Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Computing & Information Science Division, National Institute of Epidemiology-Indian Council of Medical Research, Chennai, Tamil Nadu, India.
Indian J Med Res. 2022 Jun;156(6):742-749. doi: 10.4103/ijmr.ijmr_3311_21.
BACKGROUND & OBJECTIVES: HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking.
Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics.
The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001).
INTERPRETATION & CONCLUSIONS: High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.
在印度，艾滋病毒哨点监测（HSS）已用于多年来跟踪疫情。然而，由于 ANC 哨点数量有限，每个哨点的样本量较小，因此无法在当地进行可靠的跟踪。由于更好的地域覆盖范围，预防母婴传播（PPTCT）规划数据具有潜在优势，这可能提供更准确的艾滋病毒病例估计数；因此，我们将 HSS 产前检查数据与 PPTCT 规划数据进行了比较，以跟踪艾滋病毒。
在 2015 年开展 HSS 和 PPTCT 规划的 499 个监测点中，采用分层随机抽样方法选择了 210 个监测点（140 个城市和 70 个农村）。对 HSS（n=72981）和 PPTCT（n=112832）的数据记录进行了机密链接。比较了 HSS 和 PPTCT 参与者的社会人口统计学特征。使用卡方检验比较 HSS 产前检查的艾滋病毒流行率与 PPTCT 规划数据。还对艾滋病毒流行率的州和哨点水平相关性进行了分析。使用 Kappa 统计量估计了 HSS 和 PPTCT 艾滋病毒阳性结果的一致性。
HSS 和 PPTCT 参与者的年龄分布相似（范围：23 至 27 岁）；然而，HSS 产前检查参与者受教育程度更高，而 PPTCT 记录的家庭主妇比例更高。HSS 和 PPTCT 之间的艾滋病毒流行率相关性很高（州水平 r=0.9，哨点水平 r=0.7）。HSS 产前检查和 PPTCT 之间的 HIV 阳性结果一致性良好（kappa=0.633）。在 26 个州报告了相似的流行率，而在 PPTCT 覆盖范围较低的三个州，PPTCT 的流行率明显低于 HSS。HSS 中的总体艾滋病毒流行率为 0.31%，而 PPTCT 中的流行率为 0.22%（P<0.001）。
高质量的 PPTCT 规划数据可以提供印度可靠的艾滋病毒趋势。在以 PPTCT 为基础的监测取代 HSS 之前，应分阶段试用一个操作框架。
