title: Is Zimbabwe ready to transition from anonymous unlinked sero-surveillance to using prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance?: results of PMTCT utility study, 2012.
abstract: BACKGROUND
  Prevention of mother-to-child transmission of HIV (PMTCT) programs collect socio-demographic and HIV testing information similar to that collected by unlinked anonymous testing sero-surveillance (UAT) in antenatal settings. Zimbabwe evaluated the utility of PMTCT data in replacing UAT.
  
  
  METHODS
  A UAT dataset was created by capturing socio-demographic, testing practices from the woman's booking-card and testing remnant blood at a laboratory from 1 June to 30 September 2012. PMTCT data were collected retrospectively from ANC registers. UAT and PMTCT data were linked by bar-code labels that were temporarily affixed to the ANC register. A questionnaire was used to obtain facility-level data at 53 sites.
  
  
  RESULTS
  Pooled HIV prevalence was 15.8 % (95 % CI 15.3-16.4) among 17,349 women sampled by UAT, and 16.3 % (95 % CI 15.8 %-16.9 %) among 17,150 women in PMTCT datasets for 53 sites. Pooled national percent-positive agreement (PPA) was 91.2 %, and percent-negative agreement (PNA) was 98.7 % for 16,782 women with matched UAT and PMTCT data. Based on UAT methods, overall median prevalence was 12.9 % (Range 4.0 %-19.4 %) among acceptors and refusers of HIV test in PMTCT compared to 12.5 % ((Range 3.4 %-19.5 %) among acceptors in ANC registers. There were variations in prevalence by site.
  
  
  CONCLUSIONS
  Although, there is no statistical difference between pooled HIV prevalence in UAT compared to PMTCT program, the overall PPA of 91.2 % and PNA of 98.7 % fall below World Health Organisation (WHO) benchmarks of 97.6 % and 99.6 % respectively. Zimbabwe will need to strengthen quality assurance (QA) of rapid HIV testing and data collection practices. Sites with good performance should be prioritised for transitioning.
authors.affiliation: Centers for Disease Control and Prevention, 38 Nelson Mandela Rd, Box 3088, Harare, Zimbabwe. egonese@cdc.gov.
authors.forename: E
authors.initials: E
authors.lastname: Gonese
authors.affiliation: Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe. mushavia@yahoo.co.uk.
authors.forename: A
authors.initials: A
authors.lastname: Mushavi
authors.affiliation: Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe. mungatim@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Mungati
authors.affiliation: Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe. mutsa.mhangara@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Mhangara
authors.affiliation: Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe. janet.dzangare@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Dzangare
authors.affiliation: Ministry of Health and Child Care Zimbabwe, Mukwati Building, Corner Livingstone/Fifth Street, Harare, Zimbabwe. atp.director@ymail.com.
authors.forename: O
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA. idi0@cdc.gov.
authors.forename: J
authors.initials: J
authors.lastname: Dee
authors.affiliation: National Institute of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA. peter.kilmarx@nih.gov.
authors.forename: P H
authors.initials: PH
authors.lastname: Kilmarx
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Parirenyatwa Hospital, Mazoe Street, Harare, Zimbabwe. gshambira@yahoo.com.
authors.forename: G
authors.initials: G
authors.lastname: Shambira
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Parirenyatwa Hospital, Mazoe Street, Harare, Zimbabwe. mufutatshimanga@gmail.com.
authors.forename: M T
authors.initials: MT
authors.lastname: Tshimanga
authors.affiliation: South Africa Centre for Epidemiological Modelling and Analysis, Stellenbosch University, 19 Jonkershoek Road, Stellenbosch, 7602, South Africa. jhargrove@sun.ac.za.
authors.forename: J
authors.initials: J
authors.lastname: Hargrove
mesh_terms: D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D062486:Public Health Surveillance / Q000379:methods*; D012189:Retrospective Studies; D015030:Zimbabwe / Q000453:epidemiology