(HTS_TST (Includes HTS_TST_POS) ) Number of individuals who received HIV Testing Services (HTS) and received their test results
This indicator is intended to monitor trends in the uptake of HTS (regardless of the service delivery modality and population group) within a country.
The disaggregation by test result provides information about the proportion of persons testing HIV positive and the effectiveness of HTS programs in identifying people living with HIV (PLHIV) over time.
Further disaggregations are intended to monitor access to and uptake of HTS by population (age, sex, test result), and HTS setting and service delivery modality. The findings can support national governments and PEPFAR programs to determine the coverage and identify gaps in HTS services. These data may also be useful for projecting programmatic commodities and system needs such as HIV test kits and other staffing resources, although the numerator reflects the number of individuals tested, not the number of tests performed.
Number of individuals who received HIV Testing Services (HTS) and received their test results
Sum results across all reporting periods.
Existing HTS registers, log books, and reporting forms already in use to capture HTS can be revised to include the updated disaggregation categories. Examples of data collection forms include client intake forms, activity report forms, or health registers such as HTS registers, health information systems and non-governmental organization records.
Data for the numerator should be generated by counting the total number of individuals who received HTS and their test results.
Note: Although several other MER indicators (see below) may report on the HIV status of individuals, actual testing of individuals must be reported under HTS_TST. Thus any persons who are newly tested as part of the programs linked to the indicators listed below (i.e. PMTCT, TB, VMMC, Prevention services) must be reported as part of the HTS_TST indicator.
Note: Serologic testing of pediatric patients should be counted under HTS_TST. However, HIV virologic testing of HIV-exposed infants should be counted under PMTCT_EID.
For an individual to be counted under this indicator, that individual’s HIV diagnosis must be confirmed as per in-country testing algorithms. For example, an HIV-positive rapid HIV test performed at the community- or facility- level must be confirmed with a second test, which may be performed at the same site or at a different facility. If the confirmatory test is performed at a different facility, then this may entail follow-up by implementing partners to confirm the diagnosis before reporting on this indicator.
Note: Testing for verification of HIV status before treatment initiation is different from confirmatory testing, since this is only done for persons who have already been diagnosed HIV-positive following the initial algorithm. All clients diagnosed HIV-positive should be retested with a second specimen and a second operator using the same testing strategy or algorithm before enrolling the client in care and/or initiating ART, but verification retesting is primarily done as a quality assurance activity to ensure those enrolled in treatment services are HIV positive. Thus, these verification retests should not be counted under HTS_TST, since this will have already been counted at the point of the initial confirmatory test.
Disaggregates: Service Delivery Modality
In addition to reporting the total number of individuals tested and receiving their test results and the total type of test results received (negative, positive), HTS_TST data should be disaggregated by service delivery modality, and then also by age/sex/test result within each service delivery modality.
Service delivery modalities are defined as:
1. Community-based testing - Any testing done outside of a designated health facility
- Index case testing: This refers to an approach focused on testing individuals in the social or sexual networks of HIV-positive persons, including family members, sexual partners, needle-sharing partners, and other high-risk contacts. Index patient testing can be done using novel approaches such as incentivized case finding, peer-driven outreach, and partner notification services. This approach can be done in other community-based settings (home-based, mobile, or other community platforms); community index testing includes if the index case finding/tested originated in the community, even if the subsequent testing was done in the facility. Importantly - If an individual could be reported under both index testing and another community modality, that person should be reported only once under community index testing.
- Home-based testing: Any testing that occurs in a person’s home, including door-todoor testing and targeted home visits
- Mobile testing: Including any ad hoc or temporary testing locations, such as a community center, school, or mobile unit (Testing related to VMMC services is not included here. Instead that should be reported under facility based testing)
- VCT: Any standalone VCT center that exists outside of a designated health facility (e.g. Drop-in-center, wellness clinic where HTS services are provided, site designated for key populations, etc.)
- Other community platforms: Including any other modality not captured above (e.g. Ad hoc testing campaign that does not satisfy the mobile testing definition). OVC testing should be entered under this modality.
- Facility-based testing: Any testing occurring inside a designated health facility
2. Index Case Testing
- Index Case Testing: This refers to an approach focused on testing individuals in the social or sexual networks of HIV-positive persons, including family members, sexual partners, needle-sharing partners, and other high-risk contacts. Index patient testing can be done using novel approaches such as incentivized case finding, peer-driven outreach, and partner notification services.
- Facility index testing includes if the index case finding/tested originated in the facility, even if the subsequent testing was done in the community.
- This approach can be done in other facility-based settings as described above, but if an individual could be reported under both index testing and another modality, that person should be reported only once under index testing.
3. Provider Initiated Counseling and Testing in certain clinical settings, including:
- Inpatient: Including surgery and any inpatient ward
- Pediatrics: Testing for children under 5 in any health facility setting, such as an under 5/EPI (immunization or well child services) clinic. This does not include testing for malnourished children (see below), virologic testing, and non-diagnostic rapid HIV testing which is reported under PMTCT_EID. Children under 5 may be tested in other service delivery modalities as well (OPD), but if an individual could be reported under both “pediatrics” and another facility modality, that person should be reported only once under pediatrics. Index testing for family members above … age based on pediatrics clinics should be included under index testing.
- Malnutrition facilities: Clinics and inpatient wards predominately dedicated to the treatment of malnourished children. While this service delivery modality may be part of either inpatient or outpatient services, if an individual could be reported under both malnutrition and another service delivery point, report an individual only once and under malnutrition.
- TB: This includes all TB patients originating from TB clinics and contacts of TB patients. Refer to TB_STAT for guidelines on data collection for TB
- PMTCT (ANC Only): HIV testing for pregnant women as part of the PMTCT program at antenatal care clinics (ANC) to align with PMTCT_STAT. Refer to PMTCT_STAT reference sheet for guidelines on data collection.
- VMMC: This is HIV testing for males as part of the VMMC programs both in facility based and mobile outreach programs VMMC programs. Testing is recommended through the VMMC program, although not mandatory. Refer to VMMC_CIRC for guidelines on data collection for VMMC.
- Other PITC: this includes any other PITC modality that is not captured above, such as testing women and their partners or family members in labor and delivery wards; testing done in family planning centers, etc. b. Voluntary Counseling and Testing (VCT):
- VCT is a form of client-initiated HTS, integrated into facilities that specifically provide this service. This is separate from services offered as part of inpatient or outpatient services as described above. Even though some VCT sites in health facilities might be linked with outpatient or inpatient services, if an individual could be reported under both VCT and another service delivery point, report an individual only once and under the non-VCT modality.
Provision of information (tested, tested positive, tested negative) on key Populations (FSW, MSM, Transgender, PWID, and people in prisons and other enclosed settings) who were tested and received their results should be reported here. Importantly, reporting on this disaggregate is optional.
Key population disaggregation* see Appendix 1 to support the identification of key populations at HTS service delivery; If a patient identifies as more than one of the KPs, please enter in all of those that are relevant (therefore KP disaggregations can equal more than the total);
NOTE: both KP-specific and clinical partners have the option to complete these disagg, but only if safe to maintain these files and to report.
Age and sex data on KPs tested and receiving their results will not be reported—these disaggregates are separate and distinct from disaggregates for male/female. Please refer to the KP_PREV and PP_PREV indicator reference sheets for more information on working with KPs.
The first priority of data collection and reporting of HTS among key populations must be to do no harm. These data must be managed with confidentiality to ensure the identities of the individuals are protected to prevent further stigma and discrimination of key populations.
Data Systems and Tools
When developing or modifying existing M&E systems and tools to collect and report on this indicator, the following information should be considered (* designates data elements that are required for HTS_TST reporting in DATIM):
4. This indicator counts the number of individuals tested not the number of test conducted. All efforts to ensure data are collected on individuals vs. number of tests should be made. Within HTS registers, collecting data on the following variables should be considered to help in these efforts:
a. Retesting status: new tester, re-tester (i.e. tested in the last 3 months), retesting for verification of HIV-positive diagnosis
b. HIV testing services - *HIV test results, date of HIV test, receipt of HIV test results, previously tested during the reporting period
c. Demographic - Client’s Unique ID, name, *sex, and *age at time of HTS services
d. Date at which individuals tested positive was linked with treatment
e. Site - *site name and ID, district, region, province, and *service delivery modality
5. Using unique identifiers for individuals is one way to account for retesting and avoid double reporting if electronic systems are available to easily link data through these unique identifiers. Another approach is to record information about prior testing on the HTS client register.
6. For an individual to be counted under this indicator, that individual’s HIV diagnosis must be confirmed as per in-country testing algorithms. For example, an HIV-positive rapid HIV test performed at the community- or facility- level must be confirmed with a second test, which may be performed at the same site or at a different facility. If the confirmatory test is performed at a different facility, then this may entail follow-up by implementing partners to confirm the diagnosis before reporting on this indicator.
7. Note: Testing for verification of HIV status before treatment initiation is different from confirmatory testing, since this is only done for persons who have already been diagnosed HIV-positive following the initial algorithm. All clients diagnosed HIVpositive should be retested with a second specimen and a second operator using the same testing strategy or algorithm before enrolling the client in care and/or initiating ART, but verification retesting is primarily done for quality assurance of treatment services. Thus, these retests should not be counted under HTS_TST, since this will have already been counted at the point of the initial confirmatory test.
8. Patient level Deduplication: adding to the HTS facility and community registers (has patient been tested in the last 3 months). This additional data point in the patient testing registries can help partners de-duplicate at the reporting level.
How to review for data quality
Only one age disaggregation type is used for age/sex/test result received: The number of individuals newly receiving ART must be disaggregated by age and sex. If possible, the full age/sex disaggregations should be used. If the full age/sex disaggregations are not possible, then, and only then, should the aggregated age/sex disaggregations be used, do NOT complete both age/sex disaggregations.
Numerator ≥ subtotal of each disaggregate group: The total number of individuals receiving HTS (numerator) should be equal to the sum of each individual disaggregation group (age/sex/test result, service delivery modality). If the sum of each individual disaggregation group (age/sex/test result, service delivery modality) is greater than the total number of individuals receiving HTS (numerator), then there were more individuals entered for the disaggregations than for the overall number of individuals receiving HTS and this should be corrected. If the sum of each individual disaggregation group (age/sex/test result, service delivery modality) is less than the total number of individuals receiving HTS, then some data are missing for the disaggregations and this should be corrected.
Site level: both facility and community by service delivery area.
Note: Data entry screens differ by facility and community levels.
Patients re-tested during the reporting should be de-duplicated prior to data entry into DATIM, entered only once, with their last test result entered.
Numerator: Number of individuals who received HIV Testing Services (HTS) and received their test results
1. Community Service Delivery Modality
Index testing, Home-based testing, Mobile testing, VCT testing, Other community testing platforms
2. Facility Service Delivery Modality/Result Received
Inpatient, Pediatric, Malnutrition facilities, PMTCT (ANC only), TB, VMMC, other PITC, VCT, Index testing;
3. Service Delivery Modality/Ag e/Sex/Result Received (FINE AGE DISAGGREGA TIONS)
For each service delivery modality listed above (except Pediatric and Malnutrition facilities which have no age/sex disaggregation)
- <1 Positive
- 1-9 Positive
- 10-14 M Positive
- 10-14 F Positive
- 15-19 M Positive
- 15-19 F Positive
- 20-24 M Positive
- 20-24 F Positive
- 25-49 M Positive
- 25-49 F Positive
- 50+ M Positive
- 50+ F Positive
- <1 Negative
- 1-9 Negative
- 10-14 M Negative
- 10-14 F Negative
- 15-19 M Negative
- 15-19 F Negative
- 20-24 M Negative
- 20-24 F Negative
- 25-49 M Negative
- 25-49 F Negative
- 50+ M Negative
- 50+ F Negative
- <1 Total
- 1-9 Total
- 10-14 M Total
- 10-14 F Total
- 15-19 M Total
- 15-19 F Total
- 20-24 M Total
- 20-24 F Total
- 25- 49 M Total
- 25-49 F Total
- 50+ M Total
- 50+ F Total
4. Service Delivery Modality/Ag e/Result Received (COARSE AGE DISAGGREGA TIONS)
For each service delivery modality (except Pediatric and Malnutrition facilities which have no age/sex disaggregation):
<15 positive M, <15 positive F, <15 negative F, <15 negative M, +15M positive, +15 F positive, +15 M negative, +15 F negative, sub-total
5. Key Populations
MSM, Transgender, FSW, PWID, People in prisons or other enclosed settings
6. Key Populations by Result
For each KP above: PWID positive, MSM positive, FSW positive, Transgender positive, people in prisons or other enclosed populations positive; PWID negative, MSM negative, FSW negative, Transgender negative, people in prisons or other enclosed populations negative; PWID total, MSM total, FSW total, Transgender total, people in prisons or other enclosed settings total
Description of Disaggregate
- Only for community-based testing for HTS_TST
- Only for facility-based testing for HTS_TST
- Note: VMMC and PMTCT (ANC only) have only age disaggregation as these service delivery modalities only reach one sex
- Conditional: Only use with permission from HQ. Note: VMMC and PMTCT (ANC only) have only age disaggregation as these service delivery modalities only reach one sex
- OPTIONAL: At the time of HIV testing, did the patient identify as one of the following key populations:
- MSM: Men who have sex with men. A male that has sex with men or both and women
- TG: Person who identifies as transgender. Transgender (male to) female: individual was born a boy, but identifies as a woman: Transgender (female to) male: client was born a girl, but identifies as a man
- SW: Sex worker. A person whose main source (includes both monetary and non-monetary) of income comes from sex work.
- PWID: People who inject drugs. Any person who has injected illicit or illegal drugs in the last 6 months.
- Person in prisons or other enclosed setting. If client is currently incarcerated, then classify as Person in prison or other enclosed setting.
6. OPTIONAL, see definitions of key populations above.
The numerator captures the number of individuals who received HIV Testing Services (HTS) and received their test results. At a minimum this means the person was tested for HIV and received their HIV test results.
MER 1.0 to 2.0 Change
Age/sex disaggregates modified to align across indicators. Service delivery modalities rationalized and simplified to avoid overlap and create mutually exclusive delivery modalities; HTS service delivery modalities reflect both facility and community settings.
PEPFAR Support definition
Standard definition of DSD and TA-SDI used.
Provision of key staff or commodities individuals receiving HTS services include: ongoing procurement of critical HTS related commodities such as rapid HIV test kits or requisite materials (lancets, capillary tubes), samples and materials for proficiency testing, or other HIV diagnostic commodities, or funding for salaries of HCW who deliver HTS services including counselors, laboratory technicians, program managers, community health workers. Staff who are responsible for the completeness and quality of routine patient records (paper or electronic) can be counted here; however, staff who exclusively fulfill MOH and donor reporting requirements cannot be counted.
For HTS services, ongoing support for service delivery improvement includes: this ongoing support for service delivery improvement can include: clinical mentoring/supportive supervision, HTS training, HTS guidance development, infrastructure/renovation of facilities (fixed, mobile, and outreach sites), site level QI/QA, routine support of HTS M&E and reporting, or HIV test kits consumption forecasting and supply management.