Central African Journal of Public Health 
Volume 4, Issue 5, October 2018, Pages: 143-148 
Received: Aug. 28, 2018; Accepted: Sep. 6, 2018; Published: Oct. 10, 2018

Authors
Jack Hyyombo Tambwe Kokolomami, Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, DRC;
 
Department of Research, Monitoring and Evaluation, Health Services Development Fund, Kinshasa, DRC
John Shungu Okende, Department of Research, Monitoring and Evaluation, Health Services Development Fund, Kinshasa, DRC
Placide Okitayemba Welo, National Program Against HIV/AIDS, Ministry of Public Health, Kinshasa, DRC
Felly Isumeliko Ekofo, National Program Against HIV/AIDS, Ministry of Public Health, Kinshasa, DRC
Etienne Mutombo Mpoyi, World Health Organization Bureau for DRC, Kinshasa, DRC
Patrick Kalambayi Kayembe, Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, DRC

 

 

 

Abstract

Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen’s Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 – 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.