Number of HIV-positive persons receiving Cotrimoxizole (CTX) prophylaxis

Export Indicator

Number of HIV-positive persons receiving Cotrimoxizole (CTX) prophylaxis
What it measures

CTX prophylaxis is a simple and cost-effective intervention that reduces the risk of opportunistic infections (OIs) and mortality in HIV-positive children and adults. WHO recommends administration of CTX for the following groups: adults with HIV infection, including pregnant women, children with HIV infection, and infants exposed to HIV. The WHO guidelines offer countries a choice of whether to provide CTX broadly or according to disease stage.

Rationale

This indicator is important to country teams and HQ for several reasons including:
• Assesses scale-up and coverage of CTX prophylaxis
• Identifies gaps in services to improve scale-up and coverage
• Provides data to assess quality of care
• Focuses on a primary intervention for HIV-positive infants, children, and adults
• Informs program planning and budget allocations to improve utilization of resources to focus on this essential intervention.

Numerator

Number of HIV-positive persons receiving Cotrimoxizole (CTX) prophylaxis

Denominator

Program coverage: Use numerator from Indicator C2.1.D
Population coverage: Number of HIV-positive individuals who are eligible for CTX, (according to national guidelines)

Calculation

Not applicable

Method of measurement

The numerator can be generated by counting the number of HIV-positive individuals receiving CTX prophylaxis at some point during the reporting period.

Explanation of Numerator
Individuals should be considered to be “receiving” CTX prophylaxis if CTX has been prescribed and obtained by the patient (provided by a program or procured by the patient). The indicator is not meant to account for short term lapses in adherence or short term stock outs. If individuals are served by more than one program that might provide CTX prophylaxis, the figure should be adjusted as needed so that the numerator represents only unique individuals receiving CTX within the reporting period.

Countries should focus on compiling data for the numerator from patient registers at facilities. Where patient level data are not available, countries may develop program or facility level estimates of coverage with CTX and apply these estimates to the total number of individuals receiving care and support services through those programs or facilities. HIV-positive individuals receiving CTX in both the private sector and the public sector should be included in the numerator where data for both are available.

Provision of Cotrimoxizole is one of the key services included under “clinical” services. [The information will be considered in the context of the national policy on CTX in the country, the total numbers of HIV-positive individuals in the country, WHO guidelines, and the numbers of HIV-positive individuals receiving HIV care services.] 

Disaggregation:
Essential/not reported Recommended Recommended Males
Recommended Females
Age represents an individual’s age at the end of the reporting period or when last provided with CTX.

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

Countries may be at different phases in developing national guidelines on provision of CTX for HIV-positive individuals. The figure of individuals served by more than one program should be adjusted as needed so that the numerator represents only unique individuals receiving CTX within the reporting period, which would be impossible without unique IDs and electronic monitoring systems. Although countries may not have a system in place yet to collect and report coverage of CTX among HIV-positive individuals, the goal should be to develop such a system.
This indicator permits monitoring trends in the numbers and proportion of HIV-positive persons receiving CTX prophylaxis. Since countries have different guidelines for provision of CTX to HIV-positive individuals, cross-country comparisons of aggregate estimates and proportions must be interpreted with caution and with reference to eligibility criteria.

In addition to tracking the numbers of persons on prophylaxis, this indicator can be interpreted as a proportion, or measure of coverage, using various denominators as appropriate. Coverage can be considered using different denominators, for example the proportion of HIV-positive persons in care (receiving at least one clinical service) receiving CTX, the proportion of the estimated number of HIV-positive persons in the country (or area receiving PEPFAR support) receiving CTX, or the proportion of HIV-positive individuals who are eligible for CTX, (according to national guidelines) who are receiving CTX.

This indicator attempts to track progress in scale-up of CTX to HIV-positive individuals in a country. The indicator does not attempt to capture interruptions in drug availability or patient adherence to prescribed therapy. The reports will need to be interpreted in the context of national policies (some countries recommend CTX for all HIV-positive individuals, some prioritize specific sub-groups). As countries strengthen systems to collect data, there should be regular reporting to PEPFAR Headquarters on changes in eligibility criteria and on systems to track individuals receiving CTX.

Further information