Co-management of tuberculosis and HIV treatment

Export Indicator

Percentage of estimated HIV-positive incident tuberculosis (TB) cases that received treatment for both TB and HIV
What it measures

Progress in detecting and treating TB among people living with HIV

Rationale

TB is a leading cause of morbidity and mortality among people living with HIV, including those receiving antiretroviral therapy. Prompt TB treatment and early antiretroviral therapy are critical for reducing the mortality due to HIV-associated TB and must be the highest-priority activity for both the AIDS Programme and National TB Programme. A measure of the percentage of HIV-positive TB patients that access appropriate treatment for their TB and HIV is therefore very important.

 

Numerator

Number of HIV-positive new and relapse TB patients started on TB treatment during the reporting period who were already on antiretroviral therapy or started on antiretroviral therapy during TB treatment within the reporting year

Denominator

Estimated number of incident TB cases in people living with HIV

Calculation

Numerator/denominator

Method of measurement

For the numerator.: Facility antiretroviral therapy registers and reports; programme monitoring tools. Count the total number of HIV-positive new and relapse TB patients who were started on TB treatment (as recorded in the TB register) and antiretroviral therapy, or those already on antiretroviral therapy (as recorded in the antiretroviral therapy register). The information should be reconciled quarterly and annually with the TB registers in the relevant basic management units before consolidation and reporting.

For the denominator: Programme data and estimates of incident TB cases among people living with HIV. WHO calculates annual estimates of the number of incident TB cases in people living with HIV. The denominator estimates, provided by countries on notification and antiretroviral therapy coverage, become available only in August of the reporting year and do not need to be provided at the time of reporting. The estimates for 2017 are available at http://www.who.int/tb/country/data/download/en.

Measurement frequency

Data should be collected continuously at the facility level, reconciled with the TB registers and aggregated periodically, preferably monthly or quarterly, and reported annually. The most recent year for which data and estimates are available should be reported here.

Disaggregation
  • Sex.
  • Age (<15 and 15+ years).
  • Cities.
Strengths and weaknesses

Adequate detection and treatment of TB will prolong the lives of people living with HIV and reduce the community burden of TB. WHO provides annual estimates of the burden of TB among people living with HIV, based on the best available country estimates of HIV prevalence and TB incidence. All people living with HIV newly infected with TB should start TB treatment and antiretroviral therapy within eight weeks of starting TB treatment, regardless of CD4 count. The people with both HIV and TB with profound immunosuppression (such as CD4 counts less than 50 cells/mm3) should receive antiretroviral therapy within the first two weeks of initiating TB treatment. TB treatment should be started in accordance with national TB programme guidelines.

This indicator measures the extent to which collaboration between national TB and HIV programmes ensures that people living with HIV and TB are able to access appropriate treatment for both diseases. However, this indicator will be affected by low uptake of HIV testing, poor access to HIV care services and antiretroviral therapy and poor access to TB diagnosis and treatment. Separate indicators for each of these factors should be referred to when interpreting the results of this indicator.

It is important that those providing HIV care and antiretroviral therapy record TB diagnosis and treatment, since this information has implications for antiretroviral therapy eligibility and choice of antiretroviral regimen. It is therefore recommended that the date TB treatment starts be recorded in the antiretroviral register.

Further information
WHO policy on collaborative TB/HIV activities. Geneva: World Health Organization; 2012
 
Global tuberculosis report 2018. Geneva: World Health Organization; 2018 (http://www.who.int/tb/publications/global_report/en).ganization; 20178
 
A guide to monitoring and evaluation for collaborative TB/HIV activities: 2015 revision. Geneva: World Health Organization; 2015 (http://www.who.int/tb/publications/monitoring-evaluation-collaborative-t...).