Management of viral hepatitis C
Export Indicator
Percentage of people living with HIV on antiretroviral therapy who were tested for, diagnosed with and treated for chronic hepatitis C virus (HCV) infection
What it measures
This indicator measures the testing and treatment cascade for chronic HCV infection among people living with HIV on antiretroviral therapy: the proportion of people tested for chronic HCV infection; the proportion of people diagnosed with chronic HCV infection; and the proportion of people initiated on HCV treatment among those diagnosed with chronic HCV infection.
The indicator monitors trends in HCV testing, a critical intervention for assessing needs related to managing chronic HCV infection. HCV testing provides information on the prevalence of HIV and HCV coinfection, informing clinicians on the need for further clinical and laboratory evaluation and treatment.
Rationale
Measuring the hepatitis burden among people living with HIV and in populations at risk can help national planners determine the resources needed to address both HIV and HCV. Testing for HCV coinfection among people living with HIV can inform clinicians on the need for further clinical and laboratory evaluation and the need to adapt treatment. The prevalence of HCV coinfection is especially high among people living with HIV who inject drugs.
Many people living with HIV and receiving antiretroviral therapy die from liver disease resulting from untreated chronic HCV. Testing people living with HIV for HCV identifies HIV and HCV coinfection and allows for adaptation of treatment. Highly effective HCV treatment with a high rate of virus clearance, regardless of subtype, is available.
WHO currently recommends treatment for all people with chronic HCV to achieve HCV cure. This indicator measures progress towards providing treatment to all people living with HIV coinfected with chronic HCV.
Numerator
A. Number of people living with HIV on antiretroviral therapy who were tested for HCV using the recommended testing sequency (anti-HCV followed by HCV RNA or HCV antigen) during the reporting period.
B. Number of people living with HIV on antiretroviral therapy who have been diagnosed with chronic HCV infection (positive HCV RNA (PCR) or HCV core antigen) by the end of the reporting period.
C. Number of people living with HIV on antiretroviral therapy diagnosed with chronic HCV infection who have initiated HCV treatment by the end of the reporting period.
Denominator
A. Number of people living with HIV on antiretroviral therapy during the reporting period.
B. Number of people living with HIV on antiretroviral therapy who were tested for HCV using the recommended testing sequency (anti-HCV followed by HCV RNA or HCV antigen) during the reporting period.
C. Number of people living with HIV on antiretroviral therapy and coinfected with chronic HCV who have been diagnosed with a positive HCV RNA (PCR) or HCV core antigen by the end of the reporting period.
Calculation
Numerator A/Denominator A
Numerator B/Denominator B
Numerator C/Denominator C
Method of measurement
The numerator and denominator are calculated from clinical records of health-care facilities providing HIV treatment and care.
Measurement frequency
Annual.
Disaggregation
People who inject drugs.
People newly enrolled on antiretroviral therapy.
Additional information requested
None.
Strengths and weaknesses
People who are anti-HCV positive have serological evidence of past or present infection. People who are anti-HCV positive must be tested for HCV RNA (which detects HCV circulating in the blood) to differentiate resolved infections from current infections that require treatment.
This indicator monitors progress in HCV testing and treatment activities on a regular basis. It does not reflect the overall proportion of people coinfected with HIV and HCV on antiretroviral therapy who are aware of their HCV coinfection.
This indicator also monitors access to HCV treatment for people living with HIV on antiretroviral therapy coinfected with HCV. The weakness is that it reflects only one year of activity. Describing the cumulative effect of people coinfected with HIV and HCV starting treatment requires compiling cumulative data on the number of people starting treatment and accounting for people newly infected with HCV and reinfected with HCV in the denominator.
Collecting information on past or current injecting drug use allows reporting of disaggregated data for people who inject drugs. Recording information on stigmatized and commonly criminalized behaviours such as drug use poses a risk where an individual can be identified. Efforts must be made to ensure patient records and registers avoid disclosing information that would permit identification of individuals engaged in stigmatized or criminalized behaviours.
Further information
Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240055315).
Updated recommendations on treatment of adolescents and children with chronic HCV infection, and HCV simplified service delivery and diagnostics. Geneva: World Health Organization; 2022 https://www.who.int/publications/i/item/9789240052734).
Consolidated guidelines on person-centred viral hepatitis strategic information: using data to support country scale-up of hepatitis prevention, diagnosis and treatment services. Geneva: World Health Organization; 2024 https://www.who.int/publications/i/item/9789240091313).