Institute of Global Health, University of Geneva, Geneva, Switzerland.
Department of Health Services, County Government of Kwale, Kwale, Kenya.
PLoS One. 2022 Dec 1;17(12):e0278450. doi: 10.1371/journal.pone.0278450. eCollection 2022.
While many countries including Kenya transitioned from sentinel surveillance to the use of routine antenatal care (ANC) data to estimate the burden of HIV, countries in Sub Saharan Africa reported several challenges of this transition, including low uptake of HIV testing and sub national / site-level differences in HIV prevalence estimates. In Kenya voluntary HIV testing is offered to all 1st ANC clients. However, some women may decline testing. We aim to predict the HIV positivity (as a proxy of prevalence) at ANC assuming 100% uptake of HIV testing and compare this to the observed positivity.
Using a cross sectional study design, we examine routine data on HIV testing among all women attending ANC in Kwale County, Kenya, for the period January 2015 to December 2019.We used a generalized estimating equation with binomial distribution to model the observed HIV prevalence as explained by HIV status ascertainment. We then used marginal standardization to predict the HIV prevalence at 100% HIV status ascertainment and make recommendations to improve the utility of ANC routine data for HIV surveillance.
HIV testing at ANC was at 91.3%, slightly above the global target of 90%. If there was 100% HIV status ascertainment at ANC, the HIV prevalence would be 2.7% (95% CI 2.3-3.2). This was 0.3% lower than the observed prevalence. Across the yearly predictions, there was no difference between the observed and predicted values except for 2018 where the HIV prevalence was underestimated with an absolute bias of -0.2 percent. This implies missed opportunities for identifying new HIV infections in the year 2018.
Imperfect HIV status ascertainment at ANC overestimates HIV prevalence among women attending ANC in Kwale County. However, the use of ANC routine data may underestimate the true population prevalence. There is need to address both community level and health facility level barriers to the uptake of ANC services.
包括肯尼亚在内的许多国家已经从哨点监测过渡到利用常规产前保健 (ANC) 数据来估计艾滋病毒负担，但撒哈拉以南非洲国家报告了这一过渡的几个挑战，包括艾滋病毒检测率低以及国家/地点一级艾滋病毒流行率估计值存在差异。在肯尼亚，所有首次 ANC 就诊者都可以自愿接受艾滋病毒检测。但是，有些女性可能会拒绝检测。我们的目的是假设 100%接受艾滋病毒检测，预测 ANC 中的艾滋病毒阳性率（作为流行率的代表），并将其与实际阳性率进行比较。
我们使用横断面研究设计，检查 2015 年 1 月至 2019 年 12 月期间肯尼亚夸莱县所有参加 ANC 的妇女的 HIV 检测常规数据。我们使用二项分布广义估计方程来对 HIV 检测确定的 HIV 现患率进行建模。然后，我们使用边缘标准化预测在 100% HIV 状态确定时的 HIV 流行率，并提出改进 ANC 常规数据用于艾滋病毒监测的建议。
ANC 中的 HIV 检测率为 91.3%，略高于全球 90%的目标。如果 ANC 中的 HIV 状态确定率达到 100%，则 HIV 流行率将为 2.7%（95%CI 2.3-3.2）。这比实际流行率低 0.3%。在每年的预测中，除了 2018 年，观察值和预测值之间没有差异，2018 年的 HIV 流行率被低估，绝对偏差为-0.2%。这意味着在 2018 年错过了发现新的艾滋病毒感染的机会。
ANC 中 HIV 状态确定不完美会高估参加夸莱县 ANC 的妇女中的艾滋病毒流行率。然而，使用 ANC 常规数据可能会低估真实的人群流行率。需要解决社区一级和卫生设施一级接受 ANC 服务的障碍。
