Percent of HIV-positive patients in HIV care or treatment (pre-ART or ART) who started TB treatment

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Percent of HIV-positive patients in HIV care or treatment (pre-ART or ART) who started TB treatment
What it measures

All HIV-positive patients should be screened for TB disease. Those patients who “screen positive” are TB suspects and should be linked to additional evaluation, diagnosis, and treatment for TB disease.

Rationale

This indicator will help monitor the proportion of HIV-positive patients who are diagnosed with active TB disease and receive TB treatment. The data collected from countries using this indicator will allow USG to monitor increases over time. HQ can use this data to identify countries that are making progress that might point to best practices and lessons learned that may be useful to other countries. HQ can also use this data to identify countries that may require additional programming and technical assistance. Similarly, country teams and partners can use this data to assess the increase of TB diagnosis and treatment in specific sites.

Numerator

Number of HIV-positive patients in HIV care who started TB treatment

Denominator

Program coverage: Indicator number C2.1.D (HIV+ Clinical care indicator)

Calculation

Numerator / Denominator

Method of measurement

The numerator can be generated by counting the number of HIV-positive adults and children in HIV care or treatment (pre-ART or ART) who were started on TB treatment during the reporting period.

Denominator: Indicator C2.1.D

Explanation:
Numerator - HIV care and treatment sites should screen HIV patients for TB disease at every visit to identify TB suspects accordingly the national TB screening algorithm for PLWH e.g. symptom screening questionnaire, chest X-ray. In some HIV care and treatment sites, TB diagnosis may be made at the HIV site, but patients may be referred to the TB clinic to start and complete TB treatment. In other HIV care and treatment sites, patients may be screened for TB and then referred to TB clinic for diagnosis and treatment for TB disease as appropriate. Patients identified as TB suspects should be diagnosed for active TB disease based on national diagnostic algorithm in the country. Regardless, linkage between HIV and TB sites is critical to ensure that PLWH who have active TB disease start (and complete) TB treatment accordingly to national TB treatment guidelines in the country. HIV sites should document whether a patient starts TB treatment in the appropriate column on the WHO pre-ART/ART register.

Measurement frequency

Continuously

Disaggregation

Age group:

Condom type: N/A

Education: N/A

Gender: N/A

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

Type/Timing of testing: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator is intended to provide information on the proportion of HIV-positive patients in care and treatment that are started on TB treatment. An increase in this indicator over time would suggest improvements in TB screening and access to TB diagnosis and treatment services among HIV patients. This indicator should be interpreted along with the indicator on TB screening. If the results on the TB screening indicator increase, it is expected that the results on this indicator on TB treatment will also increase. Similarly, if the results on the TB screening indicator go up, but the results on the TB treatment indicator go down, this may suggest a problem with linking HIV patients to TB diagnosis and treatment services. The indicator would be affected by low uptake of HIV testing, poor access to HIV care services and antiretroviral treatment, and poor access to TB diagnosis and treatment. Separate indicators exist for each of these and should be referred to when interpreting the results of this indicator.
This indicator has several limitations that result from the minimal TB data that is collected in HIV sites. The WHO pre-ART/ART register indicates TB treatment start date and stop date but does not indicate whether patients successfully complete TB treatment (i.e. are cured). HIV programs are encouraged to closely monitor TB patients once they start TB treatment and if possible be in contact with TB clinics to ensure that those patients who start TB treatment do complete successfully. Similarly, although it is difficult to obtain data on how many patients were identified as TB suspects and how many patients were actually diagnosed with TB treatment, ideally programs would collect data at each point in the cascade to know what proportion of HIV patients were screened for TB, screened positive (identified as a TB suspect), diagnosed with TB, and treated for TB. However, the data sources and additional time required to report this data may not be realistic for most programs.

Further information