Potential Utility of Routine Programmatic Data in Monitoring National and State-Level HIV Epidemic in Nigeria: Data Triangulation Analysis

Nigeria relies on data from periodic resource-intensive surveys such as antenatal HIV seroprevalence sentinel surveys (ANC-HSS) and population-based National AIDS and Reproductive Health Surveys (NARHS) for its HIV control efforts. Nigeria has not explored the use of readily available routine programmatic data (RPD) to easily inform and monitor epidemic control efforts at local settings in near real time. This study aimed to determine the utility of RPDs (Prevention of Mother-To-Child Transmission [PMTCT] and HIV Testing and Counseling [HTC]) as a proxy for monitoring HIV epidemic in Nigeria. Using World Health Organization 12 step triangulation procedures, we compared state-level seropositivity data from PMTCT and HTC programs to HIV prevalence data from NARHS and ANC-HSS reports in relevant pairs from 2010 to 2014 in Nigeria. The study population was pregnant women and general population. We abstracted relevant data from PEPFAR Nigeria data source and published national survey reports. We compared visual (scatterplots and maps) patterns and trends, and performed Pearson correlation and univariate linear regression models of the estimates for best matched/contiguous years for which data were available. Correlation between PMTCT2014 and ANC-HSS2014 was positive and significant (R=0.7,p<0.001). ANC-HSS2014 and HTC2014 were slightly correlated (R=0.4,p<0.05). Significant correlation was observed between ANC-HSS2010 and PMTCT2013 (R=0.8,p<0.001) and between ANC-HSS2010 and HTC2013 (R=0.6, p<0.001). All RPD sources and ANC-HSS indicated a decreasing trend in national HIV prevalence in Nigeria. PMTCT2014 data showed strong capability of predicting HIV prevalence in ANC-HSS2014 in regression model (B=2.09,p<0.0001). Use of routine PMTCT data in monitoring HIV prevalence among women of reproductive age could be more valid and reliable in local settings than the use of HTC data. Use of RPD to monitor national and sub-national-level HIV epidemic in between national surveys in Nigeria could maximize program resources, and promote a more responsive and efficient actions toward epidemic control.