(VL_SUPPRESSION_NAT) Percentage of people living with HIV on ART with a suppressed viral load

Export Indicator

Percentage of people living with HIV on ART with a suppressed viral load
Rationale

Viral suppression is the third and last 90 of the global target, and the ultimate goal of the HIV treatment cascade. Patients on ART who achieve and maintain viral suppression minimize their risk of disease progression and HIV transmission. Viral suppression is a critical quality of service quality; unsuppressed viral load can be indicative of suboptimal treatment adherence, and can lead to the development and spread of drug resistance.

This indicator is harmonized with GARPR indicator 4.6 (https://aidsreportingtool.unaids.org/static/docs/GARPR_Guidelines_2016_E...)

Numerator

Number of people living with HIV and on ART [in the reporting period] who have a suppressed viral load (<1000 copies/mL)

Denominator

TX_CURR_NAT

Method of measurement

Numerator: The numerator can be generated by counting the number of adults and children receiving antiretroviral therapy at the end of the reporting period. Count the patient if, during the reporting months, viral load has been recorded and is <1000 copies/mL. For countries with other thresholds (e.g. undetectable <50 copies/ml or <400 copies/ml), preliminary evidence from several studies suggests the proportion of those with 50 copies/ml or above and less than 1000 copies/ml is small, so no adjustment is required. The testing threshold value should be reported in the narrative for countries with thresholds other than <1000 copies/ml.

Viral-load testing should be routine rather than episodic; for example, when treatment failure is suspected. If multiple viral-load tests are done annually for a person, only the last routine test result should be reported. Results from episodic viral loads should not be reported. If viral-load testing coverage is less than 75% of those receiving antiretroviral therapy in the reporting year, results should be interpreted with caution.

Tools for measuring viral load may vary across countries. Routine viral-load suppression tests from clinical and program data should be reported where available. In countries where such data are not available, results from HIV population-based surveys or drug-resistance surveys based on a random sample of people on antiretroviral therapy may be reported. Countries should report the source of the numerator and denominator data, and data from both sources should be reported if available, although clinical and program data are preferred. If results from a survey are used, that should be included when reporting.

Where clinical and program data are available from routine monitoring systems, results will be recorded in patient files or in a laboratory system. Data should be deduplicated where patients receive multiple viral-load tests in a year. If an HIV population-based or drug-resistance survey is used in place of routine program monitoring data, measurement of viral load should be done for the entire population of HIV- positive individuals where ARV is detected in specimens. Selfreported treatment status has been shown to be of limited quality. Therefore, viralload estimates among those who report receiving antiretroviral therapy should not be used.

Measurement frequency

Annually.

Explanation of the numerator

Disaggregation:

Disaggregated data is required. If data is available use the Age/Sex disaggregate, if not available use the Sex disaggregate. Do not enter both.

- Sex: Male, Female

- Coarse Age/Sex Disag: Female<15, Male <15, Female 15+, Male 15+

Explanation of the denominator

(see TX_CURR_NAT/SUBNAT for more details)

TX_CURR_NAT Denominatoris not collected as part of indicator, but rather is calculated as TX_CURR_NAT Numerator.

Further information

Subnational reporting:

Subnational data will not be collected for FY16, but subnational collection will start for FY17 data collection.

Entered by

USG PEPFAR team

Narratives

Narratives should include information on how the National estimates have been derived for both results and targets.

Targets

Host country teams often set targets by OU level. Targets should aligned with the 90-90-90 UNAIDS HIV response initiative.

If the host country does not develop targets for this indicator, then for planning purposes, data should be entered that includes MOH results from the previous reporting with the PEPFAR planned targets (at the least).