Percent of infants born to HIV-infected mothers who are infected

The estimated percentage of infants born to HIV-infected mothers who are also infected with HIV.  For further background and details on this indicator, see Gage et al. (2005); PEPFAR (2009) and UNAIDS (2009).

This indicator is calculated as:

(Number of infants born to HIV-infected mothers who are HIV-infected / Total estimated number of HIV-infected pregnant women) x 100

The indicator is calculated by taking the weighted average of the probabilities of mother-to-child transmission (MTCT) for pregnant women receiving and not receiving the various combination antiretroviral (ARV) prophylactic and treatment regimens, as well as the distribution of infant-feeding practices. Data for the numerator is drawn from national program records. Data required for the modeling can be collected through indicators for the number of women who received ARV prophylaxis to reduce MTCT (PEPFAR #P1.2.D) and for the percent of infants born to HIV-infected mothers who were tested within 12 months of birth (PEPFAR #C4.1.D). The data can be put into a computer-modeling program, such as Spectrum, commonly used for HIV projections. This will assess the impact of the programs to reduce MTCT by estimating the proportion of infants born to HIV-infected women. Other Excel-based spreadsheets, such as the “MTCT rate calculator“, (developed by the U.S. Centers for Disease Control and Prevention), also facilitate this estimation (PEPFAR, 2009). The indicator can be calculated annually, or more frequently, depending on a country’s monitoring needs.

Spectrum, or other statistical modeling based on program coverage and efficacy studies and data.

This indicator is used to assess progress toward eliminating MTCT of HIV primarily through increased provision of ARV medicines and is included as a core indicator in the WHO/UNAIDS/UNICEF/The Global Fund “Three Interlinked Patient Monitoring Systems” (WHO et al., 2010). Programs to prevent mother-to-child transmission (PMTCT) are consistent with achieving Millennium Development Goals #6. to combat HIV/AIDS and #4. to reduce infant and child mortality. In the absence of preventative interventions, infants born to and breastfed by HIV-infected women have about a one-in-three chance of acquiring infection, which can happen during pregnancy, during labor and delivery, or after delivery through breastfeeding. The risk of MTCT can be reduced through the complementary approaches of ARV prophylaxis for the mother, with or without prophylaxis to the infant, implementation of safe delivery practices, and use of safe alternatives to breastfeeding. ARV prophylaxis followed by exclusive breastfeeding may also reduce the risk of vertical transmission when breastfeeding is limited to the first six months. In low-income countries, significant difficulties exist in implementing these strategies due to constraints in accessing, affording and using voluntary counseling and testing services, reproductive health, and maternal and child health services with integrated PMTCT interventions (UNAIDS, 2009). However, substantial reductions in mother-to-child transmission can be achieved through approaches such as short-course ARV prophylaxis.

This indicator allows assessment of the impact of PMTCT programs by estimating the percentage of infants who are HIV-infected out of those born to HIV-infected pregnant women. Where possible, countries should try to monitor PMTCT using actual data on the HIV status and survival of infants born to HIV-infected women during follow-up health care visits with these infants. For further technical guidance on interventions and indicators for PMTCT, see UNAIDS (2010).

If an infant becomes positive, the indicator cannot distinguish between different pathways of infection (i.e., ARV treatment failure or infection during breastfeeding). Therefore, the indicator may underestimate the rates of MTCT in countries where long periods of breastfeeding are common (Gage et al., 2005). In countries where other forms of PMTCT (e.g. caesarean section) are widely practiced, the indicator will typically overestimate MTCT (PEPFAR, 2009). Consequently, trends in this indicator may not reflect overall trends in MTCT of HIV.  It is difficult to follow-up on mother-infant pairs, particularly at the national level, due to the time lag in reporting and the number and range of health facility sites.  In countries where data are available and confirmatory tests are being conducted, an effort should be made to monitor the percentage of HIV-infected infants born to HIV-infected mothers using actual data for the numerator and denominator.

Pediatric care, PMTCT, HIV care, Child health, Morbidity

Gage A, Ali D, Suzuki C, 2005, A Guide for Measuring and Evaluating Child Health Programs, Chapel Hill, NC: MEASURE Evaluation.  

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR.

UNAIDS, 2009, Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on Construction of Core Indicators, Geneva: UNAIDS.

UNAIDS, 2010, Prevention of Mother-To-Child Transmission of HIV (PMTCT): Technical Guidance Note for Global Fund HIV Proposals, Geneva: UNAIDS.

WHO, UNAIDS, UNICEF, The Global Fund, 2010, Three Interlinked Patient Monitoring Systems for HIV Care/ART, MCH/PMTCT and TB/HIV: Standardized Minimum Data Set and Illustrative Tools, Geneva: WHO.