title: Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure.
abstract: In low-income countries (LICs), HIV sentinel surveillance surveys (HIV-SSS) are recommended in between two demographic and health surveys, due to low-cost than the latter. Using the classical unlinked anonymous testing (UAT), HIV-SSS among pregnant women raised certain ethical and financial challenges. We therefore aimed at evaluating how to use prevention of mother-to-child transmission of HIV (PMTCT) routine data as an alternative approach for HIV-SSS in LICs.
  
  
  
  A survey conducted through 2012 among first antenatal-care attendees (ANC1) in the ten regions of Cameroon. HIV testing was performed at PMTCT clinics as-per the national serial algorithm (rapid test), and PMTCT site laboratory (PMTCT-SL) performances were evaluated by comparison with results of the national reference laboratory (NRL), determined as the reference standard.
  
  
  
  Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (49 · 3% aged 15-24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 81 · 2%, ranging from 58 · 8% (South region) to 100% (West region); thus implying that 18 · 8% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 99 · 3%, without significant disparity across sites. At population-level, this implies that every year in Cameroon, ~2,500 HIV-infected women are wrongly declared seronegative, while ~1,000 are wrongly declared seropositive. Only 44 · 4% (16/36) of evaluated laboratories reached the quality target of 80%.
  
  
  
  The study identified weaknesses in routine PMTCT HIV testing. As Cameroon transitions to using routine PMTCT data for HIV-SSS among pregnant women, there is need in optimizing quality system to ensure robust routine HIV testing for programmatic and surveillance purposes.
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon. sergebillong@yahoo.fr.|Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon. sergebillong@yahoo.fr.|Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon. sergebillong@yahoo.fr.
authors.forename: Serge C
authors.initials: SC
authors.lastname: Billong
authors.affiliation: Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Dee
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon. josephfokam@gmail.com.|Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon. josephfokam@gmail.com.|Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon. josephfokam@gmail.com.|Chair of Virology, Department of Experimental Medicine and Surgery, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy. josephfokam@gmail.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Fokam
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon.|Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon.
authors.forename: Georges
authors.initials: G
authors.lastname: Nguefack-Tsague
authors.affiliation: Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Gabriel L
authors.initials: GL
authors.lastname: Ekali
authors.affiliation: Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Raoul
authors.initials: R
authors.lastname: Fodjo
authors.affiliation: Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon.
authors.forename: Edith S
authors.initials: ES
authors.lastname: Temgoua
authors.affiliation: Faculty of Medicine, University of Antanarivo, Antananarivo, Madagascar.
authors.forename: Edson-Joan
authors.initials: EJ
authors.lastname: Billong
authors.affiliation: Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Sosso
authors.affiliation: Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Cameroon Country Office, Yaoundé, Cameroon.
authors.forename: Jembia J
authors.initials: JJ
authors.lastname: Mosoko
authors.affiliation: Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon.
authors.forename: Francisca
authors.initials: F
authors.lastname: Monebenimp
authors.affiliation: Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon.|Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention andmanagement, Yaoundé, Cameroon.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ndjolo
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon.|Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé1, Yaoundé, Cameroon.|Division of Operational Health Research, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Anne-Cecile Z-K
authors.initials: AZ
authors.lastname: Bissek
authors.affiliation: Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Cameroon Country Office, Yaoundé, Cameroon.
authors.forename: Omotayo
authors.initials: O
authors.lastname: Bolu
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), National AIDS Control Committee, Yaoundé, Cameroon.|Central Technical Group, National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Jean-Bosco N
authors.initials: JN
authors.lastname: Elat
mesh_terms: D000293:Adolescent; D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening; D008875:Middle Aged; D011203:Poverty; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011295:Prenatal Care / Q000592:standards; D018571:Sentinel Surveillance; D055815:Young Adult