Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure
Authors:
- Serge C. BillongSBSerge C. Billong
- Jacob DeeJDJacob Dee
- Joseph FokamJFJoseph Fokam
- Georges Nguefack-TsagueGNGeorges Nguefack-Tsague
- Gabriel L. EkaliGEGabriel L. Ekali
- Raoul FodjoRFRaoul Fodjo
- Edith S. TemgouaETEdith S. Temgoua
- Edson-Joan BillongEBEdson-Joan Billong
- Samuel M. SossoSSSamuel M. Sosso
- Jembia J. MosokoJMJembia J. Mosoko
- Francisca MonebenimpFMFrancisca Monebenimp
- Alexis NdjoloANAlexis Ndjolo
Open Access
- 3 January 2017
- journal article
- research article
- Published by Springer Nature in BMC Infectious Diseases
- Vol. 17 (1) , 1-11
Abstract
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. 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. 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%. 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.Keywords
Funding Information
- U.S. President’s Emergency Plan for AIDS Relief (5U2GPS002758)
- World Health Organization
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