Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 5;17(1):469.
doi: 10.1186/s12879-017-2540-4.

Transitioning from antenatal surveillance surveys to routine HIV testing: a turning point in the mother-to-child transmission prevention programme for HIV surveillance in Brazil

Gerson Fernando Mendes Pereira  1 , Meritxell Sabidó  2   3   4 , Alessandro Caruso  2 , Adele Schwartz Benzaken  2
Affiliations

Transitioning from antenatal surveillance surveys to routine HIV testing: a turning point in the mother-to-child transmission prevention programme for HIV surveillance in Brazil

Gerson Fernando Mendes Pereira et al. BMC Infect Dis. .

Abstract

Background: In 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).

Methods: We 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.

Results: Of 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.

Conclusions: Although 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.

Keywords: Brazil; HIV; Pregnant women; Surveillance.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Antenatal care participants in prevention of mother-to-child transmission and antenatal care surveillance survey data. ANC: antenatal care; PMTCT: prevention of mother-to-child transmission; SS: surveillance survey
See this image and copyright information in PMC

References

    1. Brazilian Ministry of Health, Secretariat of Health Surveillance, Department of STI, Aids and Viral Hepatitis. The Brazilian response to HIV and AIDS. Global AIDS Response Progress Reporting (GARPR). Narrative Report 2015. Brasília, DF: Brazilian Ministry of Health. 2015. http://www.unaids.org/sites/default/files/country/documents/BRA_narrativ....
    1. Pereira GF, Sabidó M, Caruso A, Oliveira SB, Mesquita F, Benzaken AS. HIV Prevalence among Pregnant Women in Brazil: A National Survey. Rev Bras Ginecol Obstet. 2016;38(8):391–398. doi: 10.1055/s-0036-1592102. - DOI - PMC - PubMed
    1. Souza Junior PR, Szwarcwald CL, Barbosa Junior A, Carvalho MF, Castilho EA. HIV infection during pregnancy: the Sentinel Surveillance Project, Brazil, 2002. Rev Saude Publica. 2004;38(6):764–772. doi: 10.1590/S0034-89102004000600003. - DOI - PubMed
    1. Szwarcwald CL, Barbosa Junior A, Souza-Junior PR, et al. HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil. Braz J Infect Dis. 2008;12(3):167–72. - PubMed
    1. Szwarcwald CL, Souza-Jr PRB. Estimate of HIV prevalence among Brazilian population aged 15–49 years. Epidemiological Bulletin of Sexually Transmitted Infections/AIDS 2006. III year, number 1. Secondary Estimate of HIV prevalence among Brazilian population aged 15–49 years. Epidemiological Bulletin of Sexually Transmitted Infections/AIDS 2006. III year, number 1 2006. http://www.aids.gov.br/publicacao/2006/boletim-epidemiologico-aids-e-dst....

MeSH terms