Background: Routine health system data are central to monitoring HIV trends. In Mozambique, the reported number of women receiving antenatal care (ANC) and antiretroviral therapy for prevention of mother-to-child transmission (PMTCT) has exceeded the Spectrum-estimated number of pregnant women since 2017. In some provinces, reported HIV prevalence in pregnant women has declined faster than epidemiologically plausible. We hypothesized that these issues are linked and caused by programmatic overenumeration of HIV-negative pregnant women at ANC. Methods: We triangulated program-reported ANC client numbers with survey-based fertility estimates and facility birth data adjusted for the proportion of facility births. We used survey-reported ANC attendance to produce adjusted time series of HIV prevalence in pregnant women, adjusted for hypothesized program double counting. We calibrated the Spectrum HIV estimation models to adjusted HIV prevalence data to produce adjusted adult and pediatric HIV estimates. Results: ANC client numbers were not consistent with facility birth data or modeled population estimates indicating ANC data quality issues in all provinces. Adjusted provincial ANC HIV prevalence in 2021 was median 45% [interquartile range 35%–52% or 2.3 percentage points (interquartile range 2.5–3.5)] higher than reported HIV prevalence. In 2021, calibrating to adjusted antenatal HIV prevalence lowered PMTCT coverage to less than 100% in most provinces and increased the modeled number of new child infections by 35%. The adjusted results better reconciled adult and pediatric antiretroviral treatment coverage and antenatal HIV prevalence with regional fertility estimates. Conclusions: Adjusting HIV prevalence in pregnant women using nationally representative household survey data on ANC attendance produced estimates more consistent with surveillance data. The number of children living with HIV in Mozambique has been substantially underestimated because of biased routine ANC prevalence. Renewed focus on HIV surveillance among pregnant women would improve PMTCT coverage and pediatric HIV estimates.

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莫桑比克常规产前艾滋病毒患病率数据的三角测量和调整后的艾滋病毒估计

背景：常规卫生系统数据对于监测艾滋病毒趋势至关重要。在莫桑比克，自 2017 年以来报告的接受产前护理 (ANC) 和抗逆转录病毒治疗以预防母婴传播 (PMTCT) 的妇女人数已超过 Spectrum 估计的孕妇人数。在一些省份，报告的艾滋病毒感染率孕妇的下降速度比流行病学上合理的速度要快。我们假设这些问题是相互关联的，并且是由 ANC 对 HIV 阴性孕妇的计划性过度计数造成的。 方法：我们对项目报告的 ANC 客户数量与基于调查的生育率估计和根据机构出生比例进行调整的机构出生数据进行了三角测量。我们使用调查报告的 ANC 出勤率来生成孕妇 HIV 患病率的调整时间序列，并根据假设的项目重复计算进行调整。我们校准了 Spectrum HIV 估计模型，以调整 HIV 患病率数据，从而生成调整后的成人和儿童 HIV 估计值。 结果：ANC 客户数量与机构出生数据或模型人口估计不一致，表明所有省份的 ANC 数据质量问题。2021 年调整后的省级 ANC HIV 患病率中位数比报告的 HIV 患病率高出 45% [四分位距 35%–52% 或 2.3 个百分点（四分位距 2.5–3.5）]。2021年，根据调整后的产前艾滋病毒感染率进行校准，大多数省份的预防母婴传播覆盖率降至不足100%，并且模拟的新发儿童感染人数增加了35%。调整后的结果更好地将成人和儿童抗逆转录病毒治疗覆盖率以及产前艾滋病毒患病率与地区生育率估计值进行了协调。 结论：使用全国代表性的 ANC 出勤率家庭调查数据调整孕妇的艾滋病毒感染率，得出的估计值与监测数据更加一致。由于常规 ANC 患病率存在​​偏差，莫桑比克感染艾滋病毒的儿童人数被大大低估。重新关注孕妇的艾滋病毒监测将提高预防母婴传播的覆盖率和儿童艾滋病毒的估计。