HIV Treatment: Antiretroviral Therapy

Export Indicator

Percentage of adults and children currently receiving antiretroviral therapy among all adults and children living with HIV
What it measures

Progress towards providing antiretroviral therapy to all people for treatment.

Rationale

Antiretroviral therapy (ART) has been shown to reduce HIV-related morbidity and mortality amongst those living with HIV and to reduce transmission of HIV. In recent years the guidelines on eligibility for antiretroviral therapy have changed a number of times. In addition national guidelines do not always match global guidelines. As a result, antiretroviral therapy coverage has been reported in numerous ways including being based on global guidelines, on national guidelines or both. When the guidelines are modified to include more people who are living with HIV, the coverage values for countries decrease. To avoid multiple antiretroviral therapy coverage values it has been decided to present the number of people on antiretroviral therapy in relation to the total number of people living with HIV. The estimated coverage using all people living with HIV as a denominator will not be much different than had the denominator been all people eligible for antiretroviral therapy under the 2013 antiretroviral therapy guidelines, because approximately 85% of people living with HIV are eligible under these new guidelines.

Numerator

Number of adults and children currently receiving antiretroviral therapy
in accordance with the nationally approved treatment protocol (or WHO standards) at the end of the reporting period

Denominator

Estimated number of adults and children living with HIV

Calculation

Numerator / Denominator Percentages should be given for 2012 to track annual trends in coverage

Method of measurement

Data should be collected continuously at the facility level. Data should be aggregated periodically. The most recent full year of data should be used for annual reporting.
Programme monitoring and estimates of ART need. For the numerator: facility-
based antiretroviral therapy registers and corresponding cross-sectional forms.
For the denominator: HIV estimation models such as Spectrum
Disaggregation:
• Sex
• Age( <1 year, 1-4 years, 5 – 9, 10 – 14, 15 – 19, 20 – 24, >25
• Public/Private
• persons newly initiating antiretroviral therapy during the last reporting year (this indicator should be available from the same sources as the total number of people receiving antiretroviral therapy)

Measurement frequency

Continuously

Disaggregation

Age-group:

> (greater than) 15 years

< (less than) 1 year

1 year - 4 years

5 years - 14 years

Gender:

Female

Male

Sector:

Private

Public

Explanation of the numerator

The numerator can be generated by counting the number of adults and children who received antiretroviral therapy at the end of the reporting period.
The numerator should equal the number adults and children who ever started antiretroviral therapy 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, in other words, those who are excluded from the numerator, are patients who died, stopped treatment or are lost to follow-up.
Some patients pick up several months of antiretroviral drugs at one visit, which could include antiretroviral medicine received for the last months of the reporting period, but not be recorded as visits for the last months in the patient register. Efforts should be made to account for these patients, as they need to be included in the numerator.
Antiretroviral medicines taken only for the purpose of prevention of mother-to-child transmission and postexposure prophylaxis are not included in this indicator. HIV-positive pregnant women who are on lifelong antiretroviral therapy are included in this indicator.
The number of adults and children currently receiving antiretroviral therapy can be obtained through data collected from facility-based antiretroviral therapy 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 antiretroviral therapy in the private sector and public sector should be included in the numerator where data are available.

Explanation of the denominator

National criteria for ART eligibility varies by country. To make this indicator comparable across countries global reports will present the ART coverage for adults and children as a percentage of all people living with HIV.
Although coverage will be calculated using the total number of people living with HIV, please also provide the number eligible for ART under your national ART criteria guidelines, and please provide this for each disaggregation category as available.
The denominator is generated by estimating the number of people living with HIV. In previous years UNAIDS and WHO have reported on the percentage eligible based on the number eligible according to WHO criteria. However in 2014 this will change to include all people living with HIV. This does not endorse the concept that all people living with HIV should receive antiretroviral therapy; instead this is a simpler measure that will not change over time and will result in coverage values that are consistent when compared globally and when calculated for national purposes.
Denominator estimates are most often based on the latest data available from sentinel surveillance used with a HIV modeling programme such as Spectrum. For further information on estimates of HIV need and the use of Spectrum please refer to the UNAIDS/WHO Reference Group on Estimates, Modelling and Projections methodology.

Strengths and weaknesses

This indicator permits monitoring trends in coverage but does not attempt to distinguish between different forms of antiretroviral therapy or to measure the cost, quality or effectiveness of, or adherence to the treatment regimen provided. These will each vary within and between countries and are liable to change over time.
The degree of utilization of antiretroviral therapy will depend on factors such as cost relative to local incomes, service delivery infrastructure and quality, availability and uptake of testing and counselling services, and perceptions of effectiveness and possible side effects of treatment.
The indicator measures the number of people provided with medication but does not measure whether the individual imbibed the medication thus it is not a measure of adherence.