People living with HIV on antiretroviral therapy
Progress towards providing antiretroviral therapy to all people living with HIV
Antiretroviral therapy has been shown to reduce HIV-related morbidity and mortality among people living with HIV, and to halt onward transmission of the virus. Studies also show that early initiation, regardless of a person’s CD4 cell count, can enhance treatment benefits and save lives. The World Health Organization (WHO) currently recommends treatment for all.
The percentage of people on antiretroviral therapy among all people living with HIV provides a benchmark for monitoring global targets over time and comparing progress across countries. When considered as a proportion of Indicator 1.1, this indicator monitors progress toward the second 90 of the UNAIDS 90-90-90 target: that 90% of people who know their HIV-positive status are accessing treatment by 2020.
Number of people on antiretroviral therapy at the end of the reporting period
Estimated number of people living with HIV (to determine treatment coverage)
Number of people among all people living with HIV who know their HIV status (to determine the second 90)
Note: Starting in 2018, countries with a population of more than 250 000 will report on this indicator by broad and detailed age groups within Spectrum. Results will be imported into the Global AIDS Monitoring reporting tool once the national file is finalized. Reporting on cities and other administrative areas of importance will still be done using the Global AIDS Monitoring reporting tool.
For the numerator. The numerator is generated by counting the number of adults and children who are on antiretroviral therapy at the end of the reporting period. The numerator should include people on antiretroviral therapy in the private sector (if these data are available). The count should include pregnant women living with HIV who are receiving lifelong antiretroviral therapy. Women taking antiretroviral medicines to prevent mother-to-child transmission and post-exposure prophylaxis (e.g., Option B) should not be counted.
Protocols should be in place to avoid duplicate counting of individuals across facilities or over time, and to ensure that all facility-level data are reported in a timely manner. The count should not include people who have stopped treatment, died or emigrated to another country, or those who were otherwise lost to follow-up at the facility during this period. People are considered lost to follow-up if they have not been seen within 28 days of the last expected clinical contact (for either an appointment or drug pick-up). Some people pick up several months of antiretroviral medicines at one visit; if the duration of the medicine picked up covers the last month of the reporting period, these people should still be counted as receiving antiretroviral therapy (as opposed to having stopped treatment or having been lost to follow-up).
Countries that have undertaken data quality assessments or reviews should adjust current and historical reported data to account for these inconsistencies. UNAIDS will work with countries to agree on a set of best practices for adjusting reported programme data specific to the country.
For the denominator. Models such as Spectrum are the preferred source for estimating the number of people living with HIV. UNAIDS will work with countries to develop a Spectrum model that matches the estimate of people living with HIV if estimates other than those produced through Spectrum are used. For numbers of people living with HIV who know their status, please see Indicator 1.1 for more information about the denominator.
Data should be collected continually at the facility level and aggregated periodically, preferably monthly or quarterly. The most recent monthly or quarterly data with the count of the number of people currently on treatment should be used for annual reporting.
- 0–14 years for children, and 15 years and older by sex (men and women) for adults. Data reported for unknown age or sex should be allocated to the age- and sex- disaggregated data cells using the same distribution of the data with known age and sex.
- Disaggregation by detailed age groups for children: <1 year, 1-4 years, 5-9 years and 10-14 years for children; and by detailed age sex groups for adults: 15-19 years, 20-24 years, 25-49 years and 50+ years.
- Cities and other administrative areas of importance.
- Numbers of people newly initiating antiretroviral therapy during the current reporting year. This disaggregation should only count people who were previously treatment naïve. These data should be available from the same sources as the total number of people receiving antiretroviral therapy.
- Numbers of people reinitiating antiretroviral therapy during the current reporting year after previously having stopped treatment or being classified as lost to follow-up. These data should be available from the same sources as the total number of people receiving antiretroviral therapy.
For countries with populations less than 250 000 reporting through Global AIDS Monitoring, please provide information about the source of the treatment data. Options include the following:
- Programme data, primarily reported in aggregate: choose this option if counts are provided to the Ministry of Health, disaggregated only by age and sex. Data may typically be reported as coming from national or programme reports with the original source being patient registers, pharmacy records or other routine aggregate reporting forms.
- Programme data, primarily reported using health identifiers: choose this option if counts reported to the Ministry of Health can be deduplicated over time and across facilities using health or uniquely identifying person-level information.
- National estimates based on population survey results: choose this option if you have used estimates from a national survey to derive an estimate of the number of people on treatment.
- National estimates based on cohort monitoring data: choose this option if you have derived estimates based on cohort data.
- Other: please use this option only in consultation with UNAIDS.
More detailed age-specific data are requested for: (a) children; (b) and separately, by sex, for adults. The subset of people newly initiating antiretroviral therapy and reinitiating treatment during the last reporting year is requested.
For all countries, please provide subnational data (where available) disaggregated by administrative areas, as well as city-specific data. Provide information for the capital city and one or two other key cities of high epidemiological relevance, such as those with the highest HIV burden or those that have committed to ending AIDS by 2030. The data entry screen has separate space for this. You also may submit the digital version of any related reports using the upload tool.
This indicator monitors trends in antiretroviral therapy coverage in a comparable way across countries and over time. It does not, however, measure treatment cost, quality, effectiveness or adherence, which vary within and between countries and are likely to change over time.
The accuracy of the number of people on antiretroviral therapy will depend on the quality of the underlying reporting system. Numbers of people on antiretroviral therapy may be under-reported due to missing or delayed reporting of facility data to the national level. Numbers of people on antiretroviral therapy also may be over-reported as a result of not removing from registries people who stopped treatment, died, transferred facilities or were lost to follow-up. Other errors - such as incorrectly abstracting data from facility-based registries or completing reporting forms - can lead to over- and under-reporting to varying degrees of magnitude.
Treatment and care. In: who.int [Internet]. Geneva: World Health Organization; c2019 (http://www.who.int/hiv/topics/treatment/en/index.html).
AV.1 PLHIV on ART, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).
TX_CURR, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf).
AV.4 New ART patients, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).
TX_NEW, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf).