Percentage of adults and children with HIV still alive and known to be on antiretroviral therapy 60 months after initiating treatment among patients initiating antiretroviral therapy during 2007

Export Indicator

Percentage of adults and children with HIV still alive and known to be on antiretroviral therapy 60 months after initiating treatment among patients initiating antiretroviral therapy during 2007
What it measures

This indicator measures the retention on ART related to the increase in survival and willingness to continue ART. It should be produced at 12 months and for longer duration of follow-up; the 24 and 60 months retention are described here (the 12 months retention is included in the GARPR indicator guidance). It completes programme coverage as a measure of the effectiveness.

Antiretroviral is a life-long intervention. Measuring retention on ART is critical for determining the effectiveness of programmes, inferring their impact and to highlight obstacles to expanding and improving them.

Rationale
Numerator

Number of adults and children who are still alive and on ART 60 months after initiating treatment among those who initiated treatment in 2007.

Denominator

Total number of adults and children who initiated ART in 2007 (or another specified period), who were expected to achieve 60-month outcomes within the 2012 reporting period (or 60 months after the specified initiation period, including those who have died since starting ART, those who have stopped ART, and those recorded as lost to follow-up at month 60.

Calculation

Numerator / Denominator

Method of measurement

Numerator and denominator: Programme monitoring tools; ART register; cohort analysis forms. In measuring retention, it is important to carefully select the patients according to the period they have initiated ART and to check their outcomes when they reached the expected duration of follow-up. Assessing outcomes at 24 months should include all patients started 2 years ago and at 60 months, all patients started 5 years ago. If the data available does not really fit this standard yearly period, it is important to specify the period the patients have initiated ART. Disaggregation: Among the people who started (denominator), in addition to reporting the (1) number of people alive and on treatment (numerator), it is also important to report the number (2) lost to follow-up, (3) stopped therapy, and (4) died. These 4 outcomes should sum to the number of people who started ART. When generating information at site level, patients transferred in should be included in the statistics and patients transferred out should be excluded. From the compilation of site reports, if the number of patients transferred in and transferred out is summed at the national level, these statistics should be reported for 12-month analysis. Data Quality Control and Notes for the Reporting Tool: National Representativeness: If this indicator is only produced in a sub-set of facilities, comment should be added on the source of information and whether the information is representative of all ART sites.

Measurement frequency
Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

The continuation of ART is mostly related to survival (but also willingness to continue). Survival might reflect the services offered but also depends on the baseline characteristics of the patients started on ART. Clinical, immunological and virological staging are independent predictors of survival under ART. Baseline characteristics of the cohort of patients should help in interpreting the results and, in particular, comparing ART sites.

Additional considerations:
If data on 24-month or 60-month retention are not available for patients that initiated antiretroviral therapy in 2010 or 2007, respectively, but available for patients that initiated antiretroviral therapy during an earlier time period (e.g. 2009 or 2008, or 2006 or 2005), please specify the period in the comment field: e.g. "Started antiretroviral therapy between [month]/[year] and [month]/[year]”.
The numerator does not require patients to have been on antiretroviral therapy continuously for the 24 month or 60 month period. For example, patients who may have missed one or two appointments or drug pick-ups, and temporarily stopped treatment since initiating treatment but are recorded as still being on treatment at month 24 or 60 are included in the numerator. On the contrary, those patients who have died, stopped treatment or been lost to follow-up at 24 or 60 months since starting treatment are not included in the numerator.
In countries where this indicator is not produced in all ART sites but in a sub-set of facilities, data should be interpreted keeping in mind the representativeness, and this should be stated in the Comments box.

Data utilization: Note any particularly low retention and assess reasons behind it, by analysing the distribution of those who are not on ART: dead, stopped, loss to follow up. If data is available, try to assess the lost-to-follow-up population to see if they are likely to be dead, stopped, or transferred out. Compare cohorts.

Further information