Sentinel surveillance for HIV-1 among pregnant women in a developing country: 3 years' experience and comparison with a population serosurvey.
OBJECTIVE
To establish unlinked, anonymous sentinel surveillance for HIV-1 among pregnant women attending an antenatal clinic, to determine age-specific seroprevalences, to monitor trends and to compare seroprevalence with that detected by a population serosurvey. To establish the sustainability and costs of surveillance.


METHODS
Sentinel surveillance for HIV through serial collection of unlinked, anonymous seroprevalence data from antenatal care; comparison of sentinel data with those from a population serosurvey; financial and general audit of the sentinel surveillance.


METHODS
A community antenatal clinic in a large urban centre, Mwanza Municipality, Tanzania, eastern Africa, between October 1988 and September 1991.


METHODS
Pregnant women attending for antenatal care.


METHODS
Age-specific HIV-1 seroprevalences, trends over time, difference from age-specific population seroprevalences, sustainability and costs.


RESULTS
Overall HIV-1 seroprevalence was 11.5% (95% confidence interval, 10.5-12.4); differences in age-specific prevalences were not significant. There was no clear evidence of change in seroprevalence over the study period in any age group, although there was some indication of a rise in some age groups in 1988-1989. Sentinel surveillance among pregnant women may have significantly underestimated population HIV-1 seroprevalence for women under the age of 35 years. HIV-1 surveillance proved feasible and sustainable. Additional recurrent costs were US$1.7 per specimen for unlinked anonymous testing and US$0.57 per woman for syphilis screening.


CONCLUSIONS
HIV-1 seroprevalence did not change significantly over 3 years, probably implying a substantial incidence of HIV-1 infection. In this setting seroprevalence in pregnant women may have underestimated population seroprevalence in women aged under 35 years. With modest inputs and good organization unlinked anonymous HIV-1 sentinel surveillance of pregnant women can be introduced and sustained in an African setting. This may usefully be carried out in conjunction with syphilis screening.
Kigadye
R M
RM
Office of the Regional Commissioner, Mwanza.
Klokke
A
A
Nicoll
A
A
Nyamuryekung'e
K M
KM
Borgdorff
M
M
Barongo
L
L
Laukamm-Josten
U
U
Lisekie
F
F
Grosskurth
H
H
Kigadye
F
F
D015492:AIDS Serodiagnosis / Q000191:economics / Q000379:methods; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000453:epidemiology / Q000517:prevention & control; D015897:Comorbidity; D003906:Developing Countries / Q000191:economics; D005240:Feasibility Studies; D005260:Female; D017408:Guidelines as Topic; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D015528:HIV Seroprevalence / Q000639:trends; D015497:HIV-1; D015498:HIV-2; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000517:prevention & control; D013587:Syphilis / Q000453:epidemiology / Q000517:prevention & control; D013588:Syphilis Serodiagnosis / Q000191:economics; D013636:Tanzania / Q000453:epidemiology; D014505:Urban Population; D014944:World Health Organization
D015483:HIV Antibodies