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Woldesenbet SA, Kufa T, Barron P, Ayalew K, Cheyip M, Chirombo BC, Lombard C, Manda S, Pillay Y, Puren AJ. Assessment of readiness to transition from antenatal HIV surveillance surveys to PMTCT programme data-based HIV surveillance in South Africa: The 2017 Antenatal Sentinel HIV Survey. Int J Infect Dis 2020; 91:50-56. [PMID: 31712090 PMCID: PMC8767461 DOI: 10.1016/j.ijid.2019.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/27/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE South Africa has used antenatal HIV surveys for HIV surveillance in pregnant women since 1990. We assessed South Africa's readiness to transition to programme data based antenatal HIV surveillance with respect to PMTCT uptake, accuracy of point-of-care rapid testing (RT) and selection bias with using programme data in the context of the 2017 antenatal HIV survey. METHODS Between 1 October and 15 November 2017, the national survey was conducted in 1,595 public antenatal facilities selected using stratified multistage cluster sampling method. Results of point-of-care RT were obtained from medical records. Blood samples were taken from eligible pregnant women and tested for HIV using immunoassays (IA) in the laboratory. Descriptive statistics were used to report on: PMTCT uptake; agreement between HIV point-of-care RT and laboratory-based HIV-1 IA; and selection bias associated with using programme data for surveillance. RESULTS PMTCT HIV testing uptake was high (99.8%). The positive percent agreement (PPA) between RT and IA was lower than the World Health Organization (WHO) benchmark (97.6%) at 96.3% (95% confidence interval (CI): 95.9%-96.6%). The negative percent agreement was above the WHO benchmark (99.5%), at 99.7% (95% CI: 99.6%-99.7%) nationally. PPA markedly varied by province (92.9%-98.3%). Selection bias due to exclusion of participants with no RT results was within the recommended threshold at 0.3%. CONCLUSION For the three components assessed, South Africa was close to meeting the WHO standard for transitioning to routine RT data for antenatal HIV surveillance. The wide variations in PPA across provinces should be addressed.
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Affiliation(s)
- Selamawit A Woldesenbet
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tendesayi Kufa
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Barron
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kassahun Ayalew
- Strategic Information Unit, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mireille Cheyip
- Strategic Information Unit, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Brian C Chirombo
- HIV and Hepatitis Program, World Health Organization, Pretoria, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health (MCWH), National Department of Health, Pretoria, South Africa
| | - Adrian J Puren
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa; Virology Department, University of the Witwatersrand, Johannesburg, South Africa
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HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011-2018): measuring and adjusting for bias from imperfect testing coverage. AIDS 2019; 33 Suppl 3:S295-S302. [PMID: 31805029 PMCID: PMC6919236 DOI: 10.1097/qad.0000000000002356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text Objective: The use of routinely collected data from prevention of mother-to-child transmission programs (ANC-RT) has been proposed to monitor HIV epidemic trends. This poses several challenges for surveillance, one of them being that women may opt-out of testing and/or test stock-outs may result in inconsistent service availability. In this study, we sought to empirically quantify the relationship between imperfect HIV testing coverage and HIV prevalence among pregnant women from ANC-RT data. Design: We used reports from the ANC Register of all antenatal care (ANC) sites in Malawi (2011–2018), including 49 244 monthly observations, from 764 facilities, totaling 4 375 777 women. Methods: Binomial logistic regression models with facility-level fixed effects and marginal standardization were used to assess the effect of testing coverage on HIV prevalence. Results: Testing coverage increased from 78 to 98% over 2011–2018. We estimated that, had testing coverage been perfect, prevalence would have been 0.4% point lower (95% CI 0.3–0.5%) than the 7.9% observed prevalence, a relative overestimation of 6%. Bias in HIV prevalence was the highest in 2012, when testing coverage was lowest (72%), resulting in a relative overestimation of HIV prevalence of 15% (95% CI 12–17%). Overall, adjustments for imperfect testing coverage led to a subtler decline in HIV prevalence over 2011--2018. Conclusion: Malawi achieved high coverage of routine HIV testing in recent years. Nevertheless, imperfect testing coverage can lead to overestimation of HIV prevalence among pregnant women when coverage is suboptimal. ANC-RT data should be carefully evaluated for changes in testing coverage and completeness when used to monitor epidemic trends.
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Woldesenbet SA, Kalou M, Mhlongo D, Kufa T, Makhanya M, Adelekan A, Diallo K, Maleka M, Singh B, Parekh B, Mohlala A, Manyike PT, Tucker TJ, Puren AJ. An overview of the quality assurance programme for HIV rapid testing in South Africa: Outcome of a 2-year phased implementation of quality assurance program. PLoS One 2019; 14:e0221906. [PMID: 31557176 PMCID: PMC6762059 DOI: 10.1371/journal.pone.0221906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/16/2019] [Indexed: 11/22/2022] Open
Abstract
Objective This is the first large-scale assessment of the implementation of HIV Rapid Test Quality Improvement Initiative in South Africa. Methods We used a quasi-experimental one group post-test only design. The intervention implemented starting April 2014 comprised health-care worker training on quality assurance (QA) of HIV rapid testing and enrolment of the facilities in proficiency testing (PT), targeting 2,077 healthcare facilities in 32 high HIV burden districts. Following the intervention, two consecutive rounds of site assessments were undertaken. The first, conducted after a median of 7.5 months following the training, included 1,915 facilities that participated in the QA training, while the second, conducted after a median of one-year following the first-round assessment included 517 (27.0%) of the 1,915 facilities. In both assessments, the Stepwise-Process-for-Improving-the-quality-of-HIV-Rapid-Testing (SPI-RT) checklist was used to score facilities’ performance in 7 domains: training, physical facility, safety, pre-testing, testing, post-testing and external quality assessment. Facilities’ level of readiness for national certification was assessed. Result Between 2016 and 2017, there were four PT cycles. PT participation increased from 32.4% (620/1,915) in 2016 to 91.5% (1,753/1,915) in 2017. In each PT cycle, PT results were returned by 76%–87% of facilities and a satisfactory result (>80%) was achieved by ≥95% of facilities. In the SPI-RT assessment, in round-one, 22.3% of facilities were close to or eligible for national certification—this significantly increased to 38.8% in round-two (P-value<0.001). The median SPI-RT score for the domains HIV pre-testing (83.3%) and post-testing (72.2%) remained the same between the two rounds. The median score for the testing domain increased by 5.6% (to 77.8%). Conclusion Facilities performance on the domains that are critical for accuracy of diagnosis (i.e. pre-testing, testing and post-testing) remained largely unchanged. This study provided several recommendations to improve QA implementation in South Africa, including the need to improve routine use of internal quality control for corrective actions.
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Affiliation(s)
- Selamawit Alemu Woldesenbet
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Mireille Kalou
- International Laboratory Branch, Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dumisani Mhlongo
- National Clinic Laboratory Interface programme, National Health Laboratory Service, Johannesburg, South Africa
| | - Tendesayi Kufa
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Makhosazana Makhanya
- Laboratory Branch, Centers for Disease Control and Prevention South Africa, Pretoria, South Africa
| | - Adeboye Adelekan
- Laboratory Branch, Centers for Disease Control and Prevention South Africa, Pretoria, South Africa
| | - Karidia Diallo
- Laboratory Branch, Centers for Disease Control and Prevention South Africa, Pretoria, South Africa
| | - Mahlatse Maleka
- Academic Affairs, Research and Quality Assurance National Health Laboratory Service, Johannesburg, South Africa
| | - Beverley Singh
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Bharat Parekh
- International Laboratory Branch, Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda Mohlala
- Strategic Evaluation, Advisory and Development (SEAD) Consulting, Cape Town, South Africa
| | - Peter T. Manyike
- Strategic Evaluation, Advisory and Development (SEAD) Consulting, Cape Town, South Africa
| | - Tim J. Tucker
- Strategic Evaluation, Advisory and Development (SEAD) Consulting, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian J. Puren
- Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Virology Department, University of the Witwatersrand, Johannesburg, South Africa
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Dee J, Garcia Calleja JM, Marsh K, Zaidi I, Murrill C, Swaminathan M. HIV Surveillance Among Pregnant Women Attending Antenatal Clinics: Evolution and Current Direction. JMIR Public Health Surveill 2017; 3:e85. [PMID: 29208587 PMCID: PMC5736873 DOI: 10.2196/publichealth.8000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022] Open
Abstract
Since the late 1980s, human immunodeficiency virus (HIV) sentinel serosurveillance among pregnant women attending select antenatal clinics (ANCs) based on unlinked anonymous testing (UAT) has provided invaluable information for tracking HIV prevalence and trends and informing global and national HIV models in most countries with generalized HIV epidemics. However, increased coverage of HIV testing, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy has heightened ethical concerns about UAT. PMTCT programs now routinely collect demographic and HIV testing information from the same pregnant women as serosurveillance and therefore present an alternative to UAT-based ANC serosurveillance. This paper reports on the evolution and current direction of the global approach to HIV surveillance among pregnant women attending ANCs, including the transition away from traditional UAT-based serosurveillance and toward new guidance from the World Health Organization and the Joint United Nations Programme on HIV/AIDS on the implementation of surveillance among pregnant women attending ANCs based on routine PMTCT program data.
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Affiliation(s)
- Jacob Dee
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Kimberly Marsh
- Strategic Information and Monitoring Division, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Irum Zaidi
- Office of the US Global AIDS Coordinator, Washington, DC, United States
| | - Christopher Murrill
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mahesh Swaminathan
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
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Belato DT, Mekiso AB, Begashaw B. Male Partners Involvement in Prevention of Mother-to-Child Transmission of HIV Services in Southern Central Ethiopia: In Case of Lemo District, Hadiya Zone. AIDS Res Treat 2017; 2017:8617540. [PMID: 28409027 PMCID: PMC5376926 DOI: 10.1155/2017/8617540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/08/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022] Open
Abstract
Male partners' involvement is a vital issue to prevent human immunodeficiency virus (HIV) transmission from mother to child; because it is much expectable that women were more vulnerable and high risk group of population portion. Therefore, to save lives of mothers and their newborn from acquiring HIV, male partners should do their maximum endeavor regardless of any determinant factors as our results revealed its status in our study context and elsewhere at past time too.
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Affiliation(s)
| | - Abera Beyamo Mekiso
- Public Health Department, College of Health Sciences, Wolayta Sodo University, Wolayta Sodo, Ethiopia
| | - Bayu Begashaw
- Public Health Department, College of Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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