The number of adults and children with advanced HIV infection who are currently receiving ART can be obtained through data collected from facility-based ART 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 ART in the private sector and public sector should be included in the numerator where data are available.  Data should be collected continuously at the facility level. This indicator should be disaggregated by sex and age (<15; 15+ years).

Data Source(s):

For the numerator: facility-based ART registers or drug supply management systems. For the denominator: HIV prevalence estimation models such as Spectrum.

Purpose:

This indicator should be reported at least annually to track trends in ART coverage. The WHO World Health Statistics (WHOSIS) website and the Global Health Observatory (GHO) website include this indicator as does the WHO, UNAIDS, UNICEF and The Global Fund three interlinked patient monitoring system (WHO, 2011; WHO et al., 2009). As the HIV pandemic matures, increasing numbers of people are reaching advanced stages of HIV infection. 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. ART should always be provided in conjunction with broader care and support services, including counseling for family caregivers (WHO et al., 2006). The proportion of people needing ART varies with the stage of the HIV epidemic and the cumulative coverage and effectiveness of ART among adults and children. The degree of utilization of ART 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.

Issue(s):

This indicator permits monitoring trends in coverage but does not distinguish between different forms of ART or measure the cost, quality or effectiveness of treatment provided. These will each vary within and between countries and are liable to change over time.

Gender Implications:

Women’s access to and utilization of HIV/AIDS treatment services may be limited by cultural gender norms that affect women’s mobility, exposure to media and HIV treatment information, women’s resources for health care services, as well as, the possible stigma associated with HIV treatment. The UNAIDS (2010) agenda for women, girls, and gender equality calls for national AIDS authorities and ministries of health to incorporate gender equality into HIV policies for the achievement of universal access to prevention, treatment, care and support for women.

References:

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. http://www.pepfar.gov/documents/organization/81097.pdf