Indian Journal of Public Health

LETTER TO THE EDITOR
Year
: 2014  |  Volume : 58  |  Issue : 4  |  Page : 287--288

Assessing prevention of parent to child transmission need in the private sector for a district: dilemma for program managers


Ritu S Parchure1, Sanjeevani Kulkarni1, Shrinivas Darak2, Vinay Kulkarni1,  
1 Prayas Health Group, Pune, Maharashtra, India
2 Prayas Health Group, Pune, Maharashtra, India; Faculty of Spatial Sciences, Population Research Centre, University of Groningen, The Netherlands

Correspondence Address:
Ritu S Parchure
Prayas Health Group, Amrita Clinic, Athawale Corner, Karve Road Corner, Deccan Gymkhana, Pune - 411 004, Maharashtra, India




How to cite this article:
Parchure RS, Kulkarni S, Darak S, Kulkarni V. Assessing prevention of parent to child transmission need in the private sector for a district: dilemma for program managers .Indian J Public Health 2014;58:287-288


How to cite this URL:
Parchure RS, Kulkarni S, Darak S, Kulkarni V. Assessing prevention of parent to child transmission need in the private sector for a district: dilemma for program managers . Indian J Public Health [serial online] 2014 [cited 2020 Nov 29 ];58:287-288
Available from: https://www.ijph.in/text.asp?2014/58/4/287/146302


Full Text

Sir,

To achieve universal coverage of prevention of parent to child transmission (PPTCT) of human immunodeficiency virus (HIV) services, national acquired immune deficiency syndrome (AIDS) control organization (NACO) has initiated involvement of the private health care sector by promoting public-private partnerships. [1] We have been collaborating with State AIDS Control Society in this initiative in six districts of Maharashtra. There are several challenges faced by private sector PPTCT program in calculating district level needs.

District specific knowledge of accurate HIV prevalence is essential to calculate area specific PPTCT need. NACO provides estimates of state-level adult prevalence. [2] However, significant variations in HIV prevalence within the state [3] make application of state-level estimates of a number of women requiring PPTCT services less useful to understand district level needs. District level prevalence is available through HIV surveillance sites' (HSS) data, [3] which is known to overestimate the needs. [4] PPTCT needs calculations based on these sources show a great disparity with field level data. As an example, using HSS 2010-2011 HIV prevalence, for the year 2011-2012, [3] the need for PPTCT in private sector in Solapur district comes to 358. [5] Applying state-level adult HIV prevalence (0.55%), [2] it comes to 197. While as per our private sector program prevalence data in 2012 (0.13%), it is 46. Thus, the actual PPTCT need in the private sector appears to be much lower than the state level/HSS estimates. The closest estimate is provided by the National PPTCT program prevalence for the state (0.18%).

In a low prevalence setting, where a large number of women have to be screened to reach a proportionately smaller number of positive women, such a wide disparity in estimates has even greater implications at program level. Obstetric care in the private sector is provided by thinly spread out health care facilities; with variable antenatal care (ANC) case loads and sporadic HIV detections. A small change in estimates would significantly alter program implementation strategies; like resource allocation, establishing supply chains and referral networks, etc.

Currently, for want of accurate estimates, program managers struggle with compromised planning and possibly wasteful interventions, because the gap analyses based on official data sources point out under-achievements. Evaluations based on erroneous estimates would lack the ability to reveal the true picture and hence would be less useful in guiding long-term program strategies.

The limitations of available data sources strongly indicate the need for better models to estimate district level needs. Issuing specific guidelines about district level PPTCT needs for private sector programs would optimize the use of limited resources. Although, increasing evidence suggests that PPTCT program prevalence provides most accurate measure of HIV prevalence in the low-risk, sexually active, general population [4] at district level, there are quality concerns with the currently available data. It would be useful to make district level PPTCT program data available in public domain and till such time that more refined HIV prevalence estimates are available, public sector PPTCT program data could be the best possible source for estimating private sector needs.

References

1Department of AIDS control (NACO). Annual Report; 2011-12.
2National Institute of Medical Statistics; Department of AIDS Control (NACO). Technical Report: India HIV Estimates; 2010.
3Department of AIDS Control (NACO). HIV Sentinel Surveillance 2010-11: A Technical Brief; 2012.
4Sgaier SK, Claeson M, Gilks C, Ramesh BM, Ghys PD, Wadhwani A, et al. Knowing your HIV/AIDS epidemic and tailoring an effective response: How did India do it? Sex Transm Infect 2012;88:240-9.
5National Health Systems Resource Center Data Management and Analysis. HMIS Analysis - 2011-12, Maharashtra-Solapur; 2012.