Estimated antiretroviral therapy coverage among people living with HIV (%)

ART coverage among people living with HIV (%)

Percent

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  HIV infection. As the HIV epidemic matures, increasing numbers of people are reaching advanced stages of HIV infection. Over recent years WHO has issued various updates in the ARV guidelines. Under the 2013 WHO consolidated guidelines, roughly 85% people living with HIV would be eligible for treatment in 2013. For reasons of comparibility across countries and over time in the context of changing recommendations, this indicator relates to the number of people receiving ART as of proportion of the overall estimated number of people living with HIV.  The ranges around the levels of people living with HIV who received ART are based on the uncertainty bounds around the estimates of people living with HIV.

The percentage of adults and children with 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 HIV infection. Numerator: Number of adults and children with 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 HIV infection.

Age, Sex, Product type

Numerator: The number of adults and children with 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. 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. Denominator: The denominator is generated by estimating the number of people with  HIV infection. 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.  

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.Predominant type of statistics: predicted Numerator: The data on people receiving antiretroviral therapy are collected through a joint joint international monitoring and reporting process  with WHO, UNICEF and the UNAIDS Secretariat.  For this purpose a joint data tool has been developed that contains Global AIDS Progress Reporting (GARPR) indicators -- before 2012 known as UNGASS indicators -- as well as as well additional WHO/UNICEF Universal Access Health Sector indicators. Data are also 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. In order to facilitate collaboration at country level, the country offices of WHO, UNICEF and the UNAIDS Secretariat, work jointly with national counterparts and partner agencies to collate and validate data in a single collaborative consultation process. In addition, at least twice a year, international data reconciliation meetings are organized to review and validate data reported to WHO, UNICEF, the UNAIDS Secretariat, the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the United States President’s Emergency Plan for AIDS Relief. Where discrepancies are identified between data reported to the different organizations, follow-up letters are sent to UNAIDS, UNICEF and WHO country offices in order to liaise with national authorities to seek clarification and resolve discrepancies. 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).    

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 living with HIV. Although WHO and UNAIDS collect data on the number of people receiving antiretroviral therapy in high-income countries, as of 2007, no estimates have been established for most high-income countries. Aggregated coverage percentages are based solely on low- and middle-income countries.

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. The “2011 UN Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS” (General Assembly resolution 65/277), which was adopted at the United Nations General Assembly High Level Meeting on AIDS in June 2011, mandated UNAIDS to support countries to report on the commitments in the 2011 UN Political Declaration on HIV/AIDS.   In order to facilitate collaboration at country level, the country offices of WHO, UNICEF and the UNAIDS Secretariat, work jointly with national counterparts and partner agencies to collate and validate data in a single collaborative consultation process. In addition, at least twice a year, international data reconciliation meetings are organized to review and validate data reported to WHO, UNICEF, the UNAIDS Secretariat, the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the United States President’s Emergency Plan for AIDS Relief. Where discrepancies are identified between data reported to the different organizations, follow-up letters are sent to UNAIDS, UNICEF and WHO country offices in order to liaise with national authorities to seek clarification and resolve discrepancies. Adjustments to data for international comparability: WHO and UNAIDS strive to publish data representing the status as of December of each year. There is only a small number of countries that are unable to so, and therefore projections to end-of-year values are no longer necessary as countries that reported end-of-year values represented 98% of the total estimated number of people receiving ART at the end of 2012 in low- and middle-income countries.