People living with HIV who know their 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

 

Method of measurement

There are three methods for estimating the proportion of people living with HIV who know their status. Which method is used depends on the availability of data in the country.

1. HIV case reports or notifications from a routine surveillance system

For the numerator. In countries with well-functioning HIV case surveillance systems, the minimum 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 the cumulative number of people diagnosed with HIV and the cumulative number these people dying can be reported. Countries should ensure that reporting delays of case notification are less than three months or that reporting delays are adjusted for at the end of the reporting period.

Please indicate the year when national HIV case surveillance began.

2. National population-based survey with HIV testing and a direct question about knowledge of serostatus

For the numerator. The numerator is constructed as follows:

: Number of people living with HIV at the national level

:  Number of survey participants who report that they were diagnosed with HIV at their last HIV test and who also tested HIV-positive in the survey

: Number of people with HIV-positive test results in the survey

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.

3. National population-based survey with HIV biomarkers with an indirect question abou t knowledge of serostatus plus programme data on the proportion of people in HIV treatment

For the numerator. This measure is constructed for the current year as the number of people living with HIV at the national level multiplied by the midpoint of the following:

  • The percentage of people who tested positive for HIV in the survey who report ever having been tested and receiving the last test result. For older surveys (maximum <5 years prior to reporting year), this percentage is projected forward using information from the percentage point difference in ART coverage between the survey year and the current reporting year.
  • The percentage of people living with HIV on antiretroviral treatment as reported in Indicator 1.2 for the current year and depending on the region to which the country belongs (typically between 50% and 100%)

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 survey methods. UNAIDS can provide technical assistance, if requested.

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 (the number of children on treatment, as reported in indicator 1.2, among the estimated total number of children). This percentage among children is the most conservative measure. 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.

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.
  • 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 data entry sheet to provide information for the capital city as well as 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.

Explanation of the numerator

 

 

Strengths and weaknesses

Case-based reporting method

Case-based surveillance provides reasonable measures of knowledge of HIV status when: ƒ 

  • The system has been in place for long enough that all people diagnosed and still alive have been reported. ƒ
  • There are timely and complete mechanisms for reporting newly diagnosed cases to the system from all facilities that offer HIV diagnostic testing. ƒ
  • Mechanisms are in place to de-duplicate individuals reported multiple times or from multiple facilities. ƒ
  • There is sufficient follow-up of individuals to identify that are still alive, as opposed to having died or moved out of the country.

Countries relying on weak systems may over or underestimate knowledge of HIV status if: ƒ

  • De-duplication of case reports has not occurred (overestimation). ƒ
  • Deaths or out-migration among people diagnosed and reported to the system have not been removed (overestimation). ƒ
  • Case reporting is not routine from all HIV testing facilities with confirmatory capacity (underestimation).

Survey-based methods

Surveys can provide a reasonable estimate of knowledge of HIV status and the effectiveness of targeted testing services in countries in which: ƒ

  • Surveys are sufficiently powered to estimate the proportion of people who know their HIV status at the national level, or among key populations, where these surveys are conducted. ƒ
  • Data are recent (within the last five years). ƒ
  • Disclosure of HIV status or testing behaviour is accurate.

Survey-based measures can underestimate knowledge of HIV status if: ƒ

  • For the direct survey question, evidence indicates that some people do not disclose their HIV status. ƒ
  • For an indirect measure, people with a positive HIV test result who report never having been tested at the time of the survey subsequently get tested and learn their status.

Knowledge of HIV status versus diagnosed

The phrase “people living with HIV who have been diagnosed” has sometimes been used to describe the first 90 (90% of the people with HIV know their HIV status). UNAIDS prefers the phrase “know their HIV status”, since it also captures people who have self-tested HIV positive and know their HIV status but have not received a medical diagnosis of their positive status.

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).