(HTS_TST) (including HTS_TST_POS) Number of individuals who received HIV Testing Services (HTS) and received their test results

How to collect:

Existing HTS registers, log books, and reporting forms already in use to capture HTS can be revised to include the updated disaggregation categories. Examples of data collection forms include client intake forms, activity report forms, or health registers such as HTS registers, health information systems and non-governmental organization records. Data for the numerator should be generated by counting the total number of individuals who received HTS and their test results. 

Note: Although several other MER indicators (see below) may report on the HIV status of individuals, actual testing of individuals must be reported under HTS_TST. Thus, any persons who are newly tested as part of the programs linked to the indicators listed below (i.e., PMTCT, TB, VMMC, Prevention services) must be reported under one of the HTS_TST modalities, unless otherwise indicated below.

• PMTCT_STAT (data from PMTCT_STAT auto-populates to HTS_TST PMTCT ANC1-Only modality)
• TB_STAT (data from TB_STAT auto-populates to HTS_TST TB modality)

• VMMC_CIRC (data from VMMC_CIRC auto-populates to HTS_TST VMMC modality)

• HTS_INDEX (data from HTS_INDEX auto-populates to HTS_TST Index modality)

• PrEP_CURR

• PP_PREV

• KP_PREV

• OVC_HIVSTAT

Importantly, if a site does not report on TB_STAT, VMMC_CIRC, or PMTCT_STAT, any HIV testing conducted in locations related to VMMC, PMTCT or TB should be reported under the ‘Other PITC’ modality of HTS_TST. 

For an individual to be counted under this indicator, that individual’s HIV diagnosis must be confirmed using a nationally validated testing algorithm. For example, an HIV-positive rapid HIV test performed at the community- or facility- level must be confirmed with a second test, which may be performed at the same site or at a different facility. If the confirmatory test is performed at a different facility, then this may entail follow-up by implementing partners to confirm the diagnosis before reporting on this indicator. The implementing partner who first identified and tested the individual should report on HTS_TST under the appropriate modality; however, that implementing partner must ensure that the diagnosis of the individual tested is confirmed. Only a confirmed diagnosis (positive or negative) counts under HTS_TST regardless of the modality used for reporting. Similarly, simply only confirming the diagnosis of an individual who has already been tested (as per the national testing algorithm) does not fulfill the requirements for reporting on HTS_TST regardless of the modality used. 

For children <1, only if serologic tests are used for diagnostic purposes should they be reported under HTS_INDEX. Serologic tests for screening infants should be excluded (including tests to look for HIV exposure at age 9 months or another time point). For example, if the partner/program uses serologic-based testing to confirm absence of HIV infection in infants <1-year-old who have not breastfed for at least 3 months prior to testing, you may use the HTS_INDEX <1 disaggregate to report negative diagnostic results for such cases. However, since diagnosis of HIV infection in infants is based on virologic and not serologic tests, the general expectation is not to see results in the “< 1” disaggregate of the HTS_INDEX indicator. HIV virologic testing of HIV-exposed infants should be counted under PMTCT_EID and PMTCT_HEI_POS.

Retesting for verification of HIV positive status before or at antiretroviral (ART) initiation should not be counted under HTS_TST since testing of this individual will have already been counted at the point of the initial diagnosis. Retesting for verification is primarily done as a quality assurance activity to avoid misdiagnosis and to ensure those initiated on ART are indeed HIV positive. Therefore, retesting for verification should only be performed for persons who have received an HIV diagnosis but have not yet been initiated on ART. While retesting for verification should not be recorded as HTS_TST or HTS_TST_POS, these data should nevertheless be tracked and rates of discordancy monitored. 

Key Populations (KPs): 

Provision of information (tested, tested positive, tested negative) on KPs (FSW, MSM, Transgender people, PWID, and people in prisons and other closed settings) who were tested and received their results should be reported under the KP disaggregates. However, the KP disaggregate is NOT an HTS_TST modality. All KP testing should be reported under the appropriate modality. For example, a community site keeps secure and safe records of all key populations tested at that site. This community site has determined it can report on the KP disaggregate in a safe and confidential way. Of the 100 individuals KPs who were tested and received their results (including confirmation of diagnosis) at this site, the community site reports 100 under the appropriate modality (in this case, VCT) AND reports 100 under the KP disaggregate. 

See Appendix A: Key Population Classification Document, to inform identification of key populations at HTS service delivery. However, reporting of key population disaggregation should be consistent with what is described under the KP_PREV “How to review for data quality” section on mutual exclusivity of an individual who falls under multiple key population categories (e.g., FSW who injects drugs). In such instances, the individual should only be reported in ONE key population disaggregation category to avoid double-counting.

Note: Both key population-specific and clinical partners should complete these disaggregations, but only if it is safe to maintain these files and report. Age and sex data on key populations receiving tests for recent infection will not be reported. Please refer to the KP_PREV indicator reference sheets for more information on working with KPs. 

The first priority of data collection and reporting of HTS among key populations must be to do no harm. These data must be managed confidentially to ensure the identities of individuals are protected and to prevent further stigma and discrimination of key populations. 

Note the misalignment of reporting frequency between HTS_TST [quarterly] and KP_PREV [semi-annually] and the differences in the process of de-duplication of individuals (HTS_TST is de-duplicated within the quarter, whereas KP_PREV is de-duplicated within the fiscal year). For example, if a KP is reached and tested more than once within the fiscal year, s/he will only be counted once under KP_PREV but could be counted multiple times under HTS_TST KP disaggregation during same the fiscal year if the KP was tested multiple times in different quarters. However, if a KP is tested multiple times within the same quarter, s/he should be deduplicated (i.e., only be counted once in the quarter). Please be cognizant of such limitations when interpreting KP_PREV, HTS_TST, and HTS_TST_POS cascade data by key populations.

Data Systems and Tools 

When developing or modifying existing monitoring and evaluation systems and tools to collect and report on this indicator, the following information should be considered (* designates data elements that are required for HTS_TST reporting in DATIM):

1. This indicator counts the number of individuals tested not the number of tests conducted. All efforts should be made to ensure data are collected on individuals tested vs. number of tests conducted through de-duplication. Within HTS registers, collecting data on the following variables should be considered to help in these efforts:
   1. Retesting status: new tester, re-tester (i.e., tested in the last 3 months), retesting to verify an HIV-positive diagnosis before ART initiation
   2. HIV testing services - *HIV test results, date of HIV test, receipt of HIV test results, previously tested during the reporting period
   3. Demographic - Client’s Unique ID, name, *sex, and *age at time of HTS services
   4. Date HIV-positive individual was linked to treatment
   5. Site - *site name and ID, district, region, province, and *service delivery modality
2. Using unique identifiers for individuals is one way to account for retesting and avoid double reporting if electronic systems are available to easily link data through these unique identifiers. Another approach is to record information about prior testing on the HTS client register.
3. For an individual to be counted under HTS_TST, their HIV diagnosis must be confirmed using a nationally validated testing algorithm. For example, an HIV-positive rapid HIV test performed at the community- or facility- level must be confirmed with a second test, which may be performed at the same site or at a different facility. If the confirmatory test is performed at a different facility, then this may entail follow-up by implementing partners to confirm the diagnosis before reporting on this indicator. The implementing partner who first identified and tested the individual should report on HTST_TST under the appropriate modality; however, that implementing partner must ensure that the diagnosis of the individual tested is confirmed. That is, only a confirmed diagnosis (positive or negative) counts under HTS_TST regardless of the modality used for reporting. Similarly, simply only confirming the diagnosis of an individual who has already been tested (as per the national testing algorithm) does not fulfill the requirements for reporting on HTS_TST regardless of the modality used.
4. Note: Retesting for verification of HIV positive status before or at antiretroviral (ART) treatment initiation is only done for persons who have already been diagnosed HIV- positive as per the national HIV testing guidelines. All clients diagnosed HIV-positive should be retested for verification before or at ART initiation with a new specimen and preferably a second operator using the same national HIV testing strategy. Retesting for verification is primarily done as a quality assurance activity to avoid misdiagnosis and to ensure those initiated on ART and treatment services are indeed HIV positive. Thus, HIV testing conducted to verify status should not be counted under HTS_TST, since their initial HIV diagnosis will have already been counted at the point of the initial receipt of the HIV diagnosis (as per the national HIV testing guidelines).
5. Patient level Deduplication: adding “has patient been tested in the last 3 months” to the HTS facility and community registers can help implementing partners de-duplicate at the reporting level.

How to review for data quality:

Only one age disaggregation type is used for age/sex/test result received:
The number of individuals newly receiving ART must be disaggregated by age and sex.

Reporting level: Facility & Community