Number of adults and children with advanced HIV infection newly enrolled on ART

Export Indicator

Number of adults and children with advanced HIV infection newly enrolled on ART
What it measures

Measures scale-up of ART program and for pregnant women disaggregation offers a measure of the linkages between PMTCT and treatment programs.

Rationale
Numerator

Number of adults and children with advanced HIV infection newly enrolled on ART

Denominator

None

Calculation

Not applicable

Method of measurement

The numerator can be generated by counting the number of adults and children who are newly enrolled in ART in the reporting period, in accordance with the nationally approved treatment protocol (or WHO/UNAIDS standards)
Patients with records that transfer in from another facility, or who temporarily stopped therapy and have started again in the time period should not be counted. ART taken only for the purpose of prevention of mother-to-child transmission and post-exposure prophylaxis are not included in this indicator. HIV-positive pregnant women who are eligible for and initiate antiretroviral drug therapy for their own treatment are included in this indicator.

The number of adults and children with advanced HIV infection who are newly receiving ART can be obtained through data collected from drug supply management systems or facility-based ART registers.

NEW is a state defined by an individual’s beginning in a program, it is expected that the characteristics of new clients are recorded at the time they newly initiate into a program. Patients are counted as pregnant if they were pregnant at initiation of ART. Age represents an individual’s age at initiation of therapy.
For example, if a 14 year old child begins ART and then shortly after turns age 15, the child will still be counted under NEW in the

According to “WHO CASE DEFINITIONS OF HIV FOR SURVEILLANCE AND REVISED CLINICAL STAGING AND IMMUNOLOGICAL
CLASSIFICATION OF HIV-RELATED DISEASE IN ADULTS AND CHILDREN (2007)
• Clinical criteria for diagnosis of advanced HIV in adults and children with confirmed HIV infection: Presumptive or definitive diagnosis of any stage 3 or stage 4 condition.
and/or;
• Immunological criteria for diagnosing advanced HIV in adults and children five years or older with confirmed HIV infection: CD4 count less than 350 per mm3 of blood in an HIV-infected adult or child.
and/or;
• Immunological criteria for diagnosing advanced HIV in a child younger than five years of age with confirmed HIV infection: %CD4+

However, according to WHO pediatric ART guidelines (2008), all infants under 12 months of age with confirmed HIV infection should be started on ART, irrespective of clinical or immunological stage, or where virological testing is not available, infants under 12 months of age with clinically diagnosed presumptive severe HIV should start ART and confirmation of HIV infection should be obtained as soon as possible. Thus, infants under 12 months of age need not have a diagnosis of advanced HIV to be counted in this indicator. The “essential/reported” disaggregation of

Measurement frequency

Continuously

Disaggregation

Age group: (greater than) 15 years

Condom type: N/A

Education: N/A

Gender: Male, Female

Geographic location: N/A

HIV status: N/A

Pregnancy status: Pregnant, Not Pregnant

Sector: N/A

Service Type: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator permits monitoring trends in initiation but does not attempt to distinguish between different forms of ART or to measure the cost, quality or effectiveness of treatment provided. These will each vary within and between countries and are liable to change over time.

Since age and pregnancy status change over time, the comparison of NEW, CUMULATIVE, and CURRENT clients by age and pregnancy status is challenging. CURRENT is a state defined by vital/treatment status when last seen, so it is expected that characteristics of these clients would be updated each time they are seen by a program. On the contrary, NEW and CUMMULATIVE are states defined by beginning in a program, it is expected that the characteristics of new and cumulative clients are recorded at the time they newly initiate or transfer into a program and will remain at that same status over time.

Further information