Advanced HIV disease and late HIV diagnosis
Export Indicator
People living with HIV identified to have a CD4 cell count <200 cells/mm3, a criterion for advanced HIV disease.
As countries scale up HIV services, it is important to monitor whether people living with HIV have advanced HIV disease. Advanced HIV disease is associated with substantially higher mortality and morbidity from HIV, opportunistic infections and comorbidities. It also identifies people who should receive the WHO recommended package of care for advanced HIV disease to help reduce the risk of poor outcomes.
At initial HIV diagnosis or at initiation/re-initiation of antiretroviral therapy, the number of:
- Adults (aged ≥15 years) living with HIV with CD4 cell count <200 cells/mm3 recorded at that time; and,
- Children aged 5–14 years living with HIV with CD4 cell count <200 cells/mm3 or CD4 <15% recorded at that time; and,
- Children 0–59 months living with HIV.
Number of people diagnosed with HIV for the first time or initiating/re-initiating antiretroviral therapy during the reporting period with:
- Adults (aged ≥15 years): a CD4 cell count recorded within one month of initial diagnosis or initiation/re-initiation of ART; and,
- Children aged 5–14 years: a CD4 cell count (or percentage) recorded within one month of initial diagnosis or initiation/re-initiation of ART;
- Children 0–59 months: all living with HIV.
Numerator/denominator
Based on data from laboratory information systems and from the clinical records of people in treatment. Data can be compiled from health services registries, case report forms or laboratory information systems. People with CD4 count results should be included only if the CD4 test was conducted within 1 month of the time of initial diagnosis, initiation of antiretroviral therapy or reinitiation of antiretroviral therapy.
Annually.
- Aged 0–14 years (disaggregated by ages 0–59 months and 5–14 years) for children, and aged ≥15 years by sex (men and women) for adults.
- First time diagnosis, versus initiation or reinitiation of antiretroviral therapy.
The total number of people who received a CD4 test at initial diagnosis or at initiation/reinitiation of antiretroviral therapy in four mutually exclusive CD4 cell count categories (<200 cells/mm3, 200 to <350 cells/mm3, 350 to <500 cells/mm3, ≥500 cells/mm3), and the total number of people newly diagnosed with HIV, and initiating and reinitiating ART during the reporting period are requested.
Data quality review for this indicator should consider the full CD4 distribution across all four CD4 categories, assessing completeness and mutual consistency, and as the coverage and representativeness of the CD4 measurements to represent all new diagnoses and all antiretroviral therapy (re-)enrolments.
Adults living with HIV whose CD4 lymphocyte count was <200 cells/mm3 at initial diagnosis, or at initiation/reinitiation of antiretroviral therapy in the reporting period.
All children aged under 5 years are considered to have advanced HIV disease at the time of initial diagnosis or upon reinitiation of antiretroviral therapy following a period of disengagement, and so disaggregation by CD4 cell count or percentage category is not requested.
Number of people living with HIV who had a CD4 lymphocyte count within 1 month of the time of diagnosis or initiation/ reinitiation of antiretroviral therapy in the reporting period.
This indicator may not include all people diagnosed, initiated on antiretroviral therapy or reinitiated on antiretroviral therapy if there are substantial reporting delays in the diagnosis data or CD4 count test result (which may indicate a delay in linkage from diagnosis to care) or if CD4 count measurement is not routine and universal.
If the coverage of CD4 count measurement (of all new diagnoses, or of antiretroviral therapy enrolments and re-enrolments) is far below 100%, the results may not be representative for the full population of clients. If the country is not able to report CD4 results separately for people newly diagnosed, versus initiated on antiretroviral therapy and re-initiated on antiretroviral therapy, the CD4 results will be difficult to interpret