# Presentation: 361785

## HIV testing for ANC based  surveillance        in EthiopiaTsehaynesh MesseleEHNRIAddis AbabaEthiopia

## HIV surveillance in Ethiopia

- Population of 70 million
- The HIV surveillance is based on ANC surveillance
- Syphillis testing is part of the routine care in ANC clinics
- No special consent is required for syphillis testing
- ANC based surveillance started in 1989 in Addis Ababa with only one site
- Increase in the number of sites since then

## Increasing number of rural and urban sites

## Distribution of the  66 HIV Sentinel Surveillance Sites (2003)

## Site selection

- Sites were selected in consultation with regional Health Bureaus and the major criteria were:
-       -Health facility where there is ANC service
-      -Routine syphillis testing and treatment
-      -Availability of reagents

## Lab organization for surveillance

- National Referral Lab (EHNRI)

- Regional labs/testing centers

- Rural sites

- Urban sites

- Satellite sites

- Training
- Quality control for surveillance
- Quality assurance –on site supervision
-                               -Panel distribution
- Kit evaluation/testing algorithm validation
- Establishment of new laboratories
- Participation in MOH Task Forces (surveillance, PMTCT, ART)

- National Referral Lab (EHNRI)

## Sample size/period

- A minimum number of 250 (urban) and 400 (rural) mothers were sampled from each site
- Sampling period ranged from 12 to 20 weeks
- Urban sites -12 weeks and rural sites a maximum of 20 weeks
- Satellite sites  were also included

## Training

- Training of trainers  as well as regional training by RHB staff was conducted prior to the start of the surveillance
- MOH developed training manual was used
- All trainees received a copy of the surveillance protocol

## Inclusion criteria

- ANC attendees between the age of 15 to 49
- Those who have not yet been tested for syphilis
- Women not referred from other health facilities
- were included

## Samples/Testing

- Blood collection is done using vacutainer tubes/syringes
- Around 22 of the sites can perform HIV testing
- The rest of the sites are collection sites
- Samples are sent to the regional testing sites from the collection sites

## Testing/QC

- The Ethiopian Health and Nutrition Research Institute located in Addis Ababa is responsible for QC testing
- After testing is done at the sites 10%of the negatives and all the positive samples are sent to EHNRI for QC

## Testing /QC/Reporting

- Testing is done using single EIA so far
- Vironostika EIA is used both at the EHNRI and the sites
-  The testing sites send their results to Ministry of Health surveillance unit
- EHNRI sends QC results to regional labs and MOH

## National HIV prevalence

- National prevalence (2003).......................4.4%
-               Urban prevalence..........................12.6 %
-               Rural prevalence............................2.6%
-             Adult PLWHA.........................1.38 million
-                       Children ...................... 95,741
-                       Females........................... 5.0%
-                          Males.............................3.8%

## 3.9%

**3.9%**

**1.9%**

**13.0%**

**3.4%**

**5.0%**

**12.6%**

**12.5%**

**4.6%**

**2.8%**

**Urban**

**Total**

**Rural**

## HIV testing algorithm for the coming surveillance

**Two EIAs will be used based on WHO guideline for low prevalence areas**
**Regional testing sites will be using single EIA/two EIAs???**
**Samples will be sent to EHNRI for two EIA testing (Vironostika/Innotest)**
**Algorithm using the combination of EIA and rapid test will be piloted at EHNRI**
**The use of  DBS for surveillance will also be piloted in few regional laboratories**

## Challenges (1)

- High turn over of staff at the surveillance sites
- Lack of supervision
- Lack of standardization in equipment, maintenance problems
- High percentages of discordant results during QC
- As high as 43% discordance for some testing sites

##   9.4%

**  ****9.4%**

**10.0%**

**  ****8.9%**

## Overall Discordance: 9.4%

**Overall Discordance: 9.4%**

## Specimen Storage and Transport Scheme - Rural ANC Sentinel Sites

**LEVEL**

## Challenges (2)

**♦****In appropriate storage/transportation of specimens**
**♦**** ****Poor quality of specimens**
**     ****-Haemolyzed**
**     ****-Bacterial and fungal overgrowth**
**     ****-Contaminated specimens**
**♦**** ****Labeling problem**
**♦**** ****Inadequate volume of specimens**
***    ******A one week surveillance planning workshop was conducted recently (Oct. 4-8, 2004) and discussed several issues , modified the surveillance protocol to address the above issues.***

## Acknowledgement

- Ethiopian Health and Nutrition Research Institute
- Federal Ministry of Health
- Regional Health Bureaus
- CDC-Ethiopia
- CDC-Atlanta

## Ameseginalehu!!!Thank you!!!