Prevention of mother-to-child transmission of HIV: assessing the accuracy of routinely collected data on maternal antiretroviral prophylaxis coverage in Kenya
- Laura Ferguson1,2,
- Alison D Grant3,
- John O Ong'ech2,4,
- Sophie Vusha2,
- Deborah Watson-Jones3,
- David A Ross1
- 1Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- 2Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- 3Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- 4Department of Obstetrics and Gynaecology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
- Correspondence to Laura Ferguson, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, Room 121, London WC1E 7HT, UK;
Contributors LF collected the data and drafted the manuscript. SV assisted with data collection. All authors contributed to interpretation of the data and were responsible for critical revisions to the paper. All authors read and approved the final manuscript.
- Accepted 15 December 2011
Objective To explore the accuracy of routinely collected prevention of mother-to-child transmission of HIV (PMTCT) coverage data in Kenya.
Methods In case studies at two government hospitals, the authors reviewed national reporting guidelines, interviewed nurses and undertook a retrospective analysis of routine hospital data from antenatal care, maternity and HIV services from January 2009 to June 2010. Each woman attending these services was given a unique study number to enable analysis of her recorded use of PMTCT services across different hospital visits. These data were compared with the hospitals' monthly PMTCT reports to the district.
Results Where a woman made more than one visit, PMTCT drug provision could be reported multiple times for the same woman, and women known to be HIV positive prior to pregnancy were omitted from the denominator of PMTCT coverage calculations. Practices for reporting data on maternal PMTCT prophylaxis provision varied in the two hospitals. According to the study data, using the hospital registers and accounting for multiple visits by the same woman, 642 women were known to have HIV and 412 (64%) were given maternal PMTCT prophylaxis. According to the monthly reports, 430 women were diagnosed as having HIV in pregnancy-related services and 538 (125%) were given maternal PMTCT prophylaxis.
Conclusions If replicated elsewhere, these reporting practices could lead to overestimation of national PMTCT coverage. Simple yet accurate routine data collection systems are needed to monitor PMTCT coverage accurately and to highlight where changes need to be made so as to ensure that infants are born HIV free.
- prevention of mother-to-child transmission
- data quality
- evidence-based healthcare
- pregnant women
- antenatal HIV
- developing world
- service delivery
- clinical trials
Funding Funding to support this work was received from the Medical Research Council (UK)/Economic and Social Research Council (UK), the UK Department for International Development-supported Evidence for Action on HIV Treatment and Care Systems Research Programme, the Parkes Foundation and the University of London Central Research Fund. None of the study sponsors had any role in the study design; collection, analysis and interpretation of the data; writing the report or the decision to submit this paper for publication.
Competing interests None.
Ethics approval Ethics approval was provided by University of Nairobi Kenyatta National Hospital Ethics Review Committee; London School of Hygiene and Tropical Medicine Ethics Committee.
Provenance and peer review Commissioned; externally peer reviewed.