Proportion of HIV-positive registered TB patients given ART during TB treatment

Export Indicator

Percent of HIV-positive registered TB patients who are started on ART or continue previously initiated ART, during or at the end of TB treatment
What it measures

Outcome indicator to measure commitment and capacity of TB service to ensure that HIVpositive TB patients are able to access ART

Rationale
Numerator

All HIV-positive TB patients, registered over a given time period, who receive ART (are started on or continue previously initiated ART)

Denominator

All HIV-positive TB patients registered over the same given time period.

Calculation
Method of measurement

Data collection methods will depend on who provides ART for TB patients. In settings where TB patients are assessed for eligibility and started on ART by TB programme staff, data for this indicator can be captured in a modified TB register or separate TB/HIV register. The data should be reported at the completion of TB treatment in order to include all TB patients started on ART at any time over the course of their TB treatment. In settings where TB patients are referred to HIV or other care services to be assessed and started on ART, a system must be established to ensure that the TB programme is informed of the outcome of the referral, i.e. whether or not TB patients are started on ART or not, and that this information is recorded in a modified TB register or TB/HIV register. This is important not only for programme management but also for individual patient care. TB staff need to be aware of a TB patient being started on or continuing ART so that they can manage drug reactions and interactions appropriately. TB patients may be started on ART at any time during their TB treatment. The start of ART may be delayed by a delay in HIV testing or to reduce the risk of drug interactions occurring in the intensive phase. The data collection methods should be able to capture ART treatment starting at any time during TB treatment.

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

ART significantly improves the quality of life, reduces morbidity and enhances the survival of people with advanced HIV infection or AIDS. HIV-positive TB patients are one of the largest groups already in contact with the health service who are likely to benefit from ART, and efforts should be made to identify and treat those who are eligible. This indicator measures the degree to which ART has become a component of the package of care offered to HIV positive TB patients and provides a measure of the accessibility of ART to HIV-positive TB patients, drug availability, the degree to which health care providers encourage ART as a part of routine care, and the success of TB and ART health services to refer, manage, and track registered TB patients eligible for ART (i.e. the strength of the referral process). It does not measure whether patients are treated correctly with an appropriate regimen, at what point during TB treatment patients are started on ART, whether they adhere to therapy, or the quality of patient monitoring or follow-up. It also cannot measure the impact of ART among persons who are treated. The expected values for the indicator will vary depending on national eligibility criteria for ART and whether or not CD4 cell counting is available. It would be expected that, in the absence of CD4 cell counts, most HIV-positive TB patients would be started on ART; with the exception of those who decline or who, for some other reason, are not eligible to start ART. This indicator must therefore be interpreted with caution, particularly when comparing one country with another.

Further information