Proportion of HIV-positive TB patients referred to HIV care and support services during TB treatment

Export Indicator

Percent of HIV-positive TB patients referred to HIV care and support services (as defined in local or national HIV/AIDS policy) during TB treatment
What it measures

Process indicator to measure commitment and capacity of TB service to ensure that HIV positive TB patients are able to access the care and support services that are available

Rationale
Numerator

Number of HIV-positive TB patients, registered over a given time period, who are referred to HIV care and support services during their TB treatment* *This may be reported as a composite indicator of referral to any HIV care and support services or may be broken down and reported by each individual service, e.g. number referred to PMTCT, number referred to PLWHA support group. Referral to ART services should be excluded as this is covered separately – see Indicator C.5.1, Proportion of HIV-positive registered TB patients given ART during TB treatment

Denominator

Total number of HIV-positive TB patients registered over the same given time period

Calculation
Method of measurement

The means to measure this indicator will depend on what services are available for PLWHA and where they are provided. All HIV care and support services may be provided at one site, in which case only one referral will be necessary. It will be relatively straightforward to record such referrals in a modified TB register or separate register for HIV-positive TB patients by use of a checkbox. It is more likely that the range of care and support services will be offered by a variety of providers at different sites. It may therefore be necessary to have a checklist of services in the TB or TB/HIV register where referral to each available service can be recorded. Diagnosis of HIV may occur at any time during TB treatment – and the need for referral to specific services may also arise at any time during TB treatment. It is thus important that the information for this indicator be collected and reported at the end of TB treatment with the quarterly cohort outcome data. Data can be collected as a single indicator, i.e. number of HIV-positive TB patients who are referred to any HIV care and support service during their TB treatment. Alternatively, if more detailed information is required for programme management, these data can be reported by each separate care and support service, e.g. number of HIV-positive TB patients who are referred to PLWHA support group, number of HIV-positive TB patients who are referred to PMTCT service. Referral to ART services should not be included as it is detailed in Indicator C.5.1,Proportion of HIV-positive registered TB patients given ART 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

Wherever TB patients are encouraged to undergo HIV testing, new cases of HIV infection will  be identified. In addition to quality post-test counselling, it is important that TB patients newly diagnosed with HIV infection are able to access the full range of care and support services that are available for PLWHA, as stipulated in local and national HIV/AIDS policy. The services available will vary between, and even within, countries depending on resources and the needs of local populations. Such care and support services may include post-test clubs, PLWHA support groups, nutritional, social or psychological support services, and PMTCT for  pregnant women. This indicator aims to ensure that TB health care workers are aware of the needs of HIV-positive TB patients and are referring them to appropriate care and support services. This will capture only the first step in the referral process and gives no information on whether patients accept the need for referral, attend the service, or receive appropriate care and support if they do attend. Low rates of referral may indicate a lack of services in some areas or lack of awareness of the services available among TB staff. In settings where HIV and TB services are fully integrated and provided within the same site, it will be simple to record what additional care services they have been given.

Further information