Continuation of first-line regimen at 6, 12 and 24 months after initiating treatment

Export Indicator

Percentage of individuals who are still on treatment and who are still prescribed a standard first-line regimen after 6, 12 and 24 months from the initiation of treatment.
What it measures

This indicator measures the proportion of patients beginning first-line ART in a given cohort who are still on first-line therapy one year after ART begins.

Rationale

This indicator is important for tracking early warning signals of potential treatment failure. Unnecessary changes in regimen, treatment failure and intermittent ART are all associated with HIV drug resistance. The first year of treatment is most indicative of programme success in sustaining regimen continuity. Programmes in which > 80% of new patients are not on a first-line regimen after a year may be less likely to minimize the emergence of HIV drug resistance.

Numerator

Number of patients who are still on treatment and who are still prescribed a standard first-line regimen 12 months after initiating treatment.

Denominator

Total number of individuals initiating treatment on a first-line regimen in the ART start-up group in the previous 6, 12 and 24 months.

Calculation
Method of measurement

Patients beginning ART for the first time are identified through medical records. For each patient the drug regimen (drug list + dosage and frequency) is abstracted at the beginning of the first month and the last available prescriptions in the sixth, twelfth and twenty-fourth months are obtained from the treatment cards or medical records. Pharmacy records may also be used. If the person in question dies, is lost to follow-up, is transferred to another treatment programme, has stopped ART or has no drugs prescribed in month 6, 12 or 24, this should also be recorded.
Note: A person for whom a drug is substituted because of toxicity to a different first-line drug, is still considered to be on a first-line regimen.

Measurement frequency

Continuously

Disaggregation

Age group:

Education: N/A

Gender: N/A

Geographic location: N/A

Pregnancy status: N/A

Sector: N/A

Target: N/A

Time period: 6 months, 12 months, 24 months

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

Because this indicator does not measure temporary interruptions in ART it may overestimate the continuity of first-line ART. Where possible, information should also be collected on whether the drugs were picked up each month. The quality of this indicator depends on the quality of the medical records and the patient registry.

Further information