Percentage of people living with HIV on antiretroviral therapy who completed a course of tuberculosis preventive treatment among those who initiated tuberculosis preventive treatment
Export Indicator
Percentage of people living with HIV currently on antiretroviral therapy initiating tuberculosis (TB) preventive treatment and who completed a course of TB preventive treatment
What it measures
This indicator measures the effectiveness of scaled-up TB preventive treatment programmes by assessing the proportion of people living with HIV on antiretroviral therapy who completed a recommended course of TB preventive treatment during the reporting period.
Rationale
TB preventive treatment reduces the risk of developing TB disease and improves survival of all people living with HIV. Completing TB preventive treatment as prescribed optimizes its efficacy. All people on antiretroviral therapy should be screened for TB at every visit, using a clinical algorithm recommended by the World Health Organization (WHO). Adults and adolescents living with HIV who do not report any of the symptoms of TB —current cough, fever, weight loss or night sweats—are unlikely to have TB disease and should be offered TB preventive treatment. Similarly, children living with HIV who do not have poor weight gain, fever or current cough should be offered TB preventive treatment; extra care is needed to exclude TB disease in children who are also malnourished before starting TB preventive treatment.
While many countries have made progress in initiating TB preventive treatment among eligible people living with HIV, completion rates remain poor or unknown. Assessing completion of TB preventive treatment is a critical element of the TB/HIV cascade of services and essential to ensuring impact.
Numerator
Among people living with HIV who initiated any course of TB preventive treatment in 2023, the number of people on antiretroviral therapy who completed TB preventive treatment (Figures 1 and 2).
Denominator
Number of people on antiretroviral therapy who initiated any course of TB preventive treatment during 2023.
Calculation
Numerator/denominator
Method of measurement
Numerator: Programme records (for example, antiretroviral therapy registers or electronic medical records (EMRs)). Count the total number of people living with HIV on antiretroviral therapy initiating TB preventive treatment during the cohort reporting year who completed the course of TB preventive treatment. The cohort reporting year would usually be the last calendar year during which all people who initiate TB preventive treatment can be assessed for treatment completion. As mentioned above, for the 2025 reporting cycle, the cohort would comprise those initiating TB preventive treatment during 2023.
This includes all those eligible for TB preventive treatment who started TB preventive treatment (including those newly on antiretroviral therapy and currently on treatment) and who completed TB preventive treatment during the same year or the following year. Completion of TB preventive treatment should be determined on the basis of national clinical guidelines using criteria that relate to the specific regimen duration and composition (see the WHO operational handbook on tuberculosis—module 1: prevention).
Denominator: Programme records (for example, antiretroviral therapy registers or EMRs). Count the total number of people living with HIV who were on antiretroviral therapy and initiated a course of TB preventive treatment during the cohort (2023 for 2025 reporting). If a person who is initiated on TB preventive treatment dies before TB preventive treatment completion, they should be recorded in the denominator, but not in the numerator.
This reflects an annual cohort approach where 2025 reporting is based on those who initiated TB preventive treatment in 2023, regardless of whether they completed in 2023 or 2024.
Measurement frequency
Annually. A periodicity more frequent than annual may be expedient (e.g., quarterly reporting for more timely reporting of patients on a new TB preventive treatment regimen)
Disaggregation
- Gender (female, male, transgender).
- Age (<5 years, 5–14 years, 15+ years).
- Type of TB preventive treatment regimen (if the country is able to report on disaggregation).
Strengths and weaknesses
This indicator would more accurately provide information on people living with HIV who have received this intervention to reduce TB incidence and mortality among people living with HIV. It has already been field tested by United States President’s Emergency Plan for AIDS Relief (PEPFAR)
programmes for a number of years and reported through the monitoring, evaluation and reporting (MER) system.
Challenges include incomplete recording and reporting, information systems that may not capture TB preventive treatment completion, use of different criteria to determine completion and account for TB preventive treatment interruptions, and suboptimal programme implementation.
Further information
WHO operational handbook on tuberculosis. Module 1: prevention - tuberculosis preventive treatment, second edition. Geneva: World Health Organization; 2024 (https://iris.who.int/bitstream/handle/10665/378535/9789240097773-eng.pdf...).