Proportion of HIV-positive clients given treatment for latent TB infection

Export Indicator

Percent of newly diagnosed HIV-positive clients who are given treatment for latent TB infection (TB preventive therapy)
What it measures

To ensure that eligible HIV-positive individuals are given treatment for latent TB infection and thus to reduce the incidence of TB in PLWHA

Rationale
Numerator

Total number of newly diagnosed HIV-positive clients in whom active TB has been excluded who start (are given at least one dose of) treatment for latent TB infection

Denominator

Total number of newly diagnosed HIV-positive clients

Calculation
Method of measurement

The data needed for this indicator can be collected in all situations where counselling and testing for HIV are carried out, e.g. VCT centres, PMTCT sites, inpatient medical services, or at HIV care services, depending on where TB preventive therapy (TBPT) is to be administered. In all these situations, HIV-positive clients should be screened for TB, as suggested in indicator B.1.1. Those clients found not to have evidence of active TB will be offered TBPT according to nationally determined guidelines. All those accepting TBPT and receiving at least the first dose of treatment should be recorded. This information could be recorded in an extra column in the HIV care register. Accurately predicting drug requirements for supply management requires the collection of more detailed information: a TBPT register is needed, in which client attendance to collect further drug supplies (usually monthly) is recorded. From this, facilities would be able to report the number of new cases, continuing cases and completed cases on a quarterly basis. If such information is collected routinely, the indicator of choice would be 'the number of HIV-positive clients completing treatment of latent TB infection, as a proportion of the total number of HIV-positive clients started on such treatment. From pilot testing sites it is apparent that 10–50% of clients who test HIV-positive can be expected to start TBPT; some will not meet the eligibility criteria, some will decline and some will drop out during the screening process. The proportion likely to start TBPT depends on the screen used (for example, using tuberculin skin test as a screening tool reduces the number that are eligible) and also on the type of VCT facility. If a VCT facility sees mostly hospital or clinical referrals, a greater proportion would be expected to be sick and thus ineligible for treatment of latent TB infection. Higher proportions would be expected from sites linked to PMTCT or stand-alone VCT centres. Most programmes would aim for between 30% and 50% depending on the types of HIV testing and counselling facilities available.

Measurement frequency

Continuously

Disaggregation

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

The risk of developing TB is significantly increased in PLWHA. Treatment of latent TB infection will reduce the incidence of developing TB disease in PLWHA who are infected with TB but who have no active TB disease. To include clients who are given at least one dose is relatively easy, even in resource- limited settings. This information is the minimum necessary to ensure that TBPT is being offered to HIV-positive clients without evidence of active TB. However, unless further data are collected as detailed above, this indicator provides no information about how many clients adhere to or complete the TBPT course and thus no  information about the likely effectiveness of the intervention. Much greater resources are required to collect more complete data on adherence or completion, but programmes may wish to undertake periodic studies to establish, for example, adherence rates, and the accuracy of the screening questionnaire.

Further information