School of Public Health, University of Cape Town, Cape Town, South Africa.
University of Sheffield, Sheffield, United Kingdom.
PLoS One. 2024 Apr 18;19(4):e0291844. doi: 10.1371/journal.pone.0291844. eCollection 2024.
Accurate measurement of antenatal antiretroviral treatment (ART) coverage in pregnancy is imperative in tracking progress towards elimination of vertical HIV transmission. In the Western Cape, South Africa, public-sector individual-level routine data are consolidated from multiple sources, enabling the description of temporal changes in population-wide antenatal antiretroviral coverage. We evaluated the validity of different methods for measuring ART coverage among pregnant women.
We compared self-reported ART data from a 2014 antenatal survey with laboratory assay data from a sub-sample within the survey population. Thereafter, we conducted a retrospective cohort analysis of all pregnancies consolidated in the Provincial Health Data Centre (PHDC) from January 2011 to December 2020. Evidence of antenatal and HIV care from electronic platforms were linked using a unique patient identifier. ART coverage estimates were triangulated with available antenatal survey estimates, aggregated programmatic data from registers recorded in the District Health Information System (DHIS) and Thembisa modelling estimates.
Self-reported ART in the 2014 sentinel antenatal survey (n = 1434) had high sensitivity (83.5%), specificity (94.5%) and agreement (k = 0.8) with the gold standard of laboratory analysis of ART. Based on linked routine data, ART coverage by the time of delivery in mothers of live births increased from 67.4% in 2011 to 94.7% by 2019. This pattern of increasing antenatal ART coverage was also seen in the DHIS data, and estimated by the Thembisa model, but was less consistent in the antenatal survey data.
This study is the first in a high-burden HIV setting to compare sentinel ART surveillance data with consolidated individuated administrative data. Although self-report in survey conditions showed high validity, more recent data sources based on self-report and medical records may be uncertain with increasing ART coverage over time. Linked individuated data may offer a promising option for ART coverage estimation with greater granularity and efficiency.
准确测量产前抗逆转录病毒治疗 (ART) 的覆盖率对于跟踪消除垂直 HIV 传播的进展至关重要。在南非西开普省，公共部门的个体层面常规数据来自多个来源，能够描述人群中产前抗逆转录病毒覆盖率的时间变化。我们评估了不同方法测量孕妇接受 ART 治疗的覆盖率的有效性。
我们将 2014 年产前调查中的自我报告 ART 数据与调查人群中的亚样本的实验室检测数据进行了比较。此后，我们对 2011 年 1 月至 2020 年 12 月期间整合到省级卫生数据中心 (PHDC) 的所有妊娠进行了回顾性队列分析。电子平台上的产前和 HIV 护理证据使用唯一的患者标识符进行了链接。ART 覆盖率的估计与可用的产前调查估计、登记册中记录的基于项目的数据（记录在地区卫生信息系统 (DHIS) 中）以及 Thembisa 建模估计进行了三角测量。
2014 年哨点产前调查中的自我报告 ART（n = 1434）具有较高的敏感性（83.5%）、特异性（94.5%）和一致性（k = 0.8），符合实验室分析 ART 的金标准。基于链接的常规数据，活产母亲在分娩时接受 ART 的覆盖率从 2011 年的 67.4%增加到 2019 年的 94.7%。这种产前接受 ART 治疗覆盖率增加的模式也在 DHIS 数据中可见，并且 Thembisa 模型也进行了估计，但在产前调查数据中则不太一致。
这项研究是在高负担 HIV 环境中首次将哨点 ART 监测数据与整合的个体行政数据进行比较。尽管调查条件下的自我报告具有较高的有效性，但随着时间的推移，基于自我报告和医疗记录的最近数据源可能不太可靠，因为 ART 覆盖率不断增加。链接的个体数据可能是一种有前途的 ART 覆盖率估计选项，具有更高的粒度和效率。
