Number of adults and children with advanced HIV infection receiving antiretroviral therapy (ART)

Export Indicator

Number of adults and children with advanced HIV infection receiving antiretroviral therapy (ART)
What it measures

To assess progress towards providing ART to all people with advanced HIV infection; Coverage; Track progress towards legislative 5-year goals.

Rationale
Numerator

Number of adults and children with advanced HIV infection receiving antiretroviral therapy (ART)

Denominator

None

Calculation

Not applicable

Method of measurement

Data for this indicator can be generated by counting the number of adults and children who are currently receiving ART in accordance with the nationally approved treatment protocol (or WHO/UNAIDS standards) at the end of the reporting period. 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 excluded from the numerator are patients who died, stopped treatment, transferred out or are lost to follow-up (patient not seen for 3 months from last visit).

Patients on ART who initiated or transferred in during the reporting period should be counted. Patients that pick up several months of antiretroviral drugs at one visit, which could include ART received for the last months of the reporting period, but not be recorded as visits for the last months should be included in the count. 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 on antiretroviral drugs for their own treatment are included in this indicator.

The number of adults and children with advanced HIV infection who are currently receiving ART can be obtained through data collected from drug supply management systems or facility-based ART registers. Patients receiving ART in the private sector and public sector should be included in the numerator for the country as a whole.

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. Age represents an individual’s age at the end of the reporting period or when last seen at the facility. For example, a 14-year-old child will be counted as currently receiving treatment in the

SEE INDICATOR #T1.1.D FOR THE WHO CASE DEFINITIONS OF HIV FOR SURVEILLANCE AND REVISED CLINICAL STAGING AND IMMUNOLOGICAL CLASSIFICATION OF HIV-RELATED DISEASE IN ADULTS AND CHILDREN (2007)

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: N/A

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 coverage 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. 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.

A basic level of retention (or attrition) can be calculated as current clients divided by cumulative clients; that is the proportion of clients that remain on ART at the end of the reporting period of those ever started on ART.

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