Antenatal HIV Screening Programme
Monitoring Report
January to June 2014
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· the New Zealand Ministry of Health is acknowledged as the source
Disclaimer
This publication reports on information provided to the Ministry of Health by district health boards. Its purpose is to inform discussion and assist the ongoing development of the Antenatal HIV Screening Programme. All care has been taken in the production of this report, and the data was deemed to be accurate at the time of publication. However, the data may be subject to updates over time as further information is received. Before quoting or using this information, it is advisable to check the current status with the Ministry of Health.
Acknowledgements
Many people have assisted in the production of this report. In particular, the Ministry of Health would like to acknowledge those who have collected this information at the laboratories and district health boards, extracted and verified the information, and facilitated the analysis of the data.
Citation: Ministry of Health. 2014. Antenatal HIV Screening Programme: Monitoring Report January to June 2014.
Wellington: Ministry of Health.
ISBN 978-0-478-42849-0 (online)
HP 5926
Published in 2014
by the Ministry of Health
PO Box 5013, Wellington 6145, New Zealand
This document is available at www.nsu.govt.nz
Contents
Executive summary v
1 Introduction 1
1.1 Why offer screening for HIV in pregnancy? 1
1.2 Background to the universal offer of HIV screening in pregnancy in NewZealand 1
1.3 Programme monitoring and data collection 2
1.4 Information included in this report 3
1.5 Screening uptake calculations 4
1.6 Data limitations 5
2 Screening uptake 7
2.1 Antenatal HIV screening uptake by DHB 7
2.2 Antenatal HIV screening uptake by requestor 8
2.3 Antenatal HIV screening uptake by age group 11
2.4 Antenatal HIV screening uptake by ethnicity 13
2.5 Antenatal HIV screening uptake by NZDep 15
3 Initial reactive and confirmed positive results 17
3.1 Reactive EIA screening tests results 17
3.2 Confirmed HIV positive cases 17
References 18
Appendix 1: History of data collection and reporting processes 19
Appendix 2: Selected data fields and descriptions 20
List of Tables
Table 1: Data provided by DHB, 1 January to 30 June 2014 3
Table 2: Records submitted with missing NHI numbers, 1 January to 30 June 2014 6
Table 3: Screening uptake by DHB, 1 January to 30 June 2014 7
Table 4: Screening uptake by requestor type, 1 January to 30 June 2014 9
Table 5: Screening uptake by DHB and requestor type, 1 January to 30 June 2014 10
Table 6: Screening uptake by age group, 1 January to 30 June 2014 11
Table 7: Screening uptake by DHB and age group, 1 January to 30 June 2014 12
Table 8: Screening uptake by ethnicity, 1 January to 30 June 2014 13
Table 9: Screening uptake by DHB and ethnicity, 1 January to 30 June 2014 14
Table 10: Screening uptake by NZDep2006 decile, 1 January to 30 June 2014 15
Table 11: Screening uptake by DHB and NZDep2006 decile, 1 January to 30 June 2014 16
Table 12: Initial reactive screening test results and confirmed HIV positive results, 1 January to 30 June 2014 17
List of Figures
Figure 1: Data collection process from April 2010 to present 2
Figure 2: Screening uptake by DHB, 1 January to 30 June 2014 8
Figure 3: Screening uptake by requestor type, 1 January to 30 June 2014 9
Figure 4: Screening uptake by age group, 1 January to 30 June 2014 11
Figure 5: Screening uptake by ethnicity, 1 January to 30 June 2014 13
Figure 6: Screening uptake by NZDep2006 decile, 1 January to 30 June 2014 15
Executive summary
This report presents the data for the first half of 2014 and covers a six-month period of antenatal human immunodeficiency virus (HIV) screening.
The information in this report is based on screening that occurred from 1 January to 3o June 2014. All district health boards (DHBs) are providing antenatal HIV screening information.
Key points for the Antenatal HIV Screening Programme
· The Antenatal HIV Screening Programme is offered to all pregnant women and aims to reduce the risk of perinatal transmission of HIV.
· Antenatal HIV screening has been offered to women in all 20 DHBs since July 2010. Some individual DHBs started screening prior to this time.
· The National Screening Unit (NSU) is responsible for funding and monitoring this screening programme.
· No babies of women screened have been born with HIV since the programme was implemented.
· The data limitations identified in the report mean the National Screening Unit cannot monitor uptake of the programme comprehensively. The limitations do not impact on the care or management of women undergoing screening or diagnosed with HIV.
· The NSU continues to work with DHBs and laboratories to improve the data quality for this screening programme.
Key points for January to June 2014
· Data from all 20 DHBs was collected and reported on for this period.
· At the national level, the average uptake rate of antenatal HIV screening was 87percent. Because of a small number of data issues, this figure may be slightly different from the true uptake rate. Nonetheless, it is reasonable to assume that it is the most accurate figure for the screening programme to this point.
· Across DHBs, screening uptake rates range from 59percent to 100percent. Uptake rates for the Auckland region, Northland, Canterbury, Nelson Marlborough and South Canterbury can only be estimated due to data issues. In particular, a proportion of the records in these DHBs did not include a National Health Index (NHI) number, which is a nationally unique identifier. The NSU therefore does not have sufficient information to assign these records an accurate DHB of domicile (that is, the DHB area in which the woman lives).
· Antenatal HIV screening uptake rates are analysed by requestor type, age group, ethnicity and deprivation status. While there are some small differences across these factors, they are generally not large enough to be significant.
· At the national aggregate level, there were 11 reactive enzyme immuno-assay (EIA) tests reported across this reporting period. This result is lower than other reporting periods, and well within the range of 1 in 1000 which was the initial programme prediction.
· There were no HIV positive case identified through screening for this reporting period. This is in line with the data reported by the AIDS Epidemiology Group.
Antenatal HIV Screening Programme: 21
Monitoring Report 1 January to 30 June 2014
1 Introduction
1.1 Why offer screening for HIV in pregnancy?
The primary purpose of screening for the human immunodeficiency virus (HIV) in pregnancy is to reduce the risk of perinatal transmission of HIV. Without diagnosis and treatment during pregnancy, the risk of transmission is around 25–32percent. However, with diagnosis and appropriate treatment that risk is reduced to less than 1percent (Dickson et al 2002; Rongkavilit and Asmar 2004; Ziegler and Graves 2004; Centers for Disease Control and Prevention 2007; National Screening Unit 2008). No cases of perinatal transmission of HIV have been identified in New Zealand among women who have had appropriate treatment during pregnancy.
New Zealand has a low prevalence of HIV, and since 2006 the HIV epidemic among heterosexual people in New Zealand has seen a steady decline (AEG, 2014a). However, heterosexual transmission still remains the most common means of acquiring HIV in many parts of the world and specifically in the Asian Pacific region (UNAIDS, 2013). It is national policy that HIV screening be offered and recommended to all pregnant women, along with the other blood screening tests, as an integral part of antenatal care. Since July 2010, it has been a requirement that all pregnant women in New Zealand are offered screening for HIV, alongside the other tests included within the first antenatal blood screen, when they first present for antenatal care. Ensuring women make an informed decision about antenatal screening for HIV is a legal requirement under the Code of Health and Disability Services Consumers’ Rights, which is central to best practice in maternity care.
1.2 Background to the universal offer of HIV screening in pregnancy in NewZealand
In 2005, the New Zealand Government directed the National Screening Unit (NSU) of the Ministry of Health to begin to implement a nationwide Universal Offer Antenatal HIV Screening Programme. It made this decision because there was evidence that the risk assessment approach to offering screening for HIV was not working. A 2004 report by the National Health Committee (National Health Committee 2004), and the 2005 release of the findings of a case by the Health and Disability Commissioner (HDC 2005), were both strong drivers for change.
Before the national programme was implemented, Waikato District Health Board had made significant progress towards implementing an antenatal HIV screening programme in its region. It became the first district health board (DHB) to implement the national programme in March 2006. Between 2007 and 2010 the other DHBs also implemented the Antenatal HIV Screening Programme.
1.3 Programme monitoring and data collection
This report presents information for the Antenatal HIV Screening Programme between 1 January and 30 June 2014. This report presents data over a six-month timeframe. Previous to 2012, reporting was quarterly but, because a number of women have more than one test recorded during their pregnancy which creates the potential for over-reporting, sixmonthly reporting has been implemented.
Monitoring and evaluation of screening programmes are integral to good practice. Findings inform programme and provider performance against national indicators and ongoing policy development to ensure that services are safe for women and their babies. In 2006, the AIDS Epidemiology Group (AEG, University of Otago) developed a Monitoring and Evaluation Plan for the programme. AEG has overall responsibility for national surveillance of AIDS and HIV infection in New Zealand. AEG also began some qualitative research to review the impact of reactive screening or positive confirmatory results on women and their health care providers. This research concluded in June 2012 (McAllister etal 2013).
In 2008, AEG began monitoring the Antenatal HIV Screening Programme. From July 2009 routine programme monitoring transferred to the NSU. Since this time the data collection, transfer and data validation have been reviewed and redesigned. The new process was implemented from April 2010 onwards, as described in Figure 1. AEG continues to receive notifications of most HIV positive results direct from laboratories. See Appendix 1 for greater detail on data collection processes before and after 1 April 2010.
Figure 1: Data collection process from April 2010 to present
1.4 Information included in this report
The data in this report relates to all 20 DHBs participating in the Antenatal HIV Screening Programme from 1 January to 30 June 2014.
Table 1 below identifies whether or not data was received for monitoring purposes from each DHB and the date of programme implementation for each DHB.
Table 1: Data provided by DHB, 1 January to 30 June 2014
DHB / Month and year started screen / Data providedNorthland / August 2008 / Yes
Waitemata / April 2009 / Yes
Auckland / April 2009 / Yes
Counties Manukau / April 2009 / Yes
Waikato / March 2006 / Yes
Lakes / September 2008 / Yes
Bay of Plenty / August 2008 / Yes
Tairawhiti / April 2008 / Yes
Taranaki / August 2008 / Yes
Hawke’s Bay / July 2008 / Yes
Whanganui / March 2010 / Yes
MidCentral / May 2009 / Yes
Hutt Valley / June 2009 / Yes
Capital & Coast / May 2009 / Yes
Wairarapa / July 2009 / Yes
Nelson Marlborough / December 2009 / Yes
West Coast / December 2008 / Yes
Canterbury / April 2009 / Yes
South Canterbury / July 2009 / Yes
Southern / July 2010 / Yes
See Appendix 2 for a full list of data fields collected and a further description of each field.
The national laboratory algorithm for antenatal HIV screening involves a two-step process. The first step is to do an HIV enzyme immuno-assay (EIA) test. The EIA test is low cost, rapid and very sensitive and specific for HIV (99.9% approximately). The results of an EIA test can be:
· non-reactive, which means that the woman is very unlikely to be infected with HIV
· low-level reactive, which is usually non-specific cross-reactivity and not related to HIV infection
· high-level reactive, which indicates likely HIV infection.
Women who have a reactive EIA test result (low-level and high-level) are asked to provide a second blood sample for confirmatory testing. Confirmatory testing is done using a nucleic acid amplification test (NAAT) in the form of HIV viral load or PCR. This is intended to exclude or confirm HIV infection as quickly as possible, rather than waiting for a conclusive Western Blot test result which can take between three weeks and six months.
1.5 Screening uptake calculations
The screening uptake calculations are based on the following data fields.
Records included in each six-month period
Records included in this six-month period are based on the ‘Date initial sample received’, which must be between 1 January 2014 to 30 June 2014.
DHB of domicile
Each record is allocated to a DHB based on the National Health Index (NHI) information on the woman’s residential address. Where the NHI number is not provided (see Section 1.6 below on data limitations), then the DHB is shown as ‘not recorded’.
Ethnicity and NZ Deprivation decile
Ethnicity is prioritised based on NHI ethnicity information. All reporting ‘by NZDep decile’ is based on the NZDep decile as associated with the NHI-based residential address (domicile code). (Salmond et al 2007). Where the NHI number is missing, these fields are shown as ‘not reported’.