Number and percentage of adults and children enrolled in HIV care who had TB status assessed and recorded during their last visit among all adults and children enrolled in HIV care in the reporting period

Export Indicator

Number and percentage of adults and children enrolled in HIV care who had TB status assessed and recorded during their last visit among all adults and children enrolled in HIV care in the reporting period
What it measures

WHO: Number of adults and children enrolled in HIV care who had TB status assessed and recorded during their last visit.

This is a process indicator for an activity intended to reduce the impact of TB among people living with HIV. It will demonstrate the level of implementation of the recommendation that people living with HIV are screened for TB at diagnosis and at follow-up visits using their last visit as proxy measure.

Rationale

GFATM: This indicator assesses activity intended to reduce the impact of TB among people living with HIV. It demonstrates the level of implementation of the recommendation that people living with HIV be screened for TB at diagnosis and at all follow-up visits.

Numerator

Number of adults and children in HIV care, who had their TB status assessed and recorded during their last visit.
HIV care includes pre-ART and ART.

Denominator

Total number of adults and children enrolled in HIV carea in the reporting period

Calculation

Numerator / Denominator

Method of measurement

GFATM: Data should be recorded routinely at every visit on the person’s HIV care or antiretroviral therapy card and transferred onto the pre–antiretroviral therapy and antiretroviral therapy registers at all facilities providing routine HIV care. These data should be analyzed quarterly and reported on the quarterly cross- sectional reports to the national level.

TB and HIV programs should collaborate to ensure that agreed criteria for identifying a person suspected of having TB and that the methods of TB screening used are consistent with TB control program protocols. A suggested method of conducting the screening would be to ask clients living with HIV whether they are currently receiving TB treatment. If not, they are then asked about the key symptoms of TB disease (such as cough lasting more than two weeks, persistent fever, night sweats, unexplained weight loss and lymphadenopathy). A simple checklist could be used, and any positive response would indicate that the individual may be suspected of having TB. If, on questioning, they are defined as suspected of having TB (in accordance with national protocols), treatment for latent TB infection should not be given and they should be investigated for TB (or referred to a TB service for investigation) and treated appropriately.

Those found not to have TB should be offered six months of isoniazid preventive therapy.

Tools: HIV care and antiretroviral therapy patient cards with data transferred to the pre–antiretroviral therapy and antiretroviral therapy registers and then quarterly reporting formats

Frequency: data should be collected continuously and reported as part of the quarterly cross-sectional reports and analyzed quarterly or at least annually; these data could be cross-checked using card sorts during annual patient monitoring reviews

WHO: WHO recommends the use of a simplified screening algorithm for intensified TB case findings that includes 4 clinical symptoms: (1) current cough, (2) fever, (3) weight loss and (4) night sweats.
Using this simplified algorithm assessment of TB status at every visit during the reporting period (‘Yes’ if ‘no signs’, ‘suspect’ or ‘on treatment’ and ‘No’ if TB status not assessed) should be recorded on the patient HIV care/ART card, and transferred onto the pre-ART or ART registers as appropriate at all facilities providing routine HIV care. Enrolled in care includes all those continuing in care and those newly enrolled during the reporting period This data should be analysed and reported together with other cross sectional data at national level.
The numerator is taken from the pre ART and ART registers by counting the number of patients who had their TB status assessed during the reporting period. For patients who started on ART during the reporting period, care should be taken to count them in the ART register and not in the pre-ART register.
The denominator for pre-ART patients will be those seen for care during the reporting period. The denominator for ART patients will be those current on ART during the reporting period.
The denominator is taken from the pre-ART and ART registers by counting the number of patients with a visit during the reporting period. This is then recorded on the cross sectional reporting form.
TB and HIV programmes should collaborate to ensure that agreed criteria for identifying a TB suspect and methods of TB screening are used that are consistent with TB control programme protocols.

Data Quality Control and Notes for the Reporting Tool
• Please provide any comments on how this data was collected and any assumptions made in establishing a national estimate.

Measurement frequency

Continuously

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

TB status assessment among people living with HIV, followed by prompt referral for diagnosis and treatment, increases the chances of survival, improves quality of life and reduces transmission of TB in the community. TB status assessment identifies HIV-positive clients who show no evidence of active TB and would benefit from treatment with isoniazid for latent TB infection. The indicator does not measure the quality of intensified TB case-finding nor does it reveal whether those identified as suspects are investigated further or effectively for TB. However, it does emphasize the importance of intensified TB case-finding for people living with HIV at diagnosis and at every contact they have with HIV treatment and care services. Programmes should aim for a high value for this indicator (close to 100%) but should interpret it in conjunction with values of indicators related to the % of people in HIV care who are: a) on TB treatment and b) who were given treatment for latent TB infection, to ensure that appropriate action follows the screening process. A low value will demonstrate that Objective B - reducing the impact of TB among people living with HIV - is unlikely to be met.

Data utilization: See section on Strengths and Weaknesses for interpretation of data and further areas to explore. If low value, review disaggregated data and explore reasons why.

Further information

Other References: HIV/TB M&E Guide #B.1.1.1