title: Evaluation of Kenya's readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance.
abstract: BACKGROUND
  Sentinel surveillance for HIV among women attending antenatal clinics using unlinked anonymous testing is a cornerstone of HIV surveillance in sub-Saharan Africa. Increased use of routine antenatal HIV testing allows consideration of using these programmatic data rather than sentinel surveillance data for HIV surveillance.
  
  
  METHODS
  To gauge Kenya's readiness to discontinue sentinel surveillance, we evaluated whether recommended World Health Organization standards were fulfilled by conducting data and administrative reviews of antenatal clinics that offered both routine testing and sentinel surveillance in 2010.
  
  
  RESULTS
  The proportion of tests that were HIV-positive among women aged 15-49 years was 6.2% (95% confidence interval [CI] 4.6-7.7%] in sentinel surveillance and 6.5% (95% CI 5.1-8.0%) in routine testing. The agreement of HIV test results between sentinel surveillance and routine testing was 98.0%, but 24.1% of specimens that tested positive in sentinel surveillance were recorded as negative in routine testing. Data completeness was moderate, with HIV test results recorded for 87.8% of women who received routine testing.
  
  
  CONCLUSIONS
  Additional preparation is required before routine antenatal HIV testing data can supplant sentinel surveillance in Kenya. As the quality of program data has markedly improved since 2010 a repeat evaluation of the use of routine antenatal HIV testing data in lieu of ANC sentinel surveillance is recommended.
authors.affiliation: Ministry of Health, National AIDS and STI Control Programme, Kenyatta National Hospital Grounds, 19361-00202, Nairobi, Kenya. msirengo@nascop.or.ke.
authors.forename: Martin
authors.initials: M
authors.lastname: Sirengo
authors.affiliation: Global Health Sciences, University of California, San Francisco, California, USA. george.rutherford@ucsf.edu.
authors.forename: George W
authors.initials: GW
authors.lastname: Rutherford
authors.affiliation: Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya. ikg1@cdc.gov.
authors.forename: Boaz
authors.initials: B
authors.lastname: Otieno-Nyunya
authors.affiliation: Global Health Sciences, University of California, San Francisco, California, USA. tim.kellogg@ucsf.edu.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Kellogg
authors.affiliation: Ministry of Health, National AIDS and STI Control Programme, Kenyatta National Hospital Grounds, 19361-00202, Nairobi, Kenya. daviesomari@yahoo.com.
authors.forename: Davies
authors.initials: D
authors.lastname: Kimanga
authors.affiliation: Ministry of Health, National AIDS and STI Control Programme, Kenyatta National Hospital Grounds, 19361-00202, Nairobi, Kenya. dnmurags@gmail.com.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Muraguri
authors.affiliation: Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya. mamo@nphls.or.ke.
authors.forename: Mamo
authors.initials: M
authors.lastname: Umuro
authors.affiliation: Global Health Sciences, University of California, San Francisco, California, USA. joy.mirjahangir@ucsf.edu.
authors.forename: Joy
authors.initials: J
authors.lastname: Mirjahangir
authors.affiliation: Global Health Sciences, University of California, San Francisco, California, USA. ellen.stein@ucsf.edu.
authors.forename: Ellen
authors.initials: E
authors.lastname: Stein
authors.affiliation: Kenya Medical Research Institute, Nairobi, Kenya. mndisha@nltp.co.ke.
authors.forename: Margaret
authors.initials: M
authors.lastname: Ndisha
authors.affiliation: Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya. aakim@cdc.gov.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D015397:Program Evaluation; D018571:Sentinel Surveillance; D055815:Young Adult