This HIV Surveillance Report presents results from the Antenatal Care (ANC) based Sentinel HIV Surveillance
data from the 2014 round. The results showed the HIV prevalence of ANC clients at the level of sentinel sites,
regional, and national levels. It also includes HIV prevalence in urban and rural site settings. However, this
report does not include any modeling or national projections.
The 2014 ANC-based HIV Sentinel Surveillance round was unlinked anonymous, where HIV testing
was performed on left-over blood collected for routine syphilis testing, or other services like hemoglobin
determination. Data and specimens were collected at national level from 122 sentinel sites of which 79 were
rural and 43 were urban. Blood samples were tested using Vironostika HIV Ag/Ab ELISA for screening and
Murex HIV Ag/Ab ELISA as a confirmatory test for all the HIV-reactive specimens. Testing was done at 20 HIV
testing laboratories across all regions. All HIV positives, indeterminate and 10% of the HIV negative samples
were re-tested in the National HIV Referral Laboratory at EPHI for quality control. In this round, a total of 55,451
samples were collected, of which 52,942 samples were eligible for the national data analysis. The HIV test
result agreement between EPHI and all regional labs for both the positives and negatives were 96.8%.
The national unadjusted HIV prevalence among pregnant women attending ANC clinics in 2014(excluding
Army, Federal Police, Dimma refugee Camp clinics and Pynido refugee sites) was 2.2% (urban 3.9% and rural
1.4 %). The adjusted National HIV prevalence (adjusted for the relative urban and rural population size of each
region) using all the sites together are 2.0%. The HIV prevalence is heterogeneous among different regions
and settings. The Highest adjusted regional HIV prevalence was observed in Addis Ababa city Administration
(5.5%), while the lowest figure was observed in Oromia and Benishangulgumuz both (1.2%). In urban sites,
Gambella region showed the highest unadjusted HIV prevalence (7.5%) while BenishangulGumuz showed the
lowest (2.0%). Rural HIV prevalence was highest in Somali (3.8%) while 12 sites from Oromia, Tigray, Harari,
Diredawa and SNNPR regions showed the lowest (0.0) prevalence.
Since the number of sites in each region is not comparable region-to-region comparison of HIV prevalence
might be less stable and inappropriate. For national or regional planning, estimates including total people living
with HIV need for PMTCT and ART services, etc. need to be generated by projection using the updated figures
from this report.
In 2014, the HIV prevalence among 15-24 years age group was 1.7% while it was 2.6% in 25-34 age group.
This might indicate a decline in new infections. The overall trend of HIV prevalence in all age groups (15- 49)
has remarkably declined in the past 12 years (5.3% in 2003 to 1.7% in 2014).
The national syphilis prevalence (excluding Army, Federal Police, Dimma refugee Camp clinics and Pynido
refugee sites) was 1.2%. The syphilis prevalence is 1.3% in Rural and 0.7% in urban sites. It was highest (1.7%)
among the ANC clients aged 35-49 years (urban 1.3% & rural 1.9%). In addition, Syphilis positive clients were
two times higher to be HIV positive than syphilis negatives (4.3% among syphilis positives compared to 2.2%
in Syphilis negative clients).
The observed decline in HIV prevalence may have resulted from multiple factors including HIV/AIDS control
and mitigation efforts such as Behavioral Change Communication (BCC) and Information Education and
communication (IEC), community sensitization, widespread implementation and increased uptake of
antiretroviral therapy (ART), voluntary counseling and testing (VCT), condom use and other interventions.
Based on the observed declining trend of HIV prevalence overtime and heterogeneity of the epidemic in the
regions and sites, the multi-sectoral response for HIV should be maintained and further strengthened at all
levels. Special attention should be given to regions and settings with relatively higher HIV prevalence levels.
It is also important to undertake HIV incidence studies to understand the rate of new HIV infections since
prevalence figures are less informative in the era of ART scale up.
Moreover, in the era of rapid expansion and coverage of PMTCT program in the country, the unlinked
anonymous way of HIV surveillance is less acceptable in the era of service availability, the utilization of PMTCT
based HIV surveillance in place of the ANC based HIV surveillance need to be considered in the future.