Number of health-care facilities providing ART services for people living with HIV with demonstrable infection control practices that include TB control

Export Indicator

Number of health-care facilities providing ART services for people living with HIV with demonstrable infection control practices that include TB control
What it measures

This indicator measures if health facilities receiving a large number of people living with HIV have implemented measures to prevent the risk of person to person transmission of TB.

Rationale

TB infection control is part of the "3 I's" strategy in controlling the TB/HIV epidemics (together with intensified TB case finding and isoniazide preventive therapy).

Numerator

Number of health care facilities providing ART services for people living with HIV with demonstrable TB infection control practices consistent with international guidelines

Denominator
Calculation
Method of measurement

Methodology:
Facility level review of written Infection Control for TB (IC) policy with yes/no to the following questions:
- is there a written infection control plan?
- is there a person responsible for implementing TB infection control plan?
- is the waiting area well ventilated (e.g. windows and doors open)?
- are TB suspects identified on arrival at the facility and separated from other patients?
- are TB cases reported among health care workers routinely monitored and reported?

A positive response to all questions is required for a facility to be identified as having a TB infection control policy that is consistent with international guidelines. A positive answer to the question asking for a written infection control plan requires that a hard copy of the plan be available. Documentation for other components should also be sought.

Periodicity: collected annually from each facility at the time of supervisory visits and/or external review of TB/HIV activities or HIV programmes review.

Measurement tools: facility review checklist

Data Quality Control and Notes for the Reporting Tool: Supervision visits and health facility surveys

Measurement frequency

Annual

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

The existence of a written infection control policy that addresses TB and is consistent with international guidelines is the first basic step in ensuring TB infection control in health-care facilities providing (ART) services for people living with HIV. However, the existence of a policy does not mean that it is effectively implemented. Further inquiry will be needed to establish whether the infection control policy is implemented and adhered to. Analysis of policy involves subjective judgment, which can limit its use in cross-national comparisons and for capturing trends over time.
This indicator goes a step beyond measuring the simple existence of an infection control policy by defining the standards that must be met in order for there to be an acceptable practice that addresses the issue of control of TB infection in health-care facilities providing (ART) services for people living with HIV according to international guidelines, thus eliminating some, though not all, subjective judgment.

Additional considerations: Responsibility: HIV programmes

Data utilization: 100% target; all health facilities that offer antiretroviral therapy should have implemented TB infection control to prevent the transmission of TB from person to person

Further information

Other References: Guide to monitoring and evaluation for collaborative TB/HIV activities available at:
http://whqlibdoc.who.int/publications/2009/9789241598194_eng.pdf