Percentage of injecting drug users with HIV still alive and known to be on treatment a) 12 months, b) 24 months and c) 60 months after initiation of antiretroviral therapy

Export Indicator

Percentage of injecting drug users with HIV still alive and known to be on treatment a) 12 months, b) 24 months and c) 60 months after initiation of antiretroviral therapy
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 then yearly after the beginning of ART. It completes program coverage by a measure of the effectiveness.

Rationale

ART is a lifelong therapy that increases survival and reduces transmission. In WHO European Region, where injecting drug users (IDUs) are most affected by the HIV/AIDS epidemic, access to and retention in ART is among key the
interventions in health sector response.

Numerator

Number of IDUs who are still alive and on ART a) 12 months, b) 24 months, c) 60 months after initiating treatment.

Denominator

a) At 12 months: Total number of injecting drug users who initiated ART in 2009 and so, who were expected to achieve 12-month outcomes within the reporting period (2010), including those who have died since starting ART,
those who have stopped ART, and those recorded as lost to follow-up at month 12.

b) at 24 months: Total number of injecting drug users who initiated ART in 2008 and so, who were expected to achieve 24-month outcomes within the reporting period (2010), including those who have died since starting ART,
those who have stopped ART, and those recorded as lost to follow-up at month 24.

c) at 60 months: Total number of injecting drug users who initiated ART in 2005 and so, who were expected to achieve 60-month outcomes within the reporting period (2010), 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 and cohort analysis report form.

In measuring retention for the 3 different intervals, it is important to carefully select the IDU patients according the period they have started therapy and to check the outcomes when they reached the expected duration of follow-up.
Assessing outcomes at 12 months should include all IDU patients who started thearpy in the last year, at 24 months, all IDU patients who started 2 years ago and at 60 months, all IDU patients who started 5 years ago. If the data available do not fit this standard yearly period it is important to specify the period used for calculation and when the patients initiated treatment.

IDU patients must be alive and on antiretroviral therapy at 12/24/60 months after their initiation of treatment. The numerator does not require patients to have been on antiretroviral therapy continuously for the 12/24/60-months period. IDU patients who may have missed one or two appointments or drug pick-ups, and temporarily
stopped treatment during the 12/24/60 months since initiating treatment but are recorded as still being on treatment at month 12/24/60 are included in the numerator. On the contrary, those patients who have died, stopped treatment or been lost to follow-up at 12/24/60 months since starting treatment are not included in the numerator.

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 national level, these statistics should be reported for 12 months analysis.

Disaggregation As much as possible, this indicator is to be disaggregated by sex, by age (

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, sample size and
whether the information is representative of all ART sites.

Measurement frequency
Disaggregation

Age group: (greater than) 14 years

Gender: Male, Female

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 treatment). Survival might reflect the services offered but also depends on the baseline characteristics of the IDU patients started on ART. Clinical, immunological and virological staging are independent predictors of survival under ART. For injecting drug users, various underlying health conditions may additionally affect survival rates. Baseline characteristics of the cohort of patients should help in interpreting the results and in comparing ART sites.

Additional considerations: 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.

Data utilization: Note any particularly low coverage and use the data to assess the reasons behind it. Try to get data on the distribution of those who are no longer on ART: dead, stopped, loss to follow up. If data are available, try to assess loss to follow-up population to see if they are likely to be dead, stopped, or transferred out. Compare cohorts. See also indicators EUR3 and EUR 5.

Further information