The indicator has been measured using a standard question since late 1990s. The question used is easy to implement and understand. Use of standardized data collection and analysis methods, which allow for cross-country comparisons, enhance the usefulness of the indicator for measuring variations across countries and changes over time.
This indicator assesses progress in changing gender norms about women’s roles, and provides an indication of the level of gender equality. This means that an increase in women’s direct participation in decisions about their own health care is reflective of a decline in gender inequality—which is one of the structural factors driving the HIV epidemic. Due to the fact that this indicator monitors change in norms, it can be expected to change only slowly over time, and would not be directly linked to level of programming. It should be analyzed together with other indicators looking at changes in unequal gender norms, gender relations at the household and community level, women’s legal and customary rights, gender inequalities in access to health care, education, and economic and social resources, and male involvement in reproductive and child health.
This indicator is based on a question put to respondents in a survey, which means it is self- reported. Further, since the question is asked only to currently married women, it is more directly a manifestation of norms within marriage; however, such norms are likely to be reflective of gender inequality in the society as a whole.

The strength of this indicator is that it allows countries to monitor the extend to which HIV infected patients are being screened for hepatitis B – an intervention that is critical for assessing further needs related to the
management of hepatitis C. Presence of HCV a/b provides information on HIV/HCV co-infection rates, informs clinicians on need for further clinical and laboratory evaluation and treatment.

Additional considerations: Additional information regarding the number of adults and children enrolled in HIV care and screened for hepatitis C, who were diagnosed with hepatitis C during the reporting year is also requested as part of this indicator. This data allows evaluating access to treatment among those who need it.

Data utilization: Look at trends over time. Useful information for clinical management and quality control in patient management.

Timely enrolment into HIV care (shortly after acquiring infection) allows timely initiation and subsequent monitoring of ART and management of other co-morbidities and conditions that contribute to the mortality among PLHIV, in
particular, drug-dependence, TB, viral hepatitis B and C. Enrolment into HIV care is therefore an important part of HIV management and should expand as needed to all population groups in need of care to meet universal access targets.

This indicator can further serve as the denominator for other indicators, such as the number of people receiving and needing ART and patients co-infected with TB or viral hepatitis who need screening, treatment and care for their condition.

Data utilization: Look at trends over time. Although disaggregation is not required for this indicator, disaggregated data,by geographical areas in the country (if available), is useful for internal analysis of enrolment into HIV care among diagnosed and registered PLHIV.

The continuation of ART is mostly related to survival (but also willingness to continue treatment). Survival might reflect the services offered but also depends on the baseline characteristics of the IDU patients started on ART. Clinical, immunological and virological staging are independent predictors of survival under ART. For injecting drug users, various underlying health conditions may additionally affect survival rates. Baseline characteristics of the cohort of patients should help in interpreting the results and in comparing ART sites.

Additional considerations: In countries where this indicator is not produced in all ART sites but in a sub-set of
facilities, data should be interpreted keeping in mind the representativeness.

Data utilization: Note any particularly low coverage and use the data to assess the reasons behind it. Try to get data on the distribution of those who are no longer on ART: dead, stopped, loss to follow up. If data are available, try to assess loss to follow-up population to see if they are likely to be dead, stopped, or transferred out. Compare cohorts. See also indicators EUR3 and EUR 5.

OST has been documented as an effective intervention to improve pregnancy outcome, including reduced rates of neonatal morbidity and mortality. Due to stigma and discrimination of IDU women, some of them could under report their injecting drug use, which may in turn have an impact on the indicator and overestimate coverage with OST.

Data utilization: This indicator will help to monitor trends and access of IDU pregnant HIV positive women to OST.

Despite national policy, CTX prophylaxis is not always fully implemented. In addition low coverage might reflect potential bottlenecks in the system such as poor management of CTX supply, poor data collection and inadequate distribution system.

Additional considerations: This indicator that reflects coverage should also be interpreted in view of the
national recommendations for CTX.

Data utilization: General idea of whether those who require CTX are receiving it. Explore disaggregated value to see whether there are patterns at individual facility of a sub-national level (e.g. stock outs in specific places) which can be addressed.

The existence of a written infection control policy that addresses TB and is consistent with international guidelines is the first basic step in ensuring TB infection control in health-care facilities providing (ART) services for people living
with HIV. However, the existence of a policy does not mean that it is effectively implemented. Further inquiry will be needed to establish whether the infection control policy is implemented and adhered to. Analysis of policy involves
subjective judgment, which can limit its use in cross-national comparisons and for capturing trends over time. This indicator goes a step beyond measuring the simple existence of an infection control policy by defining the standards that must be met in order for there to be an acceptable practice that addresses the issue of control of TB infection in health-care facilities providing (ART) services for people living with HIV according to international guidelines -thus eliminating some, though not all, subjective judgment.

Additional considerations: Responsibility: HIV programmes

Data utilization: 100% target; all health facilities that offer antiretroviral therapy should have implemented TB infection control to prevent the transmission of TB from person to person

Other References: Guide to monitoring and evaluation for collaborative TB/HIV activities available at:
http://whqlibdoc.who.int/publications/2009/9789241598194_eng.pdf

This indicator provides valuable information about the availability of ART services in health facilities, but it does not capture information about the quality of services provided. Antiretroviral therapy itself is complex, and it should be delivered as part of a package of care interventions, including the provision of cotrimoxazole prophylaxis, the management of opportunistic infections and comorbidities, nutritional support and palliative care. Simple monitoring of ART availability does not ensure that all ART-related services are adequately provided to those who
need them. Nevertheless, it is important to know what percentage of health facilities provide ART services in order to plan for service expansion as needed to meet universal access targets.

Additional considerations
• One strategy to scale up ART services is to make ART available in more health facilities. This may be achieved by decentralizing ART services from tertiary facilities (e.g., hospitals) to primary or secondary-level health facilities. Greater availability of ART services provides crucial support to the goal of universal access to HIV treatment by 2010.
• Depending on the country's epidemic type, the denominator may not be as relevant if the HIV program strategy aims to target a limited number of sites to offer ART in.

Data utilization: To look at progress in the percentage of health facilities which provide antiretroviral therapy. Analyzing the data geographically and by type of health facilities, and triangulating the data with estimates of HIV density can provide insight into where there is a need to increase availability of ART services.

The continuation of ART is mostly related to survival (but also willingness to continue). Survival might reflect the services offered but also depends on the baseline characteristics of the patients started on ART. Clinical, immunological and virological staging are independent predictors of survival under ART. Baseline characteristics of the cohort of patients should help in interpreting the results and, in particular, comparing ART sites.

Additional considerations:
For the indicator at 12 months, the numerator does not require patients to have been on antiretroviral therapy continuously for the 12-month period. Patients who may have missed one or two appointments or drug pick-ups, and temporarily stopped treatment during the 12 months since initiating treatment but are recorded as still being on treatment at month 12 are included in the numerator. On the contrary, those patients who have died, stopped treatment or been lost to follow-up at 12 months since starting treatment are not included in the numerator.
This principle is similar when calculating the indicator at 24and 60 months.
In countries where this indicator is not produced in all ART sites but in a sub-set of facilities, data should be interpreted keeping in mind the representativeness.

Data utilization: Note any particularly low retention and assess reasons behind it, by analysing the distribution of those who are not on ART: dead, stopped, loss to follow up. If data is available, try to assess loss to follow-up population to see if they are likely to be dead, stopped, or transferred out. Compare cohorts.

The continuation of ART is mostly related to survival (but also willingness to continue). Survival might reflect the services offered but also depends on the baseline characteristics of the patients started on ART. Clinical, immunological and virological staging are independent predictors of survival under ART. Baseline characteristics of the cohort of patients should help in interpreting the results and, in particular, comparing ART sites.

Additional considerations:
For the indicator at 12 months, the numerator does not require patients to have been on antiretroviral therapy continuously for the 12-month period. Patients who may have missed one or two appointments or drug pick-ups, and temporarily stopped treatment during the 12 months since initiating treatment but are recorded as still being on treatment at month 12 are included in the numerator. On the contrary, those patients who have died, stopped treatment or been lost to follow-up at 12 months since starting treatment are not included in the numerator.
This principle is similar when calculating the indicator at 24and 60 months.
In countries where this indicator is not produced in all ART sites but in a sub-set of facilities, data should be interpreted keeping in mind the representativeness.

Data utilization: Note any particularly low retention and assess reasons behind it, by analysing the distribution of those who are not on ART: dead, stopped, loss to follow up. If data is available, try to assess loss to follow-up population to see if they are likely to be dead, stopped, or transferred out. Compare cohorts.