Retention on antiretroviral therapy at 12 months
Progress in increasing survival among adults and children living with HIV by maintaining them on antiretroviral therapy.
Number of adults and children who are still alive and receiving antiretroviral therapy 12 months after initiating treatment in 2016
- 0-14 years for children and 15 years and older by sex (men and women) for adults
- Breastfeeding status when starting therapy
The numerator is defined as the number of adults and children alive and receiving antiretroviral therapy 12 months after starting treatment. For a comprehensive understanding of survival, the following data must be collected:
- The number of adults and children in the antiretroviral therapy start-up groups starting antiretroviral therapy at least 12 months before the end ofthe reporting period.
- The number of adults and children still alive and on antiretroviral therapy at 12 months after initiating treatment.
The denominator is the total number of adults and children in the antiretroviral therapy start-up groups who initiated antiretroviral therapy at any point during the 12 months before the beginning of the reporting period, regardless of whether they are still alive or have been lost, stopped therapy or died..
For example, the reporting period 1 January to 31 December 2017 will include everyone who started antiretroviral therapy during the 12-month period from 1 January to 31 December 2016. This includes everyone receiving antiretroviral therapy as well as those who died, stopped treatment or are lost to follow-up at month 12.
At the facility level, the number of adults and children receiving antiretroviral therapy at 12 months includes people transferring in at any point from the start of treatment to the end of the 12-month period and excludes people who have transferred out during this same period to reflect the net current cohort at each facility. In other words, at the facility level, people who have transferred out will not be counted in either the numerator or the denominator. Similarly, people who have transferred in will be counted in both the numerator and denominator. At the national level, the number of transferred-in people should match the number of transferred-out people. The net current cohort (people whose outcomes the facility is currently responsible for recording; that is, the number of people in the start-up group plus any transfers in and minus any transfers out) at 12 months should therefore equal the number in the start-up cohort group 12 months before.
This denominator may underestimate true survival, since some of the people lost to follow-up are alive. The number of people alive and on antiretroviral therapy (retention on antiretroviral therapy) in a treatment cohort is captured here.
Priority reporting is for aggregate survival reporting at 12months. If comprehensive cohort patient registries are available, then countries are encouraged to track retention on treatment at 24, 36 and 48 months and yearly thereafter. This will enable the comparison over time of survival on antiretroviral therapy. As it stands, identifying whether survival at 12 months increases or decreases over time is possible. However, cause cannot be attributed to these changes. For example, if survival at 12 months increases over time, this may reflect an improvement in care and treatment practices or earlier initiation of antiretroviral therapy. Retention at 12 months needs to be interpreted in relation to the baseline characteristics of the cohort when antiretroviral therapy started; mortality will be higher at sites at which people accessed antiretroviral therapy at a later stage of infection. Collecting and reporting data on survival over longer durations of treatment outcomes may therefore provide a better picture of the long-term effectiveness of antiretroviral therapy.
WHO guidance on treatment and care (http://www.who.int/hiv/topics/treatment/en/index.html).