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HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil.

This paper describes a methodological proposal based on secondary data and the main results of the HIV-Sentinel Study among childbearing women, carried out in Brazil during 2006. A probabilistic sample of childbearing women was selected in two stages. In the first stage, 150 health establishments were selected, stratified by municipality size (<50,000; 50,000-399,999; 400,000+). In the second stage, 100-120 women were selected systematically. Data collection was based on HIV-test results registered in pre-natal cards and in hospital records. The analysis focused on coverage of HIV-testing during pregnancy and HIV prevalence rate. Logistic regression models were used to test inequalities in HIV-testing coverage during pregnancy by macro-region of residence, municipality size, race, educational level and age group. The study included 16,158 women. Results were consistent with previous studies based on primary data collection. Among the women receiving pre-natal care with HIV-test results registered in their pre-natal cards, HIV prevalence was 0.41%. Coverage of HIV-testing during pregnancy was 62.3% in the country as a whole, but ranged from 40.6% in the Northeast to 85.8% in the South. Significant differences according to race, educational level and municipality size were also found. The proposed methodology is low-cost, easy to apply, and permits identification of problems in routine service provision, in addition to monitoring compliance with Ministry of Health recommendations for pre-natal care.