DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results

Jack Hyyombo Tambwe Kokolomami; John Shungu Okende; Placide Okitayemba Welo; Felly Isumeliko Ekofo; Etienne Mutombo Mpoyi; Patrick Kalambayi Kayembe

doi:doi:10.11648/j.cajph.20180405.13

DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results

Jack Hyyombo Tambwe Kokolomami, John Shungu Okende, Placide Okitayemba Welo, Felly Isumeliko Ekofo, Etienne Mutombo Mpoyi, Patrick Kalambayi Kayembe

Published in Central African Journal of Public Health (Volume 4, Issue 5)

Received: 28 August 2018 Accepted: 6 September 2018 Published: 10 October 2018

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Abstract

Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen's Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 - 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.

Published in	Central African Journal of Public Health (Volume 4, Issue 5)
DOI	10.11648/j.cajph.20180405.13
Page(s)	143-148
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

HIV Surveillance, Anonymous Unlinked Test, Prevention of Mother-To-Child Transmission, World Health Organization Criteria Assessment, DRC

References

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[2]	Joint United Nations Programme on HIV/AIDS & World Health Organization. Guidelines for conducting HIV sentinel serosurveys among pregnant women and other groups. HIV/AIDS JUNP on, Organization WH, editors. Geneva: UNAIDS; 2003. 66 pp.
[3]	World Health Organization. Guidelines for second generation HIV surveillance: the next decade. UNAIDS/WHO Working group on global HIV/AIDS and STI surveillance. Geneva, Switzerland; 2000.
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[5]	Mirkuzie AH, Sisay MM, Hinderaker SG, Moland KM, Mørkve O. Comparing HIV prevalence estimates from prevention of mother-to-child HIV transmission programme and the antenatal HIV surveillance in Addis Ababa. 2012.
[6]	Bolu O, Anand A, Swartzendruber A, Hladik W, Marum LH, Sheikh AA, et al. Utility of antenatal HIV surveillance data to evaluate prevention of mother-to-child HIV transmission programs in resource-limited settings. Am J Obstet Gynecol. 2007;197(3 SUPPL.).
[7]	UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Guidelines for assessing the utility of data from prevention of mother-to-child transmission (PMTCT) programmes for HIV sentinel surveillance among pregnant women. 2013;52. Available from: http://apps.who.int/iris/bitstream/10665/85512/1/9789241505611_eng.pdf.
[8]	Balisanga H, Mutagoma M, Remera E, Kayitesi C, Kayirangwa E, Dee J, et al. HIV surveillance in Rwanda: readiness assessment to transition from antenatal care-based to prevention of mother-to-child transmission program-based HIV surveillance. Int J Infect Dis [Internet]. 2016;52:62-7. Available from: http://dx.doi.org/10.1016/j.ijid.2016.08.029.
[9]	Young PW, Mahomed M, Horth RZ, Shiraishi RW, Jani I V. Routine data from prevention of mother-to-child transmission (PMTCT) HIV testing not yet ready for HIV surveillance in Mozambique: a retrospective analysis of matched test results. BMC Infect Dis [Internet]. 2013;13(1):96. Available from: http://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-96.
[10]	Sirengo M, Rutherford GW, Otieno-Nyunya B, Kellogg TA, Kimanga D, Muraguri N, et al. Evaluation of Kenya’s readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance. BMC Infect Dis [Internet]. 2016;16(1):1–6. Available from: http://dx.doi.org/10.1186/s12879-016-1434-1.
[11]	Gonese E, Mushavi A, Mungati M, Mhangara M, Dzangare J, Mugurungi O, et al. Is Zimbabwe ready to transition from anonymous unlinked sero-surveillance to using prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance?: Results of PMTCT utility study, 2012. BMC Infect Dis [Internet]. 2016;16(1):1–13. Available from: http://dx.doi.org/10.1186/s12879-016-1425-2.
[12]	Pereira GFM, Sabidó M, Caruso A, Benzaken AS. Transitioning from antenatal surveillance surveys to routine HIV testing: a turning point in the mother-to-child transmission prevention programme for HIV surveillance in Brazil. BMC Infect Dis [Internet]. 2017;17(1):469. Available from: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2540-4.
[13]	Billong SC, Dee J, Fokam J, Nguefack-Tsague G, Ekali GL, Fodjo R, et al. Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: From Scientific Success to Programmatic Failure. BMC Infect Dis [Internet]. 2017;17(1):1–11. Available from: http://dx.doi.org/10.1186/s12879-016-2119-5.
[14]	Tudor Car L, Brusamento S, Elmoniry H, van Velthoven MHMMT, Pape UJ, Welch V, et al. The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review. PLoS One [Internet]. 2013;8(3):e56550. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3590218&tool=pmcentrez&rendertype=abstract.
[15]	Gumede-moyo S, Filteau S, Munthali T, Todd J, Musonda P. Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa A systematic literature review. 2017;0 (December 2016).

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APA Style

Jack Hyyombo Tambwe Kokolomami, John Shungu Okende, Placide Okitayemba Welo, Felly Isumeliko Ekofo, Etienne Mutombo Mpoyi, et al. (2018). DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results. Central African Journal of Public Health, 4(5), 143-148. https://doi.org/10.11648/j.cajph.20180405.13

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ACS Style

Jack Hyyombo Tambwe Kokolomami; John Shungu Okende; Placide Okitayemba Welo; Felly Isumeliko Ekofo; Etienne Mutombo Mpoyi, et al. DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results. Cent. Afr. J. Public Health 2018, 4(5), 143-148. doi: 10.11648/j.cajph.20180405.13

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AMA Style

Jack Hyyombo Tambwe Kokolomami, John Shungu Okende, Placide Okitayemba Welo, Felly Isumeliko Ekofo, Etienne Mutombo Mpoyi, et al. DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results. Cent Afr J Public Health. 2018;4(5):143-148. doi: 10.11648/j.cajph.20180405.13

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@article{10.11648/j.cajph.20180405.13,
  author = {Jack Hyyombo Tambwe Kokolomami and John Shungu Okende and Placide Okitayemba Welo and Felly Isumeliko Ekofo and Etienne Mutombo Mpoyi and Patrick Kalambayi Kayembe},
  title = {DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results},
  journal = {Central African Journal of Public Health},
  volume = {4},
  number = {5},
  pages = {143-148},
  doi = {10.11648/j.cajph.20180405.13},
  url = {https://doi.org/10.11648/j.cajph.20180405.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20180405.13},
  abstract = {Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen's Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 - 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.},
 year = {2018}
}

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TY  - JOUR
T1  - DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results
AU  - Jack Hyyombo Tambwe Kokolomami
AU  - John Shungu Okende
AU  - Placide Okitayemba Welo
AU  - Felly Isumeliko Ekofo
AU  - Etienne Mutombo Mpoyi
AU  - Patrick Kalambayi Kayembe
Y1  - 2018/10/10
PY  - 2018
N1  - https://doi.org/10.11648/j.cajph.20180405.13
DO  - 10.11648/j.cajph.20180405.13
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 143
EP  - 148
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20180405.13
AB  - Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen's Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 - 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.
VL  - 4
IS  - 5
ER  -

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Author Information

Jack Hyyombo Tambwe Kokolomami

Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, DRC
John Shungu Okende

Department of Research, Monitoring and Evaluation, Health Services Development Fund, Kinshasa, DRC
Placide Okitayemba Welo

National Program Against HIV/AIDS, Ministry of Public Health, Kinshasa, DRC
Felly Isumeliko Ekofo

National Program Against HIV/AIDS, Ministry of Public Health, Kinshasa, DRC
Etienne Mutombo Mpoyi

World Health Organization Bureau for DRC, Kinshasa, DRC
Patrick Kalambayi Kayembe

Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, DRC

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APA Style

Jack Hyyombo Tambwe Kokolomami, John Shungu Okende, Placide Okitayemba Welo, Felly Isumeliko Ekofo, Etienne Mutombo Mpoyi, et al. (2018). DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results. Central African Journal of Public Health, 4(5), 143-148. https://doi.org/10.11648/j.cajph.20180405.13

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ACS Style

Jack Hyyombo Tambwe Kokolomami; John Shungu Okende; Placide Okitayemba Welo; Felly Isumeliko Ekofo; Etienne Mutombo Mpoyi, et al. DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results. Cent. Afr. J. Public Health 2018, 4(5), 143-148. doi: 10.11648/j.cajph.20180405.13

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AMA Style

Jack Hyyombo Tambwe Kokolomami, John Shungu Okende, Placide Okitayemba Welo, Felly Isumeliko Ekofo, Etienne Mutombo Mpoyi, et al. DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results. Cent Afr J Public Health. 2018;4(5):143-148. doi: 10.11648/j.cajph.20180405.13

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@article{10.11648/j.cajph.20180405.13,
  author = {Jack Hyyombo Tambwe Kokolomami and John Shungu Okende and Placide Okitayemba Welo and Felly Isumeliko Ekofo and Etienne Mutombo Mpoyi and Patrick Kalambayi Kayembe},
  title = {DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results},
  journal = {Central African Journal of Public Health},
  volume = {4},
  number = {5},
  pages = {143-148},
  doi = {10.11648/j.cajph.20180405.13},
  url = {https://doi.org/10.11648/j.cajph.20180405.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20180405.13},
  abstract = {Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen's Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 - 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.},
 year = {2018}
}

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TY  - JOUR
T1  - DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results
AU  - Jack Hyyombo Tambwe Kokolomami
AU  - John Shungu Okende
AU  - Placide Okitayemba Welo
AU  - Felly Isumeliko Ekofo
AU  - Etienne Mutombo Mpoyi
AU  - Patrick Kalambayi Kayembe
Y1  - 2018/10/10
PY  - 2018
N1  - https://doi.org/10.11648/j.cajph.20180405.13
DO  - 10.11648/j.cajph.20180405.13
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 143
EP  - 148
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20180405.13
AB  - Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen's Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 - 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.
VL  - 4
IS  - 5
ER  -

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