Numerator: Number of HIV-infected pregnant women who received antiretroviral drugs during the past 12 months to reduce mother-to-child transmission.
The numerator should be disaggregated by the four general options (the first three are recommended) for HIV-infected pregnant women for the prevention of mother-to-child transmission.
Denominator: Estimated number of HIV-infected pregnant women within the past 12 months
The antiretroviral drug regimen categories for prevention of mother-to-child transmission of HIV are:
Calculation: Numerator / Denominator
Method of measurement: The numerator is calculated from national programme records aggregated from facility registers. Antiretroviral drugs can be given to HIV-infected women at various sites (antenatal care, labour and delivery and HIV care and treatment) during pregnancy, at labour or shortly after delivery.
Two methods for calculating the numerator can be used:
Counting at the time of antiretroviral drug provision: In settings with low facility delivery rates, the numerator should be compiled from patient registers depending on where the drugs are dispensed and where the data are recorded. For example, where antiretroviral drug prophylaxis is provided in the antenatal care clinic and antiretroviral therapy in the HIV care and treatment unit, countries could aggregate data from the antenatal care register (or a register for following-up HIV-positive pregnant women) and/or the antiretroviral therapy register. Note that there is a risk for double-counting when antiretroviral drugs are provided at different times or in different health facilities, Countries should therefore ensure that a data collection and reporting system is in place to minimize double-counting.3
Counting at the time of labour and delivery: In settings where a high proportion of women give birth in health facilities, countries can aggregate the numerator entirely from the labour and delivery register by counting the number of HIV-infected pregnant women who had received a specific antiretroviral drug regimen by the time of delivery. For example, when a woman who received zidovudine(AZT) during her pregnancy gives birth, health workers would record in the labour and delivery register what she received during pregnancy, placing her in category c) (see note on numerator in table above). This may be the most reliable and accurate method for calculating this indicator in settings with high facility delivery rates, as the corresponding antiretroviral drug regimen dispensed and taken can be counted at the end of the woman’s pregnancy.
All public, private and nongovernmental organization-run health facilities that provide antiretroviral drugs to HIV-infected pregnant women for prevention of mother-to-child transmission of HIV should be included.
Two methods can be used to estimate the denominator:
- a projection model, such as that provided by Spectrum software; use the output "number of pregnant woman needing prevention of mother-to-child transmission of HIV"; or
- multiply the number of women who gave birth in the past 12 months (which can be obtained from estimates of the central statistics office or the United Nations Population Division or pregnancy registration systems with complete data) by the most recent national estimate of HIV prevalence in pregnant women(which can be derived from HIV sentinel surveillance in antenatal care clinics) if Spectrum projections are unavailable.
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