HIV surveillance in Rwanda: readiness assessment to transition from antenatal care-based to prevention of mother-to-child transmission program-based HIV surveillance.
BACKGROUND
In 2013, the World Health Organization (WHO) recommended that for efficiency and ethical considerations, transitioning from antenatal clinic-based surveillance to prevention of mother-to-child transmission (PMTCT)-based routine data should be investigated. An assessment of the readiness for this transition was carried out in Rwanda in 2011 and 2013.


METHODS
This assessment applied the WHO recommended method. Individual HIV rapid testing at site was compared to antenatal surveillance results at all existing 30 sites, involving 13 292 women. In addition, PMTCT HIV testing quality assurance and PMTCT routine data quality were assessed at 27 out of the 30 sites.


RESULTS
All sentinel sites provided PMTCT services and had a high uptake of HIV testing (more than 90%). At all sites, PMTCT data were recorded in longitudinal and standardized antenatal clinic registers. Twenty-six out of 27 sites had HIV result completeness above 90%. A positive percentage agreement of 97.5% and negative percentage agreement of 99.9% were observed between routine PMTCT and sero-surveillance HIV test results. Of 27 sites, 25 scored more than 80% in all phases of HIV testing quality assurance.


CONCLUSIONS
According to WHO standards, Rwanda antenatal care HIV sero-surveillance is ready to transition to PMTCT-based sero-surveillance.
Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda. Electronic address: bahelene@gmail.com.
Helene
H
Balisanga
Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda.
Mwumvaneza
M
Mutagoma
Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda.
Eric
E
Remera
Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda.
Catherine
C
Kayitesi
US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA.
Eugenie
E
Kayirangwa
US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA.
Jacob
J
Dee
US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA.
Samuel
S
Malamba
US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, Georgia, USA.
Kimberly R
KR
Boer
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Bethany
B
Hedt-Gauthier
Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda.
Placidie
P
Umugwaneza
Rwanda Biomedical Center, Ministry of Health, PO Box 7162, Kigali, Rwanda.
Sabin
S
Nsanzimana
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control; D011295:Prenatal Care; D012432:Rwanda; D014944:World Health Organization; D055815:Young Adult
HIV diagnostic tests; HIV prevalence; Prevention of mother-to-child transmission; Routine data; Sentinel surveillance