Antiretroviral therapy coverage among people with advanced HIV infection (%)

Antiretroviral therapy coverage among people with advanced HIV infection (%)

Percent

As the HIV epidemic matures, increasing numbers of people are reaching advanced stages of HIV infection. Antiretroviral therapy (ART) has been shown to reduce mortality among those infected and efforts are being made to make it more affordable within low- and middle-income countries. This indicator assesses the progress in providing antiretroviral combination therapy to all people with advanced HIV infection.

The percentage of adults and children with advanced HIV infection currently receiving antiretroviral combination therapy in accordance with the nationally approved treatment protocols (or WHO/UNAIDS standards) among the estimated number of adults and children with advanced HIV infection.   Numerator: Number of adults and children with advanced HIV infection who are currently receiving antiretroviral combination therapy in accordance with the nationally approved treatment protocol (or WHO/UNAIDS standards) at the end of the reporting period Denominator: Estimated number of adults and children with advanced HIV infection

Sex, Age, Provider type (public/private)

Numerator The numerator can be generated by counting the number of adults and children who received antiretroviral combination therapy at the end of the reporting period. Antiretroviral therapy taken only for the purpose of prevention of mother-to-child transmission and post-exposure prophylaxis are not included in this indicator. HIV-infected pregnant women who are eligible for antiretroviral therapy and on antiretroviral therapy for their own treatment are included in this indicator. The number of adults and children with advanced HIV infection who are currently receiving antiretroviral combination therapy can be obtained through data collected from facility-based antiretroviral therapy registers or drug supply management systems. These are then tallied and transferred to cross-sectional monthly or quarterly reports which can then be aggregated for national totals. Patients receiving antiretroviral therapy in the private sector and public sector should be included in the numerator where data are available. Denominator The denominator is generated by estimating the number of people with advanced HIV infection requiring (in need of/eligible for) antiretroviral therapy. This estimation must take into consideration a variety of factors including, but not limited to, the current numbers of people with HIV, the current number of patients on antiretroviral therapy, and the natural history of HIV from infection to enrolment on antiretroviral therapy. A standard modelling method is recommended. The Estimation and Projection Package (EPP)* and Spectrum*, softwares have been developed by the UNAIDS/WHO Reference Group on Estimates, Models and Projections. Need or eligibility for antiretroviral therapy should follow the WHO definitions for the diagnosis of advanced HIV (including AIDS) for adults and children. (UNAIDS, 2009)

Outcome

WHO, UNAIDS and UNICEF are responsible for reporting data for this indicator at the international level, and have been compiling country specific data since 2003.   The data from countries are collected through three international monitoring and reporting processes. 1. Health sector response to HIV/AIDS (WHO/UNAIDS/UNICEF) 3. UNGASS Declaration of Commitment on HIV/AIDS (UNAIDS) Both processes are linked through common indicators and a harmonized timeline for reporting.    Estimating the numerator Data for the calculation of the numerator are compiled from the most recent reports received by WHO and/or UNAIDS from health ministries or from other reliable sources in the countries, such as bilateral partners, foundations and nongovernmental organizations that are major providers of treatment services.   Estimating the denominator The number of people who need antiretroviral therapy in a country is estimated using statistical modelling methods. In response to the emergence of new scientific evidence, in December 2009 WHO updated its antiretroviral therapy guidelines for adults and adolescents. According to the new guidelines, which were developed in consultation with multiple technical and implementing partners, all adolescents and adults, including pregnant women, with HIV infection and a CD4 count at or below 350 cells/mm3 should be started on antiretroviral therapy, regardless of whether or not they have clinical symptoms. Those with severe or advanced clinical disease (WHO clinical stage 3 or 4) should start antiretroviral therapy irrespective of CD4 cell count. In order to compare the impact of the new guildelines, both sets of needs for the year 2009 are included, i.e. estimated needs estimated based on a threshold for initiation of antiretroviral therapy with < 200 cells/mm3 (old guidelines) as well as < 350 cells/mm3 (new guidelines).   Estimating antiretroviral therapy coverage The estimates of antiretroviral therapy coverage presented here are calculated by dividing the estimated number of people receiving antiretroviral therapy as of December by the number of people estimated to need treatment in same year (based on UNAIDS/WHO methods). Predominant type of statistics: predicted  

Regional and global estimates are calculated as weighted averages of the country level indicator where the weights correspond to each country’s share of the total number of people needing antiretroviral therapy. Although WHO and UNAIDS collect data on the number of people receiving antiretroviral therapy in high-income countries, as of 2007, no need numbers have been established for these countries. Aggregated coverage percentages are based solely on low- and middle-income countries.

N/A

Annual

This indicator permits monitoring trends in coverage but does not attempt to distinguish between different forms of antiretroviral therapy or to measure the cost, quality or effectiveness of treatment provided. These will each vary within and between countries and are liable to change over time. The degree of utilization of antiretroviral therapy will depend on factors such as cost relative to local incomes, service delivery infrastructure and quality, availability and uptake of voluntary counseling and testing services, and perceptions of effectiveness and possible side effects of treatment. (UNAIDS, 2009) Latest country specific coverage for 2008 were not published as treatment guidelines have been revised, and the effects on treatment need for adults are currently being assessed.