Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure.
|Title||Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure.|
|Publication Type||Journal Article|
|Year of Publication||2017|
|Authors||Billong SC, Dee J, Fokam J, Nguefack-Tsague G, Ekali GL, Fodjo R, Temgoua ES, Billong E-J, Sosso SM, Mosoko JJ, Monebenimp F, Ndjolo A, Bissek A-CZ-K, Bolu O, Elat J-BN|
|Journal||BMC Infect Dis|
|Date Published||2017 01 03|
|Keywords||Adolescent, Adult, Cameroon, Databases, Factual, Feasibility Studies, Female, HIV Infections, HIV-1, Humans, Infectious Disease Transmission, Vertical, Mass Screening, Middle Aged, Poverty, Pregnancy, Pregnancy Complications, Infectious, Prenatal Care, Sentinel Surveillance, Young Adult|
BACKGROUND: In low-income countries (LICs), HIV sentinel surveillance surveys (HIV-SSS) are recommended in between two demographic and health surveys, due to low-cost than the latter. Using the classical unlinked anonymous testing (UAT), HIV-SSS among pregnant women raised certain ethical and financial challenges. We therefore aimed at evaluating how to use prevention of mother-to-child transmission of HIV (PMTCT) routine data as an alternative approach for HIV-SSS in LICs.
METHODS: A survey conducted through 2012 among first antenatal-care attendees (ANC1) in the ten regions of Cameroon. HIV testing was performed at PMTCT clinics as-per the national serial algorithm (rapid test), and PMTCT site laboratory (PMTCT-SL) performances were evaluated by comparison with results of the national reference laboratory (NRL), determined as the reference standard.
RESULTS: Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (49 · 3% aged 15-24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 81 · 2%, ranging from 58 · 8% (South region) to 100% (West region); thus implying that 18 · 8% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 99 · 3%, without significant disparity across sites. At population-level, this implies that every year in Cameroon, ~2,500 HIV-infected women are wrongly declared seronegative, while ~1,000 are wrongly declared seropositive. Only 44 · 4% (16/36) of evaluated laboratories reached the quality target of 80%.
CONCLUSIONS: The study identified weaknesses in routine PMTCT HIV testing. As Cameroon transitions to using routine PMTCT data for HIV-SSS among pregnant women, there is need in optimizing quality system to ensure robust routine HIV testing for programmatic and surveillance purposes.
|Alternate Journal||BMC Infect. Dis.|
|PubMed Central ID||PMC5209823|
|Grant List||U2G PS002758 / PS / NCHHSTP CDC HHS / United States|