(TX_PVLS) Percentage of ART patients with a viral load result documented in the medical record and/or laboratory information systems (LIS) within the past 12 months with a suppressed viral load (<1000 copies/ml)

Export Indicator

Percentage of ART patients with a viral load result documented in the medical record and/or laboratory information systems (LIS) within the past 12 months with a suppressed viral load (<1000 copies/ml)
What it measures

This indicator monitors the proportion of documented viral load tests from adult and pediatric ART patients with a suppressed result (<1,000 copies/ml), allowing ART programs to monitor individual and overall programmatic response to ART as measured by virologic suppression. Comparison of the denominator for this indicator with the result for TX_CURR can be used to estimate viral load testing coverage supported by PEPFAR.

Numerator

Number of adult and pediatric patients on ART with suppressed viral load results (<1,000 copies/ml) documented in the medical records and /or supporting laboratory results within the past 12 months

Denominator

Number of adult and pediatric ART patients with a viral load result documented in the patient medical record and /or laboratory records in the past 12 months.

Calculation

This will be collected only at Q4/APR

Method of measurement

This indicator should be collected from the clinical source to assure unduplicated patient counting and receipt of results to inform patient care. Information should come from electronic systems (EMR) if possible. Where electronic systems do not exist patient registers can be used to count patients and VL collected/sent VL test (denominator) or VL results (numerator). If the standard registers or reports do not contain all the required information, individual patient files should be reviewed. To determine if a lab test was collected/sent additional supporting information for this indicator can be obtained from standard laboratory information systems (including electronic systems or paper-based registries or logbooks), but the viral load test submission and result must be able to be linked to specific patient.

NOTE: IF the patient file does not include this information (collected/sent VL test or VL results) but the information was reported from the laboratory information system; then it is strongly recommended that IP ensure that this information is transcribed to the patient file for improved quality care and treatment services.

This indicator should be reported for all PEPFAR supported treatment sites (reported TX_CURR and TX_NEW) with VL monitoring to promote site level use and reporting of patient viral suppression information. If a PEPFAR supported treatment site has not conducted any viral load testing, a 0 should be entered for both the denominator, as well as the numerator. Where more than one result is available for the reporting period, the most recent result should be reported. If viral load sample has been sent for testing, but no result has been recorded, this should not be included in the numerator or denominator of this indicator. Programs should describe the method(s) of data collection in their APR narratives, along with describing methodology for de-duplication of results.

How to review for data quality:

 Denominator ≥ Numerator

- The number of viral load tests performed from adults and children on ART must be greater than or equal to the number of viral load tests from adult and pediatric ART patients with a viral load <1,000 copies/ml.

 Numerator ≥ subtotal of each disaggregation

- The total number of viral load tests from adult and pediatric ART patients with a viral load <1,000 copies/ml should be greater than or equal to the sum of all of the disaggregation by age/sex, pregnancy/breastfeeding status, and test indication.

Reporting Level

Site level, facility only

Measurement frequency

Report 12 months of results at Q4

Disaggregation

Numerator (Required):

Number of adults and pediatric patients on ART with suppressed viral load results (<1,000 copies/ml) documented in the medical records and /or laboratory records/syste ms within the past 12 months

Indication (Required)

Routine, Targeted, Not Documented

Pregnant/Brea st Feeding Indication (Required)

Pregnant Routine; Breastfeeding Routine; Pregnant Targeted; Breastfeeding Targeted

Age/Sex/Indic ation (Fine Disaggregate) (Required) 

<1 Routine, 1-9 Routine, 10-14 M Routine, 10-14 F Routine, 15-19 M Routine, 15-19 F Routine, 20-24 M Routine, 20-24 F Routine, 25-49 M Routine, 25-49 F Routine, 50+ M Routine, 50+ F Routine, <1 Targeted, 1-9 Targeted, 10-14 M Targeted, 10-14 F Targeted, 15-19 M Targeted, 15-19 F Targeted, 20-24 M Targeted, 20-24 F Targeted, 25-49 M Targeted, 25-49 F Targeted, 50+ M Targeted, 50+ F Targeted;

Age/Sex/Indic ation (Coarse Disaggregate) (Conditional)

<15 M Routine, 15+ M Routine, <15 F Routine, 15+F Routine, <15 M Targeted, 15+ M Targeted, <15 F Targeted, 15+F Targeted

Description of Disaggregate

Routine; Refers to viral load tests obtained at standard intervals following ART initiation to monitor virologic response to ART (Timing is dependent on the National guidelines, but should be recommended to occur at least annually).

Targeted; refers to viral load tests obtained based on a specific clinical indication, e.g., concern about disease progression or failure to respond to ART. This includes repeat viral loads done after a VL>1000.

Not documented; not indicated in the patient file, registry, or log book whether this test was targeted or routine.

This disaggregation should only be entered if finer age disaggregates are not available.

Denominator (Required):

Number of adult and pediatric ART patients with a viral load result documented in the patient medical record and /or laboratory records in the past 12 months 

Indication (Required)

Routine, Targeted, Not Documented

Pregnant/Brea st Feeding Indication (Required)

Pregnant Routine ; Breastfeeding Routine; Pregnant Targeted ; Breastfeeding Targeted

Age/Sex/Indic ation (Fine Disaggregate) (Required)

<1 Routine, 1-9 Routine, 10-14 M Routine, 10-14 F Routine, 15-19 M Routine, 15-19 F Routine, 20-24 M Routine, 20-24 F Routine, 25-49 M Routine, 25-49 F Routine, 50+ M Routine, 50+ F Routine, <1 Targeted, 1-9 Targeted, 10-14 M Targeted, 10-14 F Targeted, 15-19 M Targeted, 15-19 F Targeted, 20-24 M Targeted, 20-24 F Targeted, 25-49 M Targeted, 25-49 F Targeted, 50+ M Targeted, 50+ F Targeted; <1 Not documented, 1-9 Not documented, 10-14 M Not documented, 10- 14 F Not documented, 15-19 M Not documented, 15-19 F Not documented, 20-24 M Not documented, 20-24 F Not documented, 25-49 M Not documented, 25-49 F Not documented, 50+ M Not documented, 50+ F Not documented

Age/Sex/Indic ation (Coarse Disaggregate) (Conditional)

<15 M Routine, 15+ M Routine, <15 F Routine, 15+F Routine, <15 M Targeted, 15+ M Targeted, <15 F Targeted, 15+F Targeted; <15 M Not documented, 15+ M Not documented, <15 F Not documented, 15+F Not documented

Description of Disaggregate

Routine; Refers to viral load tests obtained at standard intervals following ART initiation to monitor virologic response to ART (Timing is dependent on the National guidelines, but should be recommended to occur at least annually).

Targeted; refers to viral load tests obtained based on a specific clinical indication, e.g., concern about disease progression or failure to respond to ART.

Not Documented; not indicated in the patient file, registry, or log book whether this test was targeted or routine.

This disaggregation should only be entered if finer age disaggregates are not available

Explanation of the numerator

If there is more than one VL test during the last 12 months, report the most recent test.

Further information

MER 1.0 to 2.0 Change

Revised Indicator combines TX_VIRAL and TX_UNDETECT. The indicator now requires the suppressed viral load result to be documented in the clinic patient record and only use the laboratory system for results if it can be linked back to the individual patient file. Age/Sex disaggregates align across the clinical cascade.

PEPFAR Support definition

Standard definition of DSD and TA-SDI used

Provision of key staff or commodities for PLHIV receiving ART include: the provision of key staff and/or commodities can include ongoing procurement of critical commodities, such as ARVs, or funding for salaries of HCW who deliver HIV treatment services. Staff who are responsible for the completeness and quality of routine patient records (paper or electronic) can be counted here; however, staff who exclusively fulfill MOH and donor reporting requirements cannot be counted.

Ongoing support for PLHIV receiving ART service delivery improvement includes: clinical mentoring and supportive supervision of staff at HIV sites providing ART, support for quality improvement activities, patient tracking system support, routine support of ART M&E and reporting, commodities consumption forecasting and supply management

DREAMS SNU Specific Guidance

None