People living with HIV who know their HIV status

Export Indicator

Percentage of people living with HIV who know their HIV status at the end of the reporting period
What it measures

Progress towards increasing the proportion of people living with HIV who know their HIV status and the efficacy of HIV testing interventions

Rationale
People living with HIV who know their HIV status will be able to access the HIV care and treatment services required to live healthy, productive lives and to reduce the potential of transmitting HIV to other people. The most effective way to ensure that people living with HIV are aware of their HIV status is to offer HIV testing services at locations and among populations with the highest HIV burden.
 
This measure is one of the 10 global indicators in the 2015 WHO Consolidated strategic information guidelines for HIV in the health sector and helps to monitor the first 90 of the UNAIDS 90–90–90 target: that 90% of the people living with HIV know their HIV status by 2020.
Numerator

Number of people living with HIV who know their HIV status

Denominator

Number of people living with HIV

Calculation
Numerator/denominator
 
Note: Starting in 2018, countries with a population of more than 250 000 will report on this indicator by broad age and sex groups 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
There are two recommended methods for estimating the proportion of people living with HIV who know their status. The method used depends on the availability of data in the country.
 
1. Direct estimates from HIV case surveillance systems
 
For the numerator. In countries with well-functioning HIV case surveillance systems, the number of people living with HIV who know their status is the same as the number of people diagnosed with HIV and reported to the surveillance system who are still alive.
 
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.
 
On case surveillance methods. An HIV case surveillance system is considered well-functioning if reporting from all facilities providing confirmatory HIV testing, care and treatment services has been in place since at least 2013 and people who have died, been lost to follow-up or emigrated are removed. Countries should ensure that reporting delays are adjusted for by including an estimated number of people diagnosed but not yet reported during the calendar year.
 
2. Modelled estimates
 
For the numerator: The approach to modelling the estimate of the number of people who know their HIV status among those living with HIV will depend on the availability of data in the country.
 
For countries with new HIV diagnosis data and CD4 count or AIDS-related deaths from vital registration data, the number of people who know their HIV status can be derived using the Case Surveillance and Vital Registration (CSAVR) fitting tool in Spectrum. A similar estimation method is available through the European Centres for Disease Control (ECDC) HIV modelling tool (https://ecdc.europa.eu/en/publications-data/hiv-modelling-tool). Estimates from other country-specific approaches to modelling this count that are based on case surveillance and clinical data may also be reported where these methods have been peer-reviewed and published.
 
For countries with survey data that either directly capture the number of HIV-positiverespondents who report that they know their status, or the number of HIV-positive people who report ever having been tested, UNAIDS recommends (as of 2018) that the first 90 be modelled using Shiny First 90 (https://shiny.dide.imperial.ac.uk/shiny90/). At this site, Shiny First 90 users can find more detailed recommendations and specifications, including the required inputs.
 
Estimates of the first 90 based only on self-reported knowledge of status or on historical survey data that have not been adjusted for changes over time since the survey was conducted should not be reported.
 
For the denominator. Estimation models such as Spectrum are the preferred source for the number of people living with HIV. UNAIDS will work with countries to develop a Spectrum model that matches the estimates of people living with HIV if other estimates other than those produced through Spectrum are used.
 
On estimating knowledge of status among children for modelled estimates. Since household surveys are often restricted to respondents of reproductive age (15–49 years old), a separate estimate of knowledge of HIV status among children (0–14 years old) may have to be constructed using programme data (e.g., the number of children on treatment, as reported in Indicator 1.2, among the estimated total number of children). When antiretroviral therapy coverage among children is used, this represents the most conservative measure of knowledge of status in this population. To derive the overall estimate of the percentage living with HIV who know their HIV status, the age-specific estimates should be averaged, weighted by the numbers of children and adults (separately) living with HIV. UNAIDS will assist countries with these calculations, where needed.
Measurement frequency

Annually

Disaggregation
  • 0–14 years for children and 15 years and older by sex (men and women) for adults.
  • 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.
Additional information requested
Please provide subnational or city-specific data for this indicator. Space has been created in the GAM reporting tool to 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.
Explanation of the numerator

 

 

Strengths and weaknesses
Case-based reporting method
 
Case-based surveillance provides reasonable measures of knowledge of HIV status in the following instances:
  • The system has been in place for long enough that all people diagnosed and still alive have been reported.
  • There are timely and complete mechanisms for reporting newly diagnosed cases to the system from all facilities that offer HIV diagnostic testing.
  • Mechanisms are in place to de-duplicate individuals reported multiple times or from multiple facilities.
  • There is sufficient follow-up of individuals to identify that they are still alive, as opposed to having died or moved out of the country
Countries relying on weak systems may overestimate or underestimate knowledge of HIV status in the following cases:
  • De-duplication of case reports has not occurred (overestimation).
  • Deaths or out-migration among people diagnosed and reported to the system have not been removed (overestimation).
  • Case reporting is not routine from all HIV testing facilities with confirmatory capacity (underestimation).
 
Modelled estimates
 
The accuracy of modelled estimates of the first 90 will depend on the quality of the data inputs in each country and the accuracy of the assumptions underpinning each model. Countries should review the quality of the data inputs with UNAIDS and the selected modelling approach to determine the extent to which modelled estimates might overstate or understate knowledge of status among people living with HIV in the country.
Further information
Consolidated strategic information guidelines for HIV in the health sector. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/164716/1/9789241508759_eng.pdf?...).
 
Spectrum software. Glastonbury (CT): Avenir Health; 2016 (http://www.avenirhealth.org/software-spectrum.php).
 
Demographic and Health Surveys (http://dhsprogram.com).