People living with HIV on antiretroviral therapy

Export Indicator

Percentage and number of adults and children on antiretroviral therapy among all adults and children living with HIV at the end of the reporting period
What it measures

Progress towards providing antiretroviral therapy to all people living with HIV

Rationale
Antiretroviral therapy has been shown to reduce HIV-related morbidity and mortality among people living with HIV and to halt onward transmission of the virus. Studies also show that early initiation, regardless of a person’s CD4 cell count, can enhance treatment benefits and save lives. WHO currently recommends treatment for all.
 
The percentage of people on antiretroviral therapy among all people living with HIV provides a benchmark for monitoring global targets over time and comparing progress across countries. It is one of the 10 global indicators in the 2015 WHO Consolidated strategic information guidelines for HIV in the health sector.
 
This indicator also monitors progress toward the second 90 of the UNAIDS 90–90–90 target: that 90% of the people who know their HIV-positive status are accessing antiretroviral therapy by 2020.
Numerator

Number of people on antiretroviral therapy at the end of the reporting period

Denominator
Estimated number of people living with HIV (to determine treatment coverage)
 
Number of people among all people living with HIV who know their HIV status (to determine the second 90)
Calculation
Numerator/denominator
 
Note: Starting in 2018, countries with a population of more than 250, 000 will report on this indicator within Spectrum. Results will be imported into the GAM reporting tool once the national file is finalized. Reporting on detailed age and sex groups will still be done using the GAM reporting tool.
Method of measurement
For the numerator. The numerator is generated by counting the number of adults and children who are on antiretroviral therapy at the end of the reporting period. The numerator should include people on antiretroviral therapy in the private sector if these data are available.
 
Some people pick up several months of antiretroviral medicine at one visit. If the duration of the medicine picked up covers the last month of the reporting period, these people should still be counted as receiving antiretroviral therapy (as opposed to having stopped treatment).
 
The count should include pregnant women living with HIV who are receiving lifelong antiretroviral therapy. Women taking antiretroviral medicines for preventing mother-to-child transmission and post-exposure prophylaxis (e.g., Option B) should not be counted.
 
The count should not include people who have stopped treatment, died or emigrated to another country, or those who were otherwise lost to follow-up at the facility during this period. Protocols should be in place to avoid duplicate counting of individuals across facilities or over time and to ensure that all facility-level data are reported in a timely manner.
 
Important: Countries should routinely conduct data quality reviews to determine the accuracy of the count data. This should include triangulation of the programme data with national procurement and drug monitoring systems and other pharmacy or drug distribution data. Estimates of coverage of antiretroviral therapy from surveys can also be used to inform or validate the numerator based on programme data, although survey results should be based on drug testing and not self-reported data since self-reported data has been shown to be of limited quality.
 
Countries that have undertaken data quality assessments or reviews should adjust current and historical reported data to account for these inconsistencies. UNAIDS will work with countries to agree on a set of best practices for adjusting reported programme data specific to the country.
 
For the denominator. Models such as Spectrum are the preferred source for estimating the number of people living with HIV. UNAIDS will work with countries to develop a Spectrum model that matches the estimate of people living with HIV if estimates other than those produced through Spectrum are used. For numbers of people living with HIV who know their status, please see Indicator 1.1 for more information about the denominator.
Measurement frequency
Data should be collected continually at the facility level and aggregated periodically, preferably monthly or quarterly. The most recent monthly or quarterly data with the count of the number of people currently on treatment should be used for annual reporting.
Disaggregation
  • 0–14 years for children, and 15 years and older by sex (men and women) for adults. Data reported for unknown age or sex should be allocated to the age- and sex- disaggregated data cells using the same distribution of the data with known age and sex.
  • As available. Disaggregation by detailed age and sex: <1 year, 1–4 years, 5–9 years and 10–14 years for children; and 15–19 years, 20–24 years, 25–49 years and 50+ years by sex (men and women) for adults; by gender (men, women, other gender) for adults.
  • Cities and other administrative areas of importance.
  • Numbers of people newly initiating antiretroviral therapy during the current reporting year (these data should be available from the same sources as the total number of people receiving antiretroviral therapy).
Additional information requested
For countries with populations less than 250 000 reporting through GAM, please provide information about the source of the treatment data. Options include the following:
  • Programme data, primarily reported in aggregate: choose this option if counts are provided to the Ministry of Health disaggregated only by age and sex. Data may typically be reported as coming from DHIS, national reports, or programme reports with the original source being patient registers, pharmacy records or other routine aggregate reporting forms.
  • Programme data, primarily reported using health identifiers: choose this option if counts reported to the Ministry of Health can be deduplicated over time and across facilities using health or uniquely identifying person-level information.
  • National estimates based on population survey results: choose this option if you have used estimates from a national survey to derive an estimate of the number of people on treatment.
  • National estimates based on cohort monitoring data: choose this option if you have derived estimates based on cohort data.
  • Other: please use this option only in consultation with UNAIDS.
More detailed age-specific data are requested for children and separately by sex for adults. The subset of people newly initiating antiretroviral therapy during the last reporting year is requested.
 
For all countries, where available, please provide subnational data (where available) disaggregated by administrative areas, as well as city-specific data. Provide information for the capital city and one or two other key cities of high epidemiological relevance, such as those with the highest HIV burden or those that have committed to ending AIDS by 2030. The data entry screen has separate space for this. You also may submit the digital version of any related reports using the upload tool.
Strengths and weaknesses
This indicator monitors trends in antiretroviral therapy coverage in a comparable way across countries and over time. It does not, however, measure treatment cost, quality, effectiveness or adherence, which vary within and between countries and are likely to change over time.
 
The accuracy of the number of people on antiretroviral therapy will depend on the quality of the underlying reporting system. Numbers of people on antiretroviral therapy may be under-reported due to missing or delayed reporting of facility data to the national level. Numbers of people on antiretroviral therapy also may be over-reported as a result of not removing people from registries who stopped treatment, died or transferred facilities. Other errors, such as incorrectly abstracting data from facility-based registries or completing reporting forms, can lead to over and underreporting to varying degrees of magnitude.
Further information

WHO guidance on treatment and care (http://www.who.int/hiv/topics/treatment/en/index.html).