Number of people known to be on treatment 12 months after initiation of antiretroviral therapy

Background

Community HIV programs must work to ensure adherence to the daily schedule of antiretroviral therapy (ART) and lifelong retention in care in order to achieve the best possible patient outcomes for people living with HIV. Community-based decentralized care became the international model for ART scale-up to address the multiple complex factors that impact patient’s retention and adherence and influence access to quality care. The decentralization approach can be described as offering ART and related services in patient’s homes and through community-based distribution points. Community participation usually translates to promotion of retention and adherence through psychosocial support, peer support, and other prevention interventions relying on counseling and knowledge promotion. Community workers have been shown to enhance retention and adherence of ART among HIV-positive beneficiaries and are used to provide nutritional and food support, educational support, transport fees, and psychosocial support. Community programs also often institute community support groups to help beneficiaries better process their illness and develop coping strategies. Community workers have been used to distribute ART refills, provide ART and consultations at patient health clubs, establish ART distribution points run by people living with HIV, and organize patient-led community ART groups. When they engage in these activities, community workers can reduce the burden for both patients and health systems. This indicator can be used to monitor progress in their efforts to provide support to people living with HIV to adhere to treatment. The number of individuals who survived at 12 months is a very important piece of information that should be used by programs to look at ART survival over time.

Numerator

Number of adults and children who are still alive and on treatment at 12 months after initiating ART

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

Community workers can track this information through continuous monitoring of HIV-positive patient treatment and care and should coordinate with facilities, providers, and community programs to ensure adherence has been achieved by the end of their first year on ART. Beneficiaries do not need to have been using ART during the entire 12-month period, and this indicator includes those who may have stopped treatment at some point, as long as they are still on treatment by the twelfth month. Beneficiaries who have died, stopped treatment, or were lost to follow-up at month 12 should not be counted in the numerator. Community workers should track patients enrolled in treatment over the course of the year and check in after one year to ensure that patients are still on treatment. If the patients are on ART at one year from their initiation date, they should be counted towards this indicator. Those who transferred out of the program should not be counted towards this indicator. Those whose initiation date is unknown, but who transferred into the program, should not be counted towards this indicator.

Data source

This information can be tracked through behaviour change communication activity fact sheets, monthly community health worker reports, community monitoring forms for people living with HIV, monthly registration forms, and client, antenatal, and child profile diaries.

Disaggregation

• Age (<1, 1–4, 5–9, 10–14, 15–19, 20–24, 25–49, 50+)
• Sex
• Key population type (sex workers, men who have sex with men, people who inject drugs, transgender people)
• Pregnancy/lactation status

Data quality considerations

The overall number reported for this indicator should be equal to the sum of individuals in each disaggregation type. It is recommended to only use one type of age disaggregation throughout; overlap should be avoided.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

ART adherence                      

Category

Key Populations, Vulnerable Children, Prevention of Mother-to-Child Transmission, HIV Prevention

Data use case

To see a data use example for this indicator, please click below.

ART Retention and an mHealth Initiative in Mozambique 

References

Mukherjee, J. S., Barry, D., Weatherford, R. D., Desai, I. K., & Farmer, P. E. (2016). Community-based ART programs: Sustaining adherence and follow-up. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106499/

Hermann, K., Damme, W. V., Pariyo, G. W., Schouten, E., Assefa, Y., Cirera, A., & Massavon, W. (2009). Community health workers for ART in sub-Saharan Africa: Learning from experience—capitalizing on new opportunities. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672918/

The United States President’s Emergency Plan for AIDS Relief (PEPFAR). (2018). Monitoring, evaluation, and reporting (MER 2.0) indicator reference guide updated release (Version 2.2). Washington, DC: PEPFAR. Retrieved from  https://www.pepfar.gov/documents/organization/263233.pdf