HIV surveillance in Rwanda: readiness assessment to transition from antenatal care-based to prevention of mother-to-child transmission program-based HIV surveillance

- All sentinel sites providing prevention of mother-to-child transmission (PMTCT) services had more than 90% uptake of HIV testing.
- At all sites, PMTCT data were recorded in longitudinal and standardized antenatal care registers.
- The positive percentage agreement was 97.5% and negative percentage agreement was 99.9% between routine PMTCT and surveillance HIV test results.
- Of 27 sites, 25 scored more than 80% in all phases of HIV testing quality assurance.
- Routine PMTCT program data are recommendable to serve as the basis for antenatal clinic HIV surveillance in Rwanda because of the universal acceptance of HIV testing, relatively low prevalence of HIV among pregnant women, high data quality, and high coverage HIV testing at the health facility level.

SummaryBackgroundIn 2013, the World Health Organization (WHO) recommended that for efficiency and ethical considerations, transitioning from antenatal clinic-based surveillance to prevention of mother-to-child transmission (PMTCT)-based routine data should be investigated. An assessment of the readiness for this transition was carried out in Rwanda in 2011 and 2013.MethodsThis assessment applied the WHO recommended method. Individual HIV rapid testing at site was compared to antenatal surveillance results at all existing 30 sites, involving 13 292 women. In addition, PMTCT HIV testing quality assurance and PMTCT routine data quality were assessed at 27 out of the 30 sites.ResultsAll sentinel sites provided PMTCT services and had a high uptake of HIV testing (more than 90%). At all sites, PMTCT data were recorded in longitudinal and standardized antenatal clinic registers. Twenty-six out of 27 sites had HIV result completeness above 90%. A positive percentage agreement of 97.5% and negative percentage agreement of 99.9% were observed between routine PMTCT and sero-surveillance HIV test results. Of 27 sites, 25 scored more than 80% in all phases of HIV testing quality assurance.ConclusionsAccording to WHO standards, Rwanda antenatal care HIV sero-surveillance is ready to transition to PMTCT-based sero-surveillance.