Number and percentage of adults and children newly enrolled in HIV care who start on treatment for latent TB infection (isoniazid preventive therapy) among the total number of adults and children newly enrolled in HIV care over a given time period

Export Indicator

Number and percentage of adults and children newly enrolled in HIV care who start on treatment for latent TB infection (isoniazid preventive therapy) among the total number of adults and children newly enrolled in HIV care over a given time period
What it measures

Number of adults and children newly-enrolled in HIV care who started on treatment for latent TB infection (TB preventive therapy (TBPT), isoniazid preventative therapy(IPT)) expressed as a proportion of the total number of adults and children newly-enrolled in HIV care over a given time period.

Rationale

To ensure that eligible people living with HIV are given treatment for latent TB infection and thus to reduce the incidence of TB among people living with HIV.

Numerator

Number of adults and children newly enrolled (i.e. started) in HIV care (pre-ART and ART) who also start (i.e. given at least one dose) isoniazid preventive therapy treatment during the reporting period
HIV care includes pre-ART and ART.

Denominator

Number of adults and children newly enrolled (i.e. started) in HIV care during the reporting period.

Calculation

Numerator / Denominator

Method of measurement

The data needed for this indicator are collected from pre–antiretroviral therapy and antiretroviral therapy registers at the HIV care service sites, depending on where TB preventive therapy is to be administered.
People living with HIV should have their TB status assessed. Those found not to have evidence of active TB will be offered TB preventive therapy according to nationally determined guidelines. All those accepting TB preventive therapy and receiving at least the first dose of treatment should be recorded. This information is being recorded
in an extra column in the HIV care registers. Accurately predicting drug requirements for supply management requires the collection of more detailed information.

This information is being recorded through an extra column in the HIV care register and on the patient treatment card. Accurately predicting drug requirements for supply management requires collecting more detailed information: a pharmacy-based TB preventive therapy (isoniazid) register should record client attendance to collect further drug supplies (usually monthly). From this register, facilities would be able to report the number of new cases, continuing cases and completed cases on a quarterly basis.

If such information is collected routinely, the indicator of choice would be the number of HIV-positive clients completing treatment of latent TB infection as a proportion of the total number of HIV-positive clients started on such treatment. Pilot testing sites show that 10–50 percent of clients who test HIV-positive can be expected to start TB preventive therapy; some will not meet the eligibility criteria, some will decline to participate and some will drop out during the screening process. The proportion likely to start TB preventive therapy depends on the screening algorithm used (for example, using tuberculin skin test as a screening tool reduces the number that are eligible) and on the type of facility at which HIV diagnosis is made. Among hospital or clinical referrals, a greater proportion would be expected to be sick and thus ineligible for treatment of latent TB infection. Higher proportions would be expected
from sites linked to preventing mother-to-child transmission of HIV or stand-alone voluntary counseling and testing centers. Most programs would aim to exceed 60 percent starting isoniazid preventive therapy depending on the types of HIV testing and counseling facilities available.

Tool: pre–antiretroviral therapy registers. The data are collated on the cross-sectional quarterly reporting formats and reported to the national level. Ideally, all new clients should be registered by HIV care (pre–antiretroviral therapy) registers. In the situations in which new clients are enrolled directly onto antiretroviral therapy registers, these need to be included.

Frequency: collected continuously and reported and analyzed quarterly

WHO/UA: HIV treatment card and modified HIV care register.
The data needed for this indicator is collected from pre ART and ART registers at the HIV care service sites, depending on where TB preventive therapy (TBPT) is to be administered. HIV-positive clients should be screened for TB. Those clients found not to have evidence of active TB will be offered TBPT according to nationally determined guidelines. All those accepting TBPT and receiving at least the first dose of treatment should be recorded. This information is being recorded in an extra column in the HIV care registers. Accurately predicting drug requirements for supply management requires the collection of more detailed information.

Data Quality Control and Notes for the Reporting Tool
• Please provide any comments on whether the data you provide covers the entire country, or is from a selected sample (if so, please provide details on what the data represents, as well as any assumptions made to extrapolate the data to a national figure).

Measurement frequency

Continuously

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

Treatment of latent TB infection will reduce the incidence of developing TB disease in People living with HIV who are infected with TB but who have no active TB disease. To include clients who are given at least one dose is relatively easy, even in resource- limited settings. This information is the minimum necessary to ensure that TB preventive therapy is being offered to HIV-positive clients without evidence of active TB. However, unless further data are collected, this indicator provides no information about how many clients adhere to or complete the TB preventive therapy course. Much greater resources are required to collect more complete data on adherence or completion, but programmes may wish to undertake periodic studies to establish, for example, adherence rates, and the accuracy of the screening questionnaire.

Additional considerations:
A pharmacy based TB preventive therapy (INH) register should record client attendance to collect further drug supplies (usually monthly). From this register, facilities would be able to report the number of new, and continuing cases and treatment completion on a quarterly basis. If such information is collected routinely, the indicator of choice would be 'the number of HIV-positive clients completing treatment of latent TB infection, as a proportion of the total number of HIV-positive clients started on such treatment".
From pilot testing sites it is apparent that 10–50% of clients who test HIV-positive can be expected to start TB preventive therapy; some will not meet the eligibility criteria, some will decline and some will drop out during the screening process. The proportion likely to start TB preventive therapy depends on the screening algorithm used (for example, using tuberculin skin test as a screening tool reduces the number that are eligible) and also on the type of facility at which HIV diagnosis is made.
Among hospital or clinical referrals, more sick patients would be ineligible for treatment of latent TB infection. Higher proportions would be expected from sites linked to PMTCT or stand-alone VCT centres. Most programmes would aim for at least 50% of people newly enrolled in HIV care starting IPT during the year.

Data utilization: If low value, explore reasons why and compare disaggregated data with the national average to identify places needing special attention and reasons for suboptimal coverage. Explore further available data on completion of TBPT/IPT.

Further information