Impact of HIV prevention, care and treatment programmes
Recent efforts to scale up access to life-saving antiretroviral therapy, including the 2016 WHO guidelines that recommend treatment for all, should significantly reduce the number of people dying from AIDS-related causes, if these services are accessible and delivered effectively. The impact of the HIV response should be assessed by monitoring changes in AIDS-related mortality over time. This indicator, modified as the total number of people who have died from AIDS-related causes in the reporting period divided by the population (per 100 000), is also included in the WHO consolidated strategic information guidelines for HIV in the health sector.
Number of people dying from AIDS-related causes during the calendar year
Total population regardless of HIV status
Numerator/denominator times 100 000
The number of people dying from AIDS-related causes can be obtained using a variety of measures, including through a vital registration system adjusted for misreporting, as part of a facility- or population-based survey that may include verbal autopsy and through mathematical modelling using such tools as Spectrum. Modelling tools typically use demographic data, HIV prevalence from survey and surveillance, the number of people receiving antiretroviral therapy, HIV incidence and assumptions around survival patterns to estimate the number of people dying. In some instances, data from vital reporting systems and estimates of underreporting and misclassification also may be incorporated into these models to derive estimates of the number of AIDS-related deaths.
Age (<5, 5–14 and 15+ years).
The source of the estimate is requested. Countries providing the number of people dying from AIDS-related causes derived from a source other than Spectrum should provide any accompanying estimates of uncertainty around this number and upload an electronic copy of the report describing how the number was calculated.
Countries should preferably report a modelled estimate rather than one derived from their vital registration system unless this system has been recently evaluated as one of high quality. Users can now opt to use their Spectrum estimate or enter nationally representative population-level data. If Spectrum estimates are chosen, the values will be pulled directly from the software once the national file is finalized.
For countries with strong vital registration systems, changes in AIDS-related mortality estimates provide an accurate measure of the impact of prevention, care and treatment programmes. Even in these systems, periodic evaluation is useful to measure delays or underreporting and misclassification of the cause of death.
For countries that do not have strong systems in place, estimates of AIDS-related deaths are an important programme monitoring tool but subject to more uncertainty. In particular, information about survival patterns for those receiving or not receiving antiretroviral therapy is important. Estimates of AIDS-related deaths should be reported along with the ranges of uncertainty. The estimate will only be as reliable as the data entered into the models and the assumptions made in the model.
Consolidated strategic information guidelines for HIV in the health sector. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/164716/1/9789241508759_eng.pdf?...).
Spectrum software. Glastonbury (CT): Avenir Health; 2016 (http://www.avenirhealth.org/software-spectrum.php).