title: Prevention of mother-to-child transmission and voluntary counseling and testing programme data: what is their utility for HIV surveillance?
abstract: OBJECTIVE
  Antenatal clinic (ANC)-based surveillance through unlinked anonymous testing (UAT) for HIV without informed consent provides solid long-term trend data in resource-constrained countries with generalized epidemics. The rapid expansion of the prevention of mother-to-child transmission (PMTCT) and voluntary counseling and testing (VCT) programmes prompts the question regarding their utility for HIV surveillance and their potential to replace UAT-based ANC surveillance.
  
  
  METHODS
  Four presentations on the use of PMTCT or VCT data for HIV surveillance were presented at a recent international conference. The main findings are presented in this paper, and the operational and epidemiological aspects of using PMTCT or VCT data for surveillance are considered.
  
  
  RESULTS
  VCT data in Uganda confirm the falling trend in HIV prevalence observed in ANC surveillance. Thailand, a country with nationwide PMTCT coverage and a very high acceptance of HIV testing, has replaced UAT data in favor of PMTCT data for surveillance. Studies from Botswana and Kenya showed that PMTCT-based HIV prevalences was similar, but the quality and availability of the PMTCT data varied.
  
  
  CONCLUSIONS
  The strength of UAT lies in the absence of selection bias and the availability of individual data. Conversely, the quantity of VCT and PMTCT programme testing data often exceed those in UAT, but may be subject to bias due to self-selection or test refusal. When using VCT or PMTCT data for surveillance, investigators must consider these caveats, as well as their varying data quality, accessibility, and availability of individual records.
authors.affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA, USA. wfh3@cdc.gov
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hladik
authors.forename: Kereng
authors.initials: K
authors.lastname: Masupu
authors.forename: Thierry
authors.initials: T
authors.lastname: Roels
authors.forename: Tanarak
authors.initials: T
authors.lastname: Plipat
authors.forename: Frank
authors.initials: F
authors.lastname: Kaharuza
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
authors.forename: Nicole
authors.initials: N
authors.lastname: Seguy
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Marum
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D017677:Age Distribution; D035041:Anonymous Testing; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011296:Prenatal Diagnosis / Q000379:methods; D015995:Prevalence; D013785:Thailand / Q000453:epidemiology