Guidance for Triangulating Data and Estimates of HIV Prevalence Among Pregnant Women and Coverage of PMTCT Using the Spectrum AIDS Impact Module

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BACKGROUND: Most countries use the Spectrum AIDS Impact Module (Spectrum-AIM), antenatal care routine HIV testing, and antiretroviral treatment data to estimate HIV prevalence among pregnant women. Nonrepresentative program data may lead to inaccurate estimates of HIV prevalence and treatment coverage for pregnant women. SETTING: One hundred fifty-four countries and subnational locations across 126 countries. METHODS: Using 2023 UNAIDS HIV estimates, we calculated 3 ratios: (1) HIV prevalence among pregnant women to all women 15-49 yrs (prevalence), (2) ART coverage before pregnancy to women 15-49 yrs ART coverage (ART prepregnancy), and (3) ART coverage at delivery to women 15-49 yrs ART coverage (PMTCT coverage). We developed an algorithm to identify and adjust inconsistent results within regional ranges in Spectrum-AIM, illustrated using Burkina Faso estimates. RESULTS: In 2022, the mean regional ratio of prevalence among pregnant women to all women ranged from 0.68 to 0.95. ART coverage prepregnancy ranged by region from 0.40 to 1.22 times ART coverage among all women. Mean regional PMTCT coverage ratios ranged from 0.85 to 1.51. The prevalence ratio in Burkina Faso was 1.59, above the typical range 0.62-1.04 in western and central Africa. Antenatal clinics reported more PMTCT recipients than estimated HIV-positive pregnant women from 2015 to 2019. We adjusted inputted PMTCT program data to enable consistency of HIV prevalence among pregnant women from programmatic routine HIV testing at antenatal clinics with values typical for western and central Africa. CONCLUSIONS: These ratios offer Spectrum-AIM users a tool to gauge the consistency of their HIV prevalence and treatment coverage estimates among pregnant women with other countries in the region.

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