-week immunization visit postpartum for all infants, given the high rate of coverage for vaccination in resource-poor settings, but the WHO recommendation has yet to translate to high EID rates. Barriers to prevention of mother-to-child transmission services in developing countries have been linked to ineffective communication and continuity between antenatal, delivery, and postnatal facilities and poor information systems.

Community workers are essential to the effort to ensure newborns are linked to immunization visits and then also HIV testing, given the importance of motivating and counseling mothers at the household level. Using community workers for case finding and community-based HIV testing has been shown to reduce the burden on health clinics and to increase enrollment in care. This indicator measures the extent to which infants born to women living with HIV are tested within two months of birth to ascertain HIV status and eligibility for ART, and the extent to which community programs are progressing towards this aim. Early diagnosis is key to ensuring early treatment, given the intensity of disease progression among children.

Numerator

Number of infants who received an HIV test within two months of birth during the reporting period

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

This indicator counts the number of infants born to HIV-positive mothers in the community that were linked to testing services within two months of birth, at least once during the reporting period. Community workers should track HIV-positive pregnant women through their pregnancies and up until the point where risk of vertical transmission to their infants is eliminated. They can collect this information by coordinating with service delivery points and community programs, but also by discussing these questions with the mothers themselves, verifying the age of the infant, and determining whether testing services were received within eight weeks of birth. The community worker should be aware of the date of testing, the infant’s age at testing, and the results of the test.

Data source

This information is normally collected through reporting forms given to community workers to track HIV-positive pregnant women and their infants through the continuum of care.

Disaggregation

• Infant age (3 months, 9 months, 18 months, within 2 months)
• Test result (Negative: within 2 months, between 2–12 months; Positive: within 2 months, between 2–12 months)
• Sex

Data quality considerations

Limiting the period to two months is said to eliminate the possibility of repeated tests for the same infant and prevent double counting. This indicator does not track whether infants have a definitive diagnosis of HIV or whether appropriate services were provided to the child based on the results of testing. It also does not look at the quality of the testing services provided. Disaggregation by test result should not be used as a proxy for mother-to-child transmission rates.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Early infant diagnosis

Category

Prevention of Mother-to-Child Transmission, Vulnerable Children, HIV Prevention

References

Woldesenbet, S. A., Jackson, D., Goga, A. E., Crowley, S., Doherty, T., Mogashoa, M. M., . . . Sherman, G. G. (2015). Missed opportunities for early infant HIV diagnosis: Results of a national study in South Africa. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337585/

The United States President’s Emergency Plan for AIDS Relief. (2018). Monitoring, evaluation, and reporting (MER 2.0) indicator reference guide updated release (Version 2.2). Washington, D.C.: PEPFAR. Retrieved from https://www.pepfar.gov/documents/organization/263233.pdf

Ahmed, S., Kim, M. H., Sugandhi, N., Phelps, B. R., Sabelli, R., Diallo, M. O., . . . The Child Survival Working Group of the Interagency Task Team on the Prevention and Treatment of HIV infection in Pregnant Women, Mothers and Children. (2013). Beyond early infant diagnosis: Case finding strategies for identification of HIV-infected infants and children. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122794/