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 the second 90 of the UNAIDS 90–90–90 target: that 90% of the people who know their HIV-positive status will be on 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

Calculation

Numerator/denominator

Note: Starting in 2018, countries have the option of constructing this Indicator by broad age- and sex-disaggregated groups using Spectrum, importing data into the reporting tool once the national file is finalized

 

Method of measurement

For the numerator. The numerator can be generated by counting the number of adults and children who are on antiretroviral therapy at the end of the reporting period. The count should not include people who have stopped treatment, died or emigrated to another country or who are 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.

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 numerator should include people on antiretroviral therapy in the private sector and public sector if these data are available.

This indicator does not include antiretroviral medicines taken only for preventing mother-to-child transmission and post-exposure prophylaxis. This indicator includes pregnant women living with HIV who are receiving lifelong antiretroviral therapy.

Countries should triangulate the numerator from programme data with national procurement and drug monitoring systems and adjust reported numbers as appropriate. Estimates of coverage of antiretroviral therapy from surveys can also be used to inform or validate the numerator.  Note that surveys that only capture self-reported data on treatment uptake should not be used, since self-reported data has been shown to be of limited quality.

Important: Countries that have undertaken data quality assessments or reviews that monitor the extent to which facilities are able to report the number of people on treatment accurately during reporting periods should adjust programme numerator data to account for these inconsistencies. UNAIDS will work with countries to agree on a set of best practices specific to the country for adjusting reported programme data.

These adjustments should be described in the “Additional information box” and the year the data quality review was done should be provided in the available box.

 

For the denominator. Estimation models such as Spectrum are the preferred source for the number of people living with HIV. If models other than Spectrum are used, documentation of the estimation method and uncertainty bounds should be provided.

 

 

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 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. These adjustments should be noted in the box providing additional information.
  • 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.

  • Public or private sector

  • 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

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.

Please provide subnational data disaggregated by administrative areas as well as city-specific data for this Indicator. Provide information for the capital city and one or two other key cities of high epidemiological relevance (for example, those that have the highest HIV burden or 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).