Percent of adults and children known to be alive and on treatment 12 months after initiation of antiretroviral therapy

Export Indicator

Percent of adults and children known to be alive and on treatment 12 months after initiation of antiretroviral therapy
What it measures

High retention is one important measure of program success and is a proxy for overall quality of program.

Rationale
Numerator

Number of adults and children who are still alive and on treatment at 12 months after initiating ART

Denominator

Total number of adults and children who initiated ART in the 12 months prior to the beginning of the reporting period, including those who have died, those who have stopped ART, and those lost to follow-up.

Calculation

Numerator / Denominator

Method of measurement

Explanation of Numerator: The numerator requires that adult and child patients must be alive and on ART at 12 months after their initiation of treatment.
For a comprehensive understanding of survival, the following data must be collected:
• Number of adults and children in the ART start-up groups initiating ART at 12 months prior to the end of the reporting period (denominator)
• Number of adults and children still alive and on ART at 12 months after initiating treatment (numerator)

The reporting period is defined as a continuous 12-month period that has ended within a pre-defined number of months from the submission of the report. The pre-defined number of months can be determined by PEPFAR or national reporting requirements. If the PEPFAR reporting period is 1 October 2009 to 31 September 2010, countries will calculate this indicator by using all patients who started ART any time during the 12-month period from 1 October 2008 to 31 September 2009. A 12-month outcome is defined as the outcome (i.e. whether the patient is still alive and on ART, dead or lost to follow-up) 12 months after starting. For example, patients who started ART during October 2008 will have reached their 12-month outcomes in October 2009.

The numerator does not require patients to have been on ART continuously for the 12-month period. Patients may be included in the numerator (and denominator) if they have missed an appointment or drug pick-up or temporarily stopped treatment during the 12 months since initiating treatment, as long as they are recorded as still being on treatment at month 12. On the contrary, those patients who have died, stopped treatment, or been lost to follow-up as of 12 months since starting treatment are not included in the numerator. For example, for those patients who started ART in October 2008, if at any point during the period October 2008 to October 2009 these patients die, are lost to follow-up (and do not return), or stop treatment (and do not restart), then at month 12 (October 2009), they are not on ART, and not included in the numerator. Conversely, a patient who started ART in October 2008 and who missed an appointment in December 2008, but is recorded as on ART in October 2009 (at month 12) is on ART and will be included in the numerator. The number of adults and children on ART at 12 months includes patients who have transferred in (and their initiation date is known) at any point from initiation of treatment to the end of the 12-month period and excludes patients who have transferred out during this same period to reflect the net current cohort at each facility. What is important is that the patient who has started ART in October 2008 is recorded as being alive and on ART 12 months after initiation, regardless of what happens from October 2008 to October 2009.

Explanation of Denominator: The denominator is the total number of adults and children in the (monthly) ART start-up groups who initiated ART at a point 12 months prior to the beginning of the reporting period, regardless of their 12-month outcome. For example, for the reporting period October 1, 2009 to September 30, 2010, this will include all patients who started ART during the 12-month period from October 1, 2008 to September 30, 2009. This includes all patients, both those on ART as well as those who are dead, have stopped treatment or are lost to follow-up at month 12. Again the denominator includes patients that have transferred in (and their initiation date is known) and excludes patients that transferred out during the time period.

This indicator should NOT be estimated. This indicator should be calculated directly from information gathered in standard ART registers or tabular analysis from electronic patient level databases.

Country teams should ensure that all sites are reporting on the same 12 ART start-up groups. Only sites that have been ope

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

At the national level, the number of transferred-in patients should match the number of transferred-out patients. Therefore, the net current cohort (the patients whose outcomes the facility is currently responsible for recording—the number of patients in the start-up group plus any transfers in, minus any transfers out) at 12 months should equal the number in the start-up cohort group 12 months prior.

Using this denominator may underestimate true “survival”, since a proportion of those lost to follow-up are alive. The number of people alive and on ART (i.e. retention on ART) in a treatment cohort is captured here.

Priority reporting is for aggregate survival reporting. If comprehensive cohort patient registries are available then it is encouraged for countries to track survival at 24, 36, and 48 months. This will enable comparison over time of survival on ART. As it stands, it is possible to identify whether survival at 12 months increases or decreases over time. However, it is not possible to attribute cause to these changes. For example, if survival at 12 months increases over time, this may reflect an improvement in care and treatment practices or earlier initiation of ART. Therefore, collection and reporting of survival over longer durations of treatment outcomes may provide a better picture of the long-term success of ART.

Further information