(TB_PREV) Proportion of ART patients who completed a standard course of TB preventive therapy within the semiannual reporting period

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Proportion of ART patients who completed a standard course of TB preventive therapy within the semiannual reporting period
What it measures

This indicator measures the performance of HIV programs in scaling up TB preventive therapy, with the goal of preventing progression to active TB disease among PLHIV and decreasing ongoing TB transmission in this population. As part of a cascade from TX_CURR to TB screening (captured in TX_TB), this indicator will inform programs on the pace of scale-up, and the proportion will allow for monitoring of cohorts through completion of therapy. Disaggregates on type of therapy will inform programs on their relative use of different regimens, and the timing of ART will allow the clinical cascade to focus on those who are newly entering care, which will better demonstrate program performance, particularly in countries that have already provided TB preventive therapy for many of their PLHIV in care.

Numerator

Number of ART patients who completed a course of TB preventive therapy during the reporting period (for continuous IPT programs, this includes the patients who have completed the first 6 months of isoniazid preventive therapy (IPT))

Denominator

Number of ART patients who are expected to complete a course of TB preventive therapy during the reporting period (for programs using continuous IPT, this includes only the patients who are scheduled to complete the first 6 months of therapy)

Calculation

How to calculate annual total:

When analyzing this data in conjunction with data on TB screening for ART patients (TX_TB), it is preferred to analyze it as a snapshot indicator and use the result reported at Q4. However, one could analyze the TB_PREV numerator independently of other data and sum the results across Q2 and Q4 to calculate the total number of ART patients who completed a course of TB preventive therapy during the fiscal year.

Method of measurement

The numerator can be generated by counting the number of PLHIV on ART who are documented as having received at least six months of IPT or have completed another standard course of TB preventive therapy. This should include the patients who completed a shorter alternative course, such as 3 months of isoniazid and rifapentine (3HP), as well as those who are on prolonged or continuous IPT who have completed their first 6 months of therapy during the semiannual reporting period. Importantly, programs should ensure that patients on continuous therapy are counted only once, and not repeated in future calculations.

 
The denominator can be generated by counting the total number of patients who are scheduled to complete a course of TB preventive therapy (or at least 6 months of IPT for those who are on a prolonged or continuous regimen) in the semiannual reporting period.
 
For IPT:
 
• Patients who are taking a standard 6-month course of IPT would be expected to complete therapy if they started IPT in the previous reporting period; therefore, all patients who started IPT at any time in the previous 6-month reporting period (i.e., the 6 months before the start of the current reporting period) should be included in the denominator. The few patients who start and complete IPT in the same reporting would also be included.
• Patients who are taking prolonged (9- or 12-month) or continuous IPT would also be expected to complete the first 6 months of IPT if they started IPT in the previous reporting period; therefore, all patients who started prolonged or continuous IPT in the previous 6-month reporting period should be included. The few patients who start and complete 6 months of IPT in the same reporting would also be included.
 
For alternative regimens:
 
• Patients who are taking a 3-month regimen of isoniazid and rifapentine would be expected to complete therapy in this reporting period if they started on therapy at any time starting 3 months prior to the start of the current reporting period to 3 months prior to the end of the current reporting period; all such persons should be included in the denominator.
• Patients who are taking a 4-month course of rifampicin would be expected to complete therapy in this reporting period if they were started on therapy at any time starting 4 months prior to the start of the current reporting period to 4 months prior to the end of the current reporting period; all such persons should be included in the denominator.
 
These data elements can be collected from the ART register or from separate TB screening (presumptive TB) or IPT registers.

How to review for data quality: 

Only one disaggregation type is used for age (coarse disaggregations).
Data Element ≥ subtotal of each of the disaggregations.

Reporting Level

Facility

Measurement frequency

Reporting frequency:

Semi-Annually

Disaggregation

Numerator Disaggregations:

Disaggregate Groups:

1. Age/Sex by Type of TB Preventive Therapy (TPT) by ART Start: [Required]

Disaggregates:

1. • IPT by newly enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
• IPT by previously enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
• Alternative TPT regimen by newly enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
• Alternative TPT regimen by previously enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
 
 
Denominator Disaggregations:
 
Disaggregate Groups:
 
1. Age/Sex by Type of TB Preventive Therapy (TPT) by ART Start: [Required]
 
Disaggregates:
 
1. • IPT by newly enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
• IPT by previously enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
• Alternative TPT regimen by newly enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
• Alternative TPT regiment by previously enrolled on ART: <15 F/M, 15+ F/M, Unknown Age F/M
 
 
Disaggregate descriptions & definitions:
 
Type of TB Preventive Therapy (TPT) by ART Start Descriptions:
 
• IPT/Newly enrolled on ART: Among those who completed 6 months of IPT, the patients who started IPT and ART in the previous reporting period.
 
• IPT/Previously enrolled on ART: Among those who completed 6 months of IPT, the patients who started IPT in the previous reporting period, but who started ART prior to the previous reporting period (i.e., patients who were on ART prior to the reporting period when they started IPT).
 
• Alternative TPT regimen/Newly enrolled on ART: Among those who completed an alternative regimen (e.g., 3-month INH and rifapentine), the patients who started the regimen and ART in the current or the previous reporting period
 
• Alternative TPT/Previously enrolled on ART: Among those who completed an alternative regimen (e.g., 3-month INH and rifapentine), the patients who started the regimen in the current or the previous reporting period, but started ART prior to previous reporting period

 

Explanation of the numerator

The numerator can be generated by counting the number of PLHIV on ART who are documented as having received at least six months of IPT or have completed another standard course of TB preventive therapy.

Explanation of the denominator

The denominator can be generated by counting the total number of patients who are scheduled to complete a course of TB preventive therapy (or at least 6 months of IPT for those who are on a prolonged or continuous regimen) in the semiannual reporting period.

Further information

Indicator changes (MER 2.0 v2.2 to v2.3):

• Numerator disaggregates have been changed to capture Age/Sex by Type of TB preventive therapy (TPT) by ART Start.
• Denominator disaggregates have been changed to capture Age/Sex by Type of TB preventive therapy (TPT) by ART Start.

PEPFAR Support definition:

Standard definition of DSD and TA-SDI used.
 
Provision of key staff or commodities for routine HIV-related services includes: ongoing provision of critical re-occurring costs or commodities (such as ARVs, TB preventive therapy and diagnostic/screening tests) or funding of salaries or provision of Health Care Workers for HIV clinic services. Staff responsible for maintaining patient records in both HIV and TB clinics are included in this category however staff responsible for fulfilling reporting and routine M&E requirements are not included.
 
Ongoing support for patients receiving routine HIV-related services includes: training of HIV service providers, clinical mentoring and supportive supervision of staff at HIV sites, infrastructure/renovation of facilities, support of HIV service data collection, reporting, data quality, QI/QA of HIV services support, ARV and IPT consumption forecasting and supply management, support of lab clinical.
 
Guiding narrative questions: 
 
1. Roughly what proportion of all PLHIV on treatment have already completed TB preventive therapy prior to this reporting period?
 
2. If TB preventive therapy was not provided to all PLHIV in care (and for who active TB disease was ruled out), what are the main reasons for limited scale-up?
 
3. Roughly what proportion of patients who received TB preventive therapy were treated with the 6-month (or longer) isoniazid regimen?
 
4. If completion rates were less than 85%, what are the main reasons why?
 
5. If less than 80% of newly enrolled PLHIV who screened negative for TB disease were started on TPT, what are the main reasons why?

Data Visualization & Use Examples:

TB/HIV Prevention and Screening Cascade:

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