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Utility of PMTCT Program Data for HIV Surveillance In Botswana-Preliminary Results

Utility of PMTCT Program Data for HIV Surveillance In Botswana-Preliminary Results. Presented by Dr K. Seipone. Republic of Botswana. Landlocked in southern Africa Area: 581,700 sq km (226,900 sq mi) - size of Kenya or France or Texas Population: 1.7 million; mostly concentrated in the east

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Utility of PMTCT Program Data for HIV Surveillance In Botswana-Preliminary Results

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  1. Utility of PMTCT Program Data for HIV Surveillance In Botswana-Preliminary Results Presented by Dr K. Seipone

  2. Republic of Botswana • Landlocked in southern Africa • Area: 581,700 sq km (226,900 sq mi) - size of Kenya or France or Texas • Population: 1.7 million; mostly concentrated in the east • Health care system decentralized in 24 health districts • About 96% of women receive ANC and 97% deliver in a health facility

  3. Background • Overall 33.7% of pregnant women infected (2007) • Approximately 14,000 HIV infected women deliver every year • Successful PMTCT program with only about 4% infected children • Following Pediatric AIDS Clinical Trials Group (PACTG) 076, the PMTCT program was piloted in 1999, nationally rolled out in 2001 • Currently, PMTCT is integrated in ANC settings and provided in all health facilities

  4. PMTCT Coverage

  5. HIV Surveillance in Botswana • Botswana conduct antenatal HIV sentinel surveillance among pregnant women since 1992 with 2 districts, now includes all 24 (27 soon) health districts • Second generation HIV Surveillance started in 2003. • ANC sentinel surveillance in 270 selected public facilities • ANC SITE = HEALTH DISTRICT • Botswana AIDS Impact Survey (BAIS), in 2001 (no HIV testing), 2004 and 2008(Include HIV testing) • Included incidence and HIV DR among pregnant women since 2005 • More than 95% of pregnant women accept to test for HIV in the PMTCT program between 2005-2007

  6. ANC Sentinel Surveillance

  7. Health District • Decentralized and comprises: • one referral/General/primary hospitals in each district • Clinics with maternity • Clinics without maternity • Health post • Private clinics

  8. Objectives • To assess the demographic similarity between PMTCT clients and ANC sentinel population • To compare HIV prevalence estimates from PMTCT program data with those from ANC surveillance data • To identify determinants for differences between PMTCT and ANC-related HIV estimates

  9. Method • Data covered period between July-September 2005-2007 • Data collected from 2 health facilities with the highest ANC attendances in each of the 24 health districts in both urban and rural areas: • ANC: Previous ANC HIV sentinel records • PMTCT: data was collected from facility ANC register (Photography) • PMTCT study sites=ANC SS sites • Age restricted to 15-49 years

  10. Bivariate and multivariate analysis were done to compare HIV prevalence estimate • Variables of interest were: age, HIV status, area, time

  11. Results 1. Data quality

  12. 18106 records reviewed: • 16,424 records were usable (91%) • 1,682 records were unusable (9%) • 212 unusable records were among ANC records (13%)*** • 103 from urban area • 109 from rural area • 1470 were among PMTCT records (87%)*** • 801 from urban area • 669 from rural area ***P<0001

  13. 2. Comparison of HIV Prevalence between PMTCT and ANC SS Data

  14. Comparison of HIV Prevalence between PMTCT and ANC Data By Area- Rural N(%)

  15. Comparison of HIV Prevalence between PMTCT and ANC Data By Area- Urban N(%)

  16. Conclusion • PMTCT program reached more pregnant women aged 15-49 years than ANC SS during the same period • ANC SS data quality is superior to that of PMTCT data • ANC SS data not significantly different from that of PMTCT program • PMTCT data can be used for HIV surveillance in Botswana

  17. Recommendations • Botswana to improve the quality of PMTCT program data • Botswana to use PMTCT data for HIV SS for HIV surveillance to address sustainability and efficiency • Space the conduct of ANC SS to 5 years to calibrate PMTCT data • Redirect ANC SS resources to improve PMTCT data quality in selected sentinel surveillance health facilities

  18. Acknowledgement • Dr Stephane Bodika, CDC • Florindo de la Hose Gomez, MOH • MRS Mpho Mmelesi, MOH • Dr Negussie Taffa, CDC Botswana • Dr Thierry Roels, CDC Botswana • Others partners: CDC-Botswana (BOTUSA), PEPFAR, BHP, WHO, UNICEF

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