Percent of adults and children with advanced HIV infection receiving ART
Number and percent of adults and children with advanced HIV infection who are currently receiving combination antiretroviral therapy (ART) in accordance with a nationally approved (or UNAIDS/WHO) treatment protocol during the reporting period. For more background on HIV staging, eligibility, and guidelines for ART see (WHO, 2006; WHO, 2010a; WHO, 2010b).
The numerator should equal the number of adults and children with advanced HIV infection who ever started ART minus those patients who are not currently on treatment prior to the end of the reporting period. Patients not currently on treatment at the end of the reporting period and excluded from the numerator are patients who died, stopped treatment or are lost to follow-up. Some patients pick up several months of antiretroviral (ARV) drugs at one visit, which could include ARV drugs received for the last months of the reporting period, but are not recorded as visits for the last months in the patient register. Efforts should be made to account for these patients because they need to be included in the numerator (UNAIDS, 2009). ART taken only for the purpose of prevention of mother-to-child transmission and post-exposure prophylaxis are not included in this indicator. HIV-infected pregnant women who are eligible for and on ART for their own treatment are included in this indicator (PEPFAR, 2009).
The denominator is an estimation of the number of people with advanced HIV infection requiring (in need of and eligible for) ART. This estimation must take into consideration a variety of factors including, but not limited to, the current numbers of people with HIV, the current number of patients on ART, and the natural history of HIV from infection to enrolment on ART. Denominator estimates most often are based on the latest data available from sentinel surveillance used with a HIV modeling program such as Spectrum. For further details on calculation and interpretation of the indicator, see PEPFAR (2009); WHO/UNICEF/UNAIDS (2011); UNAIDS (2008); WHO et al., (2006); and for additional information on estimates of HIV need and the use of Spectrum, refer to UNAIDS/WHO (2010).
This indicator is calculated as:
(Number of adults and children with advanced HIV infection who are currently receiving antiretroviral therapy (ART) / Total estimated number of adults and children with advanced HIV infection) x 100
The number of adults and children with advanced HIV infection who are currently receiving ART can be obtained through data collected from facility-based ART registers or drug supply management systems. These are then tallied and transferred to cross-sectional monthly or quarterly reports which can then be aggregated for national totals. Patients receiving ART in the private sector and public sector should be included in the numerator where data are available. Data should be collected continuously at the facility level. This indicator should be disaggregated by sex and age (<15; 15+ years).
For the numerator: facility-based ART registers or drug supply management systems. For the denominator: HIV prevalence estimation models such as Spectrum.
This indicator should be reported at least annually to track trends in ART coverage. The WHO World Health Statistics (WHOSIS) website and the Global Health Observatory (GHO) website include this indicator as does the WHO, UNAIDS, UNICEF and The Global Fund three interlinked patient monitoring system (WHO, 2011; WHO et al., 2009). As the HIV pandemic matures, increasing numbers of people are reaching advanced stages of HIV infection. ART has been shown to reduce mortality among those infected, and efforts are being made to make it more affordable within low- and middle-income countries. ART should always be provided in conjunction with broader care and support services, including counseling for family caregivers (WHO et al., 2006). The proportion of people needing ART varies with the stage of the HIV epidemic and the cumulative coverage and effectiveness of ART among adults and children. The degree of utilization of ART will depend on factors such as cost relative to local incomes, service delivery infrastructure and quality, availability and uptake of voluntary counseling and testing services, and perceptions of effectiveness and possible side effects of treatment.
This indicator permits monitoring trends in coverage but does not distinguish between different forms of ART or measure the cost, quality or effectiveness of treatment provided. These will each vary within and between countries and are liable to change over time.
Women’s access to and utilization of HIV/AIDS treatment services may be limited by cultural gender norms that affect women’s mobility, exposure to media and HIV treatment information, women’s resources for health care services, as well as, the possible stigma associated with HIV treatment. The UNAIDS (2010) agenda for women, girls, and gender equality calls for national AIDS authorities and ministries of health to incorporate gender equality into HIV policies for the achievement of universal access to prevention, treatment, care and support for women.
PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. http://www.pepfar.gov/documents/organization/81097.pdf
UNAIDS, 2009, Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on Construction of Core Indicators, Geneva: UNAIDS. http://data.unaids.org/pub/Manual/2009/JC1676_Core_Indicators_2009_en.pdf
UNAIDS, 2010, Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV, Geneva, UNAIDS. http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/agenda_for_accelerated_country_action_en.pdf
UNAIDS/WHO, 2010, Future Tools for National Estimates and Epidemiological analyses: Technical Report And Recommendations, Joint United Nations Programme on HIV/AIDS (UNAIDS) Reference Group on Estimates, Modelling and Projections, London: Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London. http://www.epidem.org/sites/default/files/reports/Future%20Tools%20Report.pdf
WHO, 2006, Case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva, WHO. http://www.who.int/hiv/pub/guidelines/HIVstaging.pdf
WHO, 2010a, ART for HIV infection in adults and adolescents, Geneva: WHO. http://www.who.int/hiv/pub/arv/adult2010/en/index.html
WHO, 2010b, ART for HIV infection in infants and children: Towards Universal Access, Geneva: WHO http://www.who.int/hiv/pub/paediatric/infants2010/en/index.html
WHO, 2011, World Health Statistics website, http://www.who.int/whosis/en/
And Global Health Observatory (GHO) website, http://www.who.int/gho/en/
WHO/UNAIDS/UNICEF/the Global Fund, 2009, Three Interlinked Patient Monitoring Systems for HIV care? Art, MCH/PMTCT and TB/HIV, Geneva: WHO/UNAIDS.
WHO/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. Geneva: WHO.
WHO, UNAIDS, The Global Fund, CDC, USAID, UNICEF, MEASURE Evaluation, US
Dept. of State: OGAC, 2006, Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis, and Malaria, Geneva: WHO. http://www.hivpolicy.org/Library/HPP000485.pdf