3 by 5, Millenium Development Goals (MDG), US President's Emergency Plan for AIDS Relief (PEPFAR), N/A, Universal Access (UA), Additional Recommended Indicators, 2009 UN General Assembly Special Session on HIV/AIDS (UNGASS)
Number of cases of sexually transmitted infections treated
Number of cases of sexually transmitted infections treated
The following sexually transmitted infections have been shown to be important co-factors for HIV
transmission or acquisition and should therefore be considered for the assessment: curable genital
ulcers, notably chancroid and syphilis; other curable sexually transmitted infections including Neisseria
gonorrhoeae and Chlamydia trachomatis, which may present as urethral discharge. Where treatment of
herpes viral infection is included as a part of national guidelines, assessment for appropriate genital ulcer
Similar types of behavior put people at risk for both sexually transmitted infections and HIV. People
with sexually transmitted infections may be at higher risk of acquiring or transmitting HIV infection
due to the co-factor effect of an existing sexually transmitted infection. Services for sexually transmitted
infections provide opportunities for comprehensive care that includes early treatment; counseling and
communication about behavior change and information for sexual partners; access to testing for HIV
infection; and an entry point into care programs for people living with HIV. Treating sexually transmitted
infections quickly and effectively reduces the possibility of further transmission of infection.
Number of cases of sexually transmitted infections (determined syndromically or
etiologically) identified at selected facilities that were treated
FrançaisNumber of circumcised clients experiencing at least one moderate or severe adverse event (AE) during or following surgery, within the reporting period
Number of circumcised clients experiencing at least one moderate or severe adverse event (AE) during or following surgery, within the reporting period
3 randomized controlled clinical trials in sub-Saharan Africa demonstrated a 60% reduction in risk of female-to-male HIV transmission among men randomized to receive circumcision (compared to uncircumcised controls). This evidence is supported by long-standing ecologic and observational data. Elective surgical male circumcision confers a partially protective effect against HIV acquisition for HIV-negative men at risk for acquiring HIV from HIV-infected female sexual partners, and may be particularly beneficial in generalized HIV epidemics and where HIV prevalence is high and male circumcision prevalence is low. Like all surgeries, male circumcision is not without risk, and the performance and reporting of safe MC services depends in part upon skill and quality of surgery, effectiveness of post-operative instructions, willingness or ability of the patient to follow post-operative instructions, suitability of the surgical candidate, level of CD4 count if HIV-positive, and the judgment of the healthcare personnel assessing AEs. Intra- and post-operative complications must be monitored to ensure maximization of the provision of safe, quality MC services, and in turn engender trust in communities and foster high demand for MC services.
Number of clients circumcised that experience (reporting back to the respective circumcising program) one or more moderate or severe AE(s) during the reporting period, according to the date of MC surgery, and disaggregated by severity (moderate and/or severe), timing of AE(s), and specific AE(s)
N/A
Programs are recommended to report the number clients experiencing moderate or severe adverse events to allow for monitoring of safe, quality service provision. Frequency and frequency of severity, of AEs above ‘an acceptable level’ is an indication of the need for investigation into causes and possible interventions. Further, disaggregation by timing of adverse event may inform planning of post-operative care considerations, particularly from mobile/remote services that may have limited availability following surgery. Disaggregation by specific type of AE may help determine the need for additional training to prevent or manage certain complications.
Reduction in Mother-to-child Transmission
Percentage of infants born to HIV-infected mothers who are infected
To assess progress towards eliminating mother-to-child HIV transmission.
In high-income countries, strategies such as antiretroviral therapy during pregnancy and following birth,
and the use of breastfeeding substitutes have greatly reduced the rate of mother-to-child HIV transmission. In low-income countries, signifi cant difficulties exist in implementing these strategies due to constraints in accessing, affording and using voluntary counselling and testing services, reproductive health, and maternal and child health services, which have integrated prevention of mother-to-child transmission interventions, including breast milk substitute (where this is part of the country’s policy on prevention of mother-tochild transmission). Nevertheless, substantial reductions in mother-to-child transmission can be achieved through approaches such as short-course antiretroviral prophylaxis.
Not applicable
Not applicable
This indicator focuses on prevention of mother-to-child transmission of HIV through increased provision
of antiretroviral medicines. The Spectrum HIV estimation modelling software takes into consideration the
type of antiretroviral regimen as well as additional factors that influence HIV transmission rates such as
infant feeding practices. For further information on Spectrum please consult the webpage of the UNAIDS/
WHO Estimates and Projections Reference Group listed below.
Generalized Epidemic: Indicator 17
Core Indicator 6, pg 18
Indicator 25, page 75
Indicator 25, page 75
Русский
EspañolHIV Treatment: Survival After 12 Months on Antiretroviral Therapy
Percentage of adults and children with HIV known to be on treatment 12 months after initiation of antiretroviral therapy
To assess progress in increasing survival among infected adults and children by maintaining them on antiretroviral therapy.
One of the goals of any antiretroviral therapy programme is to increase survival among infected individuals. As provision of antiretroviral therapy is scaled up in countries around the world, it is also important to understand why and how many people drop out of treatment programmes. These data can be used to demonstrate the effectiveness of those programmes and highlight obstacles to expanding and improving them.
Number of adults and children who are still alive and on antiretroviral therapy at 12 months after initiating treatment
Explanation of the numerator:
The numerator requires that adult and child patients must be alive and on antiretroviral therapy at 12 months after their initiation of treatment. For a comprehensive understanding of survival, the following data must be collected:
• http://www.unaids.org/en/HIV_data/Methodology/default.asp Number of adults and children in the antiretroviral therapy start-up groups initiating therapy at least 12 months prior to the end of the
reporting period;
• Number of adults and children still alive and on antiretroviral therapy at 12 months after initiating treatment.
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.
For example, for those patients who started antiretroviral therapy in May 2005, if at any point during the period May 2005 to May 2006 these patients die, are lost to follow-up (and do not return), or stop
treatment (and do not restart), then at month 12 (May 2006), they are not on antiretroviral therapy, and not included in the numerator. Conversely, a patient who started antiretroviral therapy in May 2005
and who missed an appointment in June 2005, but is recorded as on antiretroviral therapy in May 2006 (at month 12) is on antiretroviral therapy and will be included in the numerator. What is important is
that the patient who has started antiretroviral therapy in May 2005 is recorded as being alive and on therapy after 12 months, regardless of what happens from May 2005 to May 2006.
Total number of adults and children who initiated antiretroviral therapy who were expected to achieve 12-month outcomes within the reporting period, including those who have died since starting
therapy, those who have stopped therapy, and those recorded as lost to follow-up at month 12.
Explanation of denominator:
The denominator is the total number of adults and children in the antiretroviral therapy start-up groups who initiated therapy at any point during the 12 months prior to the beginning of the reporting period,
regardless of their 12-month outcome. For example, for the reporting period 1 January to 31 December 2007, this will include all patients who started antiretroviral therapy during the 12-month period from
1 January to 31 December 2006. This includes all patients, both those on antiretroviral therapy as well as those who are dead, have stopped treatment or are lost to follow-up at month 12.
At the facility level, the number of adults and children on antiretroviral therapy at 12 months includes patients who have transferred in at any point from initiation of treatment to the end of the 12-month period
and excludes patients who have transferred out during this same period to refl ect the net current cohort at each facility. In other words, at the facility level, patients who have transferred out will not be counted
either in the numerator or the denominator. Similarly, patients who have transferred in will be counted in both the numerator and denominator.
At the national level, the number of transferred-in patients should match the number of transferred-out patients. Therefore, the net current cohort (the patients whose outcomes the facility is currently
responsible for recording—the number of patients in the start-up group plus any transfers in, minus any transfers out) at 12 months should equal the number in the start-up cohort group 12 months prior.
Using this denominator may underestimate true “survival”, since a proportion of those lost to follow-up
are alive. The number of people alive and on antiretroviral therapy (i.e. retention on antiretroviral therapy)
in a treatment cohort is captured here.
Priority reporting is for aggregate survival reporting. If comprehensive cohort patient registries are
available then it is encouraged for countries to track retention on treatment at 24, 36, and 48 months
and yearly thereafter. This will enable comparison over time of survival on antiretroviral therapy. As it
stands, it is possible to identify whether survival at 12 months increases or decreases over time. However, it is not possible to attribute cause to these changes. For example, if survival at 12 months increases over time, this may reflect an improvement in care and treatment practices or earlier initiation of antiretroviral therapy. The retention on antiretroviral therapy at 12 months therefore needs to be interpreted in view of the baseline characteristics of the cohort of patients at the start of antiretroviral therapy: mortality will be higher in sites where patients accessed antiretroviral therapy at a later stage of infection. Therefore, collection and reporting of survival over longer durations of treatment outcomes may provide a better picture of the long-term effectiveness of antiretroviral therapy.
Generalized Epidemic: Indicator 16
Recommended Indicator 1, pg 14
Core Indicator 10, pg 19
Core Indicator 9, pg 27
Indicator 24, page 72
Indicator 24, page 72
Most-at-risk Populations: Reduction in HIV Prevalence
Percentage of most-at-risk populations who are HIV-infected
To assess progress on reducing HIV prevalence among most-at-risk populations
Most-at-risk populations typically have the highest HIV prevalence in countries with either concentrated
or generalized epidemics. In many cases, prevalence among these populations can be more than double the prevalence among the general population. Reducing prevalence among most-at-risk populations is a critical measure of a national-level response to HIV. This indicator should be calculated separately for each population that is considered most-at-risk in a given country: sex workers, injecting drug users, men who have sex with men.
Note: countries with generalized epidemics may also have a concentrated subepidemic among one or
more most-at-risk population. If so, it would be valuable for them to calculate and report on this indicator
for those populations.
Number of members of most-at-risk population who test positive for HIV
Number of members of most-at-risk population tested for HIV
Due to diffi culties in accessing most-at-risk populations, biases in serosurveillance data are likely to be far more significant than in data from a more general population, such as women attending antenatal clinics. If there are concerns about the data, these concerns should be reflected in the interpretation.
An understanding of how the sampled population(s) relate to any larger population(s) sharing similar risk behaviours is critical to the interpretation of this indicator. The period during which people belong to a most-at-risk population is more closely associated with the risk of acquiring HIV than age. Therefore, it is desirable not to restrict analysis to young people but to report on other age groups as well.
Trends in HIV prevalence among most-at-risk populations in the capital city will provide a useful indication of HIV-prevention programme performance in that city. However, it will not be representative of the situation in the country as a whole.
The addition of new sentinel sites will increase the samples representativeness and will therefore give a
more robust point estimate of HIV prevalence. However, the addition of new sentinel sites reduces the
comparability of values. As such it is important to exclude new sites from the calculation of this indicator
when undertaking trend analyses.
Revised guidelines on HIV surveillance on most-at-risk populations are currently being prepared by the
WHO/UNAIDS Global Working Group on STI/HIV Surveillance. For further information please refer
to: http://www.unaids.org/en/KnowledgeCentre/HIVData/Epidemiology/default.asp.
Concentrated / Low Prevalence Epidemic: Indicator 9
Indicator 23, page 70
Indicator 23, page 70
Reduction in HIV prevalence
Percentage of young people aged 15–24 who are HIV infected
To assess progress towards reducing HIV infection.
The goal in the response to HIV is to reduce HIV infection. As the highest rates of new HIV infections
typically occur in young adults, more than 180 countries have committed themselves to achieving major
reductions in HIV prevalence among young people—a 25% reduction in the most affected countries by
2005 and a 25% reduction globally by 2010.
Number of antenatal clinic attendees (aged 15–24) tested whose HIV test results are positive
Number of antenatal clinic attendees (aged 15–24) tested for their HIV infection status
HIV prevalence at any given age is the difference between the cumulative numbers of people that have
become infected with HIV up to this age minus the number who have died, expressed as a percentage of the total number alive at this age. At older ages, changes in HIV prevalence are slow to reflect changes in the rate of new infections (HIV incidence) because the average duration of infection is long. Furthermore, declines in HIV prevalence can refl ect saturation of infection among those individuals who are most vulnerable and rising mortality rather than behaviour change. At young ages, trends in HIV prevalence are a better indication of recent trends in HIV incidence and risk behaviour. Thus, reductions in HIV incidence associated with genuine behaviour change should first become detectable in HIV prevalence figures for 15–19-year-olds. Where available, parallel behavioural surveillance survey data should be used to aid interpretation of trends in HIV prevalence.
In countries where the age at which young people first have sexual intercourse is late and/or levels of
contraception use are high, HIV prevalence among pregnant women of 15–24 years of age will differ from that among all women in the age group.
This indicator (using data from antenatal clinics) gives a fairly good estimate of relatively recent trends in
HIV infection in locations where the epidemic is heterosexually driven. It is less reliable as an indicator
of HIV-epidemic trends in locations where most infections remain temporarily confined to most-at-risk
populations.
To supplement data from antenatal clinics, an increasing number of countries have included HIV testing
in population-based surveys. If a country has produced HIV prevalence estimates from survey data these
estimates should be included in the comments box for this indicator to allow for comparisons between
multiple surveys. If available, survey based estimates should be disaggregated by sex.
The addition of new sentinel sites will increase the samples representativeness and will therefore give a
more robust point estimate of HIV prevalence. However, the addition of new sentinel sites reduces the
comparability of values. As such it is important to exclude new sites from the calculation of this indicator
when undertaking trend analyses.
Generalized Epidemic: Indicator 15, page 50
Indicator 22, page 68
Indicator 22, page 68
Injecting Drug Users: Safe Injecting Practices
Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they injected
To assess progress in preventing injecting drug use-associated HIV transmission.
Safer injecting and sexual practices among injecting drug users are essential, even in countries where other modes of HIV transmission predominate, because: (i) the risk of HIV transmission from contaminated injecting equipment is extremely high; and (ii) injecting drug users can spread HIV (e.g., through sexual transmission) to the wider population.
Note: countries with generalized epidemics may also have a concentrated sub-epidemic among injecting drug users. If so, it would be valuable for them to calculate and report on this indicator for this population.
Number of respondents who report using sterile injecting equipment the last time they injected drugs
Number of respondents who report injecting drugs in the last month
Surveying injecting drug users can be challenging. Consequently, data obtained may not be based on a
representative sample of the national injecting drug user population being surveyed. If there are concerns that the data are not based on a representative sample, these concerns should be refl ected in the interpretation of the survey data. Where different sources of data exist, the best available estimate should be used. Information on the sample size, the quality and reliability of the data, and any related issues should be included in the report submitted with this indicator.
The extent of injecting drug use-associated HIV transmission within a country depends on four factors:
(i) the size, stage and pattern of dissemination of the national AIDS epidemic; (ii) the extent of injecting
drug use; (iii) the degree to which injecting drug users use contaminated injecting equipment; and (iv) the patterns of sexual mixing and condom use among injecting drug users and between injecting drug users and the wider population. This indicator provides information on the third factor.
To maximize the utility of these data, it is recommended that the same sample used for the calculation of
this indicator be used for the calculation of the other indicators related to these populations.
Indicator 21, page 65
Indicator 21, page 65
Injecting Drug Users: Condom Use
Percentage of injecting durg users reporting the use of a condom the last time they had sexual intercourse
To assess progress in preventing sexual transmission of HIV.
Safer injecting and sexual practices among injecting drug users are essential, even in countries where other modes of HIV transmission predominate, because: (i) the risk of HIV transmission from contaminated injecting equipment is extremely high; and (ii) injecting drug users can spread HIV (e.g. through sexual transmission) to the wider population.
Note: countries with generalized epidemics may also have a concentrated subepidemic among injecting
drug users. If so, it would be valuable for them to calculate and report on this indicator for this population.
Number of respondents who reported that a condom was used the last time they had sex
Number of respondents who report having injected drugs and having had sexual intercourse in the last month
Surveying injecting drug users can be challenging. Consequently, data obtained may not be based on a
representative sample of the national injecting drug user population being surveyed. If there are concerns
that the data are not based on a representative sample, these concerns should be refl ected in the interpretation of the survey data. Where different sources of data exist, the best available estimate should be used. Information on the sample size, the quality and reliability of the data, and any related issues should be included in the report submitted with this indicator.
The extent of injecting drug use-associated HIV transmission within a country depends on four factors:
(i) the size, stage and pattern of dissemination of the national AIDS epidemic; (ii) the extent of injecting
drug use; (iii) the degree to which injecting drug users use contaminated injecting equipment; and (iv) the patterns of sexual mixing and condom use among injecting drug users and between injecting drug users and the wider population. This indicator provides partial information on the fourth factor.
To maximize the utility of these data, it is recommended that the same sample used for the calculation of
this indicator be used for the calculation of the other indicators related to these populations.
Indicator 20, page 63
Indicator 20, page 63
Men Who Have Sex with Men: Condom Use
Percentage of men reporting the use of a condom the last time they had anal sex with a male partner
It measures progress in preventing exposure to HIV among men who have unprotected anal sex with a male partner.
Condoms can substantially reduce the risk of the sexual transmission of HIV. Consequently, consistent and correct condom use is important for men who have sex with men because of the high risk of HIV transmission during unprotected anal sex. In addition, men who have anal sex with other men may also have female partners, who could become infected as well. Condom use with their most recent male partner is considered a reliable indicator of longer-term behaviour.
Note: countries with generalized epidemics may also have a concentrated subepidemic among men who have sex with men. If so, it would be valuable for them to calculate and report on this indicator for this population.
Number of respondents who reported that a condom was used the last time they had anal sex
This includes both regular and non-regular partners, and both paid and unpaid sex. As with all indicators this indicator only provides a limited piece of information. For a comprehensive assessment of patterns of risk associated with male to male sex further information is needed, including information on the types and numbers of partners and whether the individual is the receptive or insertive partner.
Number of respondents who reported having had anal sex with a male partner in the last six months
For men who have sex with men, condom use at last anal sex with any partner gives a good indication of overall levels and trends of protected and unprotected sex in this population. This indicator does not give any idea of risk behaviour in sex with women among men who have sex with both women and men.
In countries where men in the subpopulation surveyed are likely to have partners of both sexes, condom
use with female as well as male partners should be investigated. In these cases, data on condom use should always be presented separately for female and male partners.
This indicator asks about male-to-male sex in the past six months. If you have data available on another
time period, such as the last 3 or 12 months, please include this additional data in the comments section of the reporting tool.
Surveying men who have sex with men can be challenging. Consequently, data obtained may not be based on a representative sample of the national, most-at-risk population being surveyed. If there are concerns that the data are not based on a representative sample, these concerns should be reflected in the interpretation of the survey data. Where different sources of data exist, the best available estimate should be used. Information on the sample size, the quality and reliability of the data, and any related issues should be included in the report submitted with this indicator.
To maximize the utility of these data, it is recommended that the same sample used for the calculation of
this indicator be used for the calculation of the other indicators related to these populations.
Sexual Behaviour Indicator 7, pg 88
Concentrated / Low Prevalence: Indicator 7, page 65
Indicator 19, page 61
Indicator 19, page 61
Sex Workers: Condom Use
Percentage of female and male sex workers reporting the use of a condom with their most recent client.
It measures progress in preventing exposure to HIV among sex workers through unprotected sex with clients.
Various factors increase the risk of exposure to HIV among sex workers, including multiple, non-regular
partners and more frequent sexual intercourse. However, sex workers can substantially reduce the risk of HIV transmission, both from clients and to clients, through consistent and correct condom use.
Note: Countries with generalized epidemics may also have a concentrated subepidemic among sex workers. If so, it would be valuable for them to calculate and report on this indicator for this population.
Number of respondents who reported that a condom was used with their last client
Number of respondents who reported having commercial sex in the last 12 months
Condoms are most effective when their use is consistent, rather than occasional. The current indicator
will provide an overestimate of the level of consistent condom use. However, the alternative method of
asking whether condoms are always/sometimes/never used in sexual encounters with clients in a specified period is subject to recall bias. Furthermore, the trend in condom use in the most recent sexual act will generally reflect the trend in consistent condom use.
This indicator asks about commercial sex in the past twelve months. If you have data available on another time period, such as the last 3 or 6 months, please include this additional data in the comments section of the reporting tool.
Surveying sex workers can be challenging. Consequently, data obtained may not be based on a representative sample of the national, most-at-risk population being surveyed. If there are concerns that the data are not based on a representative sample, these concerns should be refl ected in the interpretation of the survey data. Where different sources of data exist, the best available estimate should be used. Information on the sample size, the quality and reliability of the data, and any related issues should be included in the report submitted with this indicator.
To maximize the utility of these data, it is recommended that the same sample used for the calculation of
this indicator be used for the calculation of the other indicators related to these populations.
Sexual Behaviour Indicator 5, pg 85
Concentrated / Low Prevalence Epidemic: Indicator 6, page 64
Indicator 18, page 59
Indicator 18, page 59
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