MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Maputo, Mozambique.
J Acquir Immune Defic Syndr. 2024 Jan 1;95(1S):e70-e80. doi: 10.1097/QAI.0000000000003333. Epub 2024 Jan 4.
Routine health system data are central to monitoring HIV trends. In Mozambique, the reported number of women receiving antenatal care (ANC) and antiretroviral therapy for prevention of mother-to-child transmission (PMTCT) has exceeded the Spectrum-estimated number of pregnant women since 2017. In some provinces, reported HIV prevalence in pregnant women has declined faster than epidemiologically plausible. We hypothesized that these issues are linked and caused by programmatic overenumeration of HIV-negative pregnant women at ANC.
We triangulated program-reported ANC client numbers with survey-based fertility estimates and facility birth data adjusted for the proportion of facility births. We used survey-reported ANC attendance to produce adjusted time series of HIV prevalence in pregnant women, adjusted for hypothesized program double counting. We calibrated the Spectrum HIV estimation models to adjusted HIV prevalence data to produce adjusted adult and pediatric HIV estimates.
ANC client numbers were not consistent with facility birth data or modeled population estimates indicating ANC data quality issues in all provinces. Adjusted provincial ANC HIV prevalence in 2021 was median 45% [interquartile range 35%-52% or 2.3 percentage points (interquartile range 2.5-3.5)] higher than reported HIV prevalence. In 2021, calibrating to adjusted antenatal HIV prevalence lowered PMTCT coverage to less than 100% in most provinces and increased the modeled number of new child infections by 35%. The adjusted results better reconciled adult and pediatric antiretroviral treatment coverage and antenatal HIV prevalence with regional fertility estimates.
Adjusting HIV prevalence in pregnant women using nationally representative household survey data on ANC attendance produced estimates more consistent with surveillance data. The number of children living with HIV in Mozambique has been substantially underestimated because of biased routine ANC prevalence. Renewed focus on HIV surveillance among pregnant women would improve PMTCT coverage and pediatric HIV estimates.
常规卫生系统数据是监测艾滋病毒趋势的核心。在莫桑比克，自 2017 年以来，报告的接受产前护理（ANC）和抗逆转录病毒疗法预防母婴传播（PMTCT）的孕妇人数超过了 Spectrum 估计的孕妇人数。在一些省份，报告的孕妇艾滋病毒流行率下降速度快于流行病学上的合理水平。我们假设这些问题是相关的，并且是由于 ANC 程序上对艾滋病毒阴性孕妇的过度计数造成的。
我们将方案报告的 ANC 就诊人数与基于调查的生育率估计以及根据设施分娩比例调整后的设施分娩数据进行三角剖分。我们使用调查报告的 ANC 就诊情况，制作了调整后的孕妇艾滋病毒流行率时间序列，调整了假设的方案双重计数。我们校准了 Spectrum HIV 估计模型，以适应调整后的 HIV 流行率数据，以产生调整后的成人和儿科 HIV 估计数。
ANC 就诊人数与设施分娩数据或模型人口估计不一致，这表明所有省份都存在 ANC 数据质量问题。2021 年调整后的省级 ANC HIV 流行率中位数为 45%[四分位距 35%-52%或 2.3 个百分点（四分位距 2.5-3.5）]，高于报告的 HIV 流行率。2021 年，根据调整后的 ANC 艾滋病毒流行率进行校准，将大多数省份的 PMTCT 覆盖率降低到 100%以下，并使模型计算的新儿童感染人数增加了 35%。调整后的结果更好地协调了成人和儿科抗逆转录病毒治疗覆盖率以及与区域生育率估计相一致的 ANC 艾滋病毒流行率。
使用全国代表性的 ANC 就诊家庭调查数据调整孕妇的艾滋病毒流行率，产生了与监测数据更一致的估计。由于常规 ANC 流行率存在偏差，莫桑比克艾滋病毒存活儿童的人数被大大低估。重新关注孕妇艾滋病毒监测将提高 PMTCT 覆盖率和儿科 HIV 估计数。
