Indicator 6.1: "Pregnant women counselled and tested for HIV"
The percent of women who were counselled and offered voluntary HIV testing during antenatal care for their most recent pregnancy, accepted an offer of testing and received their test results, of all women who were pregnant at any time in the two years preceding the survey.
General population survey.
What It Measures
The principal active interventions to reduce mother to child infection depend on knowledge of HIV status. Knowledge of HIV status during pregnancy may also affect future reproductive choices. Ideally, women would learn their HIV status using VCT services before they choose to become pregnant. But the gap between this ideal and reality is often very wide. In practice, the first opportunity many women have to be counselled about HIV and to be offered tests may be at antenatal clinics that offer these services as a precursor to offering interventions to reduce transmission of HIV from mother to child.
To learn their HIV status in an antenatal care situation, women have to go through a number of steps. First, they must attend antenatal services. Then they must be counselled and offered an HIV test. Next they must accept a test. Finally, they must return to receive the test results. It is only after the post-test counselling that follows all of these steps that they will be able to take necessary decisions about therapy and infant feeding.
This indicator measures the percentage of women with a recent pregnancy who completed all of those steps. Data are collected in a general population survey, so the indicator gives an idea of the coverage of ANC-based counselling and testing country-wide, rather than just in specific pilot facilities.
How to Measure It
In a general population survey, women are asked when their most recent child was born, and whether they received any antenatal care before that last birth. If so, they are asked whether clinic staff talked to them about HIV infection and offered them a confidential HIV test. If yes, they are further asked if they agreed to a test and if they received the results. The questions are preceded by an assurance that the interviewer is not interested in knowing the outcome of any test.
To measure recent trends, women whose most recent birth was more than two years ago are excluded from the analysis. The indicator is the number of women counselled and offered voluntary HIV testing at ANC before their most recent birth in the last two years and received their test results, divided by the total number of women surveyed.
Strengths and Limitations
This is a broad measure of service provision to give an idea of coverage on a national scale. However, few countries may have the resources to introduce counselling and voluntary testing for pregnant women country-wide. Those countries providing prevention services for pregnant, HIV-positive women typically start with pilot projects in a few antenatal clinics. Even if all women in pilot clinics are counselled and offered testing, the indicator will typically remain low for some time. It should be used in conjunction with Mother to Child Transmission Indicator 2.
As a summary indicator, it does not attempt to diagnose at which point women are dropping out of the spectrum of care. For programme purposes, it will be important to know whether a poor result on the summary indicator is because of low initial attendance at antenatal services, because women attending services are not being offered tests, because they are refusing the offer of a test, or because they are tested but do not return for test results. Each of these points of failure has a different implication for programming, and all can be calculated from the data collected for this indicator. The summary indicator does not attempt to measure quality of counselling or other elements of service coverage.