Number of health facilities that offer antiretroviral therapy (ART)

Export Indicator

Number of health facilities that offer antiretroviral therapy (ART)
What it measures

Number of health facilities that offer ART (i.e., prescribe and/or provide clinical follow-up).
Capacity of health facilities to provide antiretroviral therapy (ART), expressed as percentage of health facilities that offer ART (i.e., prescribe and/or provide clinical follow-up). Health facilities include public and private facilities, health centres and clinics (including TB centres), as well as health facilities that are run by faith-based or
nongovernmental organizations.

Antiretroviral therapy is a cornerstone of effective HIV treatment, and measuring the percentage of health facilities that offer ART provides valuable information about ART availability.

Rationale
Numerator
Denominator
Calculation
Method of measurement

The numerator is calculated by summing of the number of facilities reporting availability of ART services. Information on the availability of specific services is usually kept at the national or sub-national level. National AIDS Programmes
should have a record of all health facilities offering ART services.
A health facility census or survey can also provide this information, along with more in-depth information on available services, provided the information is collected from a representative sample of health facilities in the country.
Responses to a series of questions establish whether providers in that facility provide ART services directly (i.e., prescribe ART and/or provide clinical follow-up for ART patients) or refer patients to other health facilities for these services. In addition, facility records documenting the current status of service provision should be consulted. One potential limitation to facility surveys or censuses is that they are usually only conducted once every few years.
Countries should regularly update their programme records on health facilities offering ART services, and supplement these data with those obtained through a health facility survey or census every few years. For health facility surveys or censuses, tools such as the Service Provision Assessment (SPA) or the Service Availability Mapping (SAM) can be used.

Data Quality Control and Notes for the Reporting Tool
• Please comment on whether the data reported is from a national facility listing or census, or from a survey. If data from the private or other sectors is missing, please comment.
If it is possible to easily report any additional information on the geographical distribution of facilities offering ART (e.g. urban/rural, %facilities with ART in areas with a high concentration of PLWA), please provide extra details.

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

This indicator provides valuable information about the availability of ART services in health facilities, but it does not capture information about the quality of services provided. Antiretroviral therapy itself is complex, and it should be delivered as part of a package of care interventions, including the provision of cotrimoxazole prophylaxis, the management of opportunistic infections and comorbidities, nutritional support and palliative care. Simple monitoring of ART availability does not ensure that all ART-related services are adequately provided to those who
need them. Nevertheless, it is important to know what percentage of health facilities provide ART services in order to plan for service expansion as needed to meet universal access targets.

Additional considerations
• One strategy to scale up ART services is to make ART available in more health facilities. This may be achieved by decentralizing ART services from tertiary facilities (e.g., hospitals) to primary or secondary-level health facilities. Greater availability of ART services provides crucial support to the goal of universal access to HIV treatment by 2010.
• Depending on the country's epidemic type, the denominator may not be as relevant if the HIV program strategy aims to target a limited number of sites to offer ART in.

Data utilization: To look at progress in the percentage of health facilities which provide antiretroviral therapy. Analyzing the data geographically and by type of health facilities, and triangulating the data with estimates of HIV density can provide insight into where there is a need to increase availability of ART services.

Further information