Data for the numerator can be aggregated from the appropriate facility registers, which can include integrated maternal and child health registers, registers on the follow-up of HIV-exposed infants or pre–ARV therapy registers (WHO et al., 2006). The register used may vary depending on the country context, for example, where HIV-exposed infants are followed up in the HIV care and treatment setting, countries may aggregate information either from a pre–ARV therapy register adapted for follow-up of HIV exposed infants or from a separate register for HIV-exposed infants. Infants covered by ARVs (either to the mother or infant) during the breastfeeding period who also received the postpartum 1-4 week prophylaxis should be counted only once, in the category for “postpartum breastfeeding period prophylaxis” (WHO/UNICEF/UNAIDS, 2011).

Data Source(s):

For the numerator, program or facility records; For the denominator, antenatal care surveillance, surveys in combination with demographic data or estimation models such as Spectrum.

Purpose:

This indicator allows countries to monitor progress in the early follow-up of HIV-exposed infants by measuring provision of CTX in line with international guidelines (WHO, 2006). The risk for MTCT can be significantly reduced by the complementary approaches of providing ARV drugs (as treatment or as prophylaxis) for the mother with ARV prophylaxis for the infant and use of safe delivery practices and recommended infant feeding (WHO/UNICEF/UNAIDS, 2011). CTX prophylaxis is a simple and cost-effective intervention to prevent Pneumocystis jirovecipneumonia (PCP) among HIV-exposed and HIV-infected infants. PCP is the leading cause of serious respiratory disease among young HIV-infected infants in resource limited countries and often occurs before HIV infection can be diagnosed. Because diagnosing HIV infection among young infants is difficult, all infants born to women living with HIV should receive CTX prophylaxis starting at 4 to 6 weeks after birth and continuing until HIV infection has been excluded and the infant is no longer at risk of acquiring HIV through breastfeeding.

Issue(s):

The indicator captures only those infants who are brought in for HIV-exposed infant follow-up services within two months of birth. It does not measure actual coverage of CTX prophylaxis for HIV-exposed infants as some infants may have been started on treatment after 2 months (PEPFAR, 2009). Inappropriate management of supplies can negatively affect the value of the indicator and significantly reduce access to CTX for HIV-exposed infants. Countries should ensure appropriate systems and tools, particularly tools for a logistics management and information system (LMIS, USAID/DELIVER, 2009), are in place to adequately procure, distribute, and manage supplies at facility, district and central levels. There is a risk of double-counting when antiretroviral drugs are provided during more than one visit or at different health facilities. Countries should establish data collection and reporting systems to minimize double-counting (WHO/UNICEF/UNAIDS, 2011).

References:

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR.  http://pdf.usaid.gov/pdf_docs/Pcaac330.pdf