Percentage of health facilities with ART services which also provide comprehensive care, including prevention services, for HIV-positive clients

Export Indicator

Percentage of facilities with ART services which also provide comprehensive care, including prevention for HIV-positive clients, or which refer to such services if they are not available on site.
What it measures

Preventive services are an imperative component of comprehensive care. Without effective prevention to reduce the number of new HIV infections, ART initiatives cannot keep pace with the spread of the disease. ART programmes present a unique opportunity to provide preventive services specifically tailored to HIV-positive people. The full range of HIV prevention services includes risk-reduction counselling, condom promotion and distribution, partner notification, harm-reduction education and services, and STI education and management. Ideally, this range of services should be available on site where ART services are provided. The minimum components of prevention services should include risk-reduction counselling and condom promotion and distribution. On sites where the delivery of preventive services is impossible an effective referral system must be in place. This means having a referral form or list identifying a specific referral site or sites for confirmed or suspected HIV-infected people at each point of service. In addition, preventive services are one of the components of comprehensive care for HIV-positive people. The following services are included.
Health services: HIV testing and pretest and post-test counselling; outpatient or inpatient treatment of opportunistic infections and other HIV-related conditions; preventive therapies for opportunistic infections, including TB; symptomatic palliative care; and antiretroviral combination therapy.
Psychological services: Emotional support and follow-up counselling; support groups and/or post-test clubs for people living with HIV/AIDS; and spiritual support.
Social and legal support: Community-based, home-based and faith-based organizations or other bodies that offer material, food, financial or legal support (such as succession planning and will-writing) for people living with HIV/AIDS and/or their families.
Support for orphans and vulnerable children: Community-based and faith-based organizations or other bodies that strengthen care and support interventions for orphans and vulnerable children affected by HIV/AIDS.
The prevention of MTCT is not included in this indicator; for this area, reference should be made to the National guide to monitoring and evaluating programmes for the prevention of HIV in infants and young children.

Rationale
Numerator

Number of health facilities providing comprehensive care, including prevention services.

Denominator

Total number of surveyed health facilities that provide ART (could be a subset of facilities surveyed for Core Indicator 5, Percentage of health facilities with systems and items for provision of antiretroviral therapy services).

Calculation
Method of measurement

Data are collected through a facility survey at points of ART delivery. If the facility offers prevention services the surveyor should record which components are provided and whether these are the most relevant to the client population (i.e. if harm reduction matches prevalent risk behaviours). If the facility does not provide prevention services the assessment should ask whether:
• there is a referral directory listing services in the area, including the name and contact information for the service;
• a written referral form is available on which providers can enter the names and locations of referral services;
• a register exists allowing surveyors to see where referrals have been made.

Measurement frequency

Every 2-4 years

Disaggregation

Age group:

Education: N/A

Gender: N/A

Geographic location: N/A

Pregnancy status: N/A

Sector: 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

This indicator looks at the provision of prevention services or referral to such services but does not assess their quality. Moreover, it cannot measure the outcome of referrals. Special studies would be required in order to assess the extent to which the services provided are relevant to risk behaviours and the nature of the epidemic and to which they are functional and used by ART patients.

Further information