People living with HIV receiving multimonth dispensing of antiretroviral medicine
Export Indicator
The proportion of all people living with HIV and currently on antiretroviral therapy, who received a multimonth (as specified below) supply of antiretroviral medicine at their most recent antiretroviral medicine check-up.
The option for people living with HIV who are clinically stable (established on antiretroviral therapy - see Definitions below) to receive multiple months of antiretroviral medicines is a key component of care that responds to the needs and preferences of people living with HIV (known as differentiated service delivery - see Definitions below). For people living with HIV who are established on antiretroviral therapy, multimonth dispensing has the potential to improve health outcomes and support long term treatment adherence, while also reducing unnecessary clinic attendance, thus contributing to system efficiency. Broadly, multimonth dispensing can contribute to efforts to achieve the 95-95-95 targets.
Adoption and roll-out of multimonth dispensing as part of national government strategies and plans are increasing. Since 2016, differentiated service delivery - including the option of multimonth dispensing - has been recommended in World Health Organization (WHO) HIV treatment and public health guidelines. The COVID-19 pandemic has particularly exposed the fragility of health systems and, in response, finding ways to maintain service delivery and reduce unnecessary clinic attendance has been prioritised.
The extent to which these models of care have been scaled up in many countries is uncertain and reporting on this indicator will support efforts to expand the offer of multimonth dispensing.
Number of people living with HIV and currently on antiretroviral therapy who received 3 - <6 or 6+ months of antiretroviral medicine at their most recent antiretroviral medicine pick-up.
(The number receiving <3 months of antiretroviral supply is also collected for validation purposes)
If countries cannot report on the number of months of antiretroviral medicine dispensed by the disaggregation described above, they could, as an alternative, report the total number of people currently on antiretroviral therapy and receiving ≥3 months of antiretroviral medicine at their last medicine pick-up.
Number of people living with HIV and currently on antiretroviral therapy.
Numerator/denominator
The data for this indicator are collected at the end of the reporting period from facility antiretroviral therapy registers (including antiretroviral therapy dispensed outside the facility), programme monitoring tools or other databases. (If data are available from the private sector these should be included).
All people currently on antiretroviral therapy should be identified. People who have not received antiretroviral medicine within 28 days of their scheduled medicine pick-up are considered lost to follow-up and should not be counted in the denominator or the numerator. For example, if antiretroviral medicine was provided for three months (12 weeks), the time since the last medicine pick-up should be no longer than 16 weeks (12 weeks plus 28 days).
For the numerator: registers should capture the duration of antiretroviral medicine dispensed for each patient currently on antiretroviral therapy at their most recent medicine pick-up visit. If possible, this should be categorized as <3 months, 3- <6 months, or 6+ months and summarized for each age/sex group.
The denominator should match the total number of people currently on antiretroviral therapy at the end of the year, and be aligned with the national values submitted through the Global AIDS Monitoring tool.
If this indicator result is only available for a proportion of people currently on treatment, please enter the number of people that the percentage is based on, as well as the national denominator value, so that it is clear what proportion of the population currently on treatment is represented in the calculation.
Please note: multimonth dispensing should not be confused with multimonth prescriptions. Someone who receives a six-month antiretroviral medicine prescription but needs to attend clinic every one or two months for refills would not be counted as receiving multimonth dispensing.
Annual
- Age 0-14
- Age 15+ by sex (male, female and transgender).
Please include any information on sustained changes in national guidance on dispensing frequency that is related to COVID-19 in the narrative report.
An indicator focused on the scale of multimonth dispensing is a pragmatic way of capturing one important aspect of differentiated service delivery. The indicator gives an overall sense of how widely a differentiated service delivery approach to HIV treatment is being adopted and the extent of possible individual benefit. It also suggests the potetial for further improvements in system efficiency through increased spacing of antiretroviral medicine dispensing.
The presence of this indicator does not imply that all individuals living with HIV should be provided multimonth supplies of antiretroviral medicines. In addition to considering people's clinical needs - multimonth dispensing applies to people established on antiretroviral therapy - dispensing frequency should also be guided by the needs and preferences of affected individuals and populations. Other factors that influence the capacity to provide multimonth supplies of antiretroviral medicines include supply chain issues, policy considerations and health care staff readiness. The fact that 100% coverage should not be seen as the target for multimonth dispensing highlights the importance of having some contextual information to guide the interpretation of results.
Focusing only on the duration of antiretroviral medicine dispensed provides an incomplete picture of differentiated service delivery. Monitoring of outcomes such as viral load suppression, patient satisfaction and retention in care would add to this picture, as would information on the quality and extent of social and other support being provided as part of differentiated service delivery. Ideally, the proportion of people living with HIV who were offered a choice of a differentiated treatment model would be captured, but this may not be feasible.
Definitions
Differentiated service delivery for HIV is defined by the WHO as a person-centered approach that simplifies and adapts HIV services to better serve the needs of people living with HIV and to optimize the available resources in health systems.
Multi-month dispensing refers to the provision of multiple months' supply of antiretroviral medicine and/or other medicines at single time point. Multimonth dispensing is frequently offered as a component of differentiated service delivery. WHO recommends that people who are established on antiretroviral therapy should be offered antiretroviral medicine refills lasting three to six months, preferably six months where feasible.
Established on antiretroviral therapy. The criteria for determining that a person is successfully established on antiretroviral therapy are a) receiving antiretroviral therapy for at least six months; b) no current illness, [which does not include well-controlled chronic health conditions]; c) good understanding of lifelong adherence: adequate adherence counselling provided; and d) evidence of treatment success: at least one suppressed viral load result within the past six months (if viral load is not available: CD4 count >200 cells/mm3, (CD4 count >350 cells/mm3 for children 3-5 years old) or weight gain, absence of symptoms and concurrent infections). The definition of being established on antiretroviral therapy should be applied to all populations, including those receiving second- and third-line regimens, those with controlled comorbidities, children, adolescents, pregnant and breastfeeding women and key populations.
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).
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/9789240031593).