Percentage of people living with HIV on antiretroviral therapy who completed a course of TB preventive treatment (TPT) among those who initiated TPT

Export Indicator

Percentage of people living with HIV initiating TB preventive treatment (TPT) and on antiretroviral therapy who completed a course of TPT
What it measures

This indicator measures the effectiveness of scaled-up TPT programmes by assessing the proportion of people living with HIV on antiretroviral therapy who completed a recommended course of TPT during the reporting period.

Rationale

TPT reduces the risk of developing active TB and improves survival of all people living with HIV. Completing TPT 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 active TB and should be offered TPT. Similarly, children living with HIV who do not have poor weight gain, fever or current cough should be offered TPT.

While many countries have made progress in initiating TPT among eligible people living with HIV, completion rates remain poor or unknown. Assessing completion of TPT is a critical element of the TB/HIV cascade of services and essential to ensuring impact.

Numerator

Number of people on antiretroviral therapy who completed TPT among those who initiated any course of TPT during the previous year e.g. 2019 cohort for 2021 reporting (See illustration below).

Denominator

Number of people on antiretroviral therapy who initiated any course of TPT during the previous year (insert same cohort year as numerator: e.g., 2019 for 2021 reporting).

Calculation

Numerator/denominator (expressed as %)

Method of measurement

(see illustration below)

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 TPT during the cohort reporting year who completed the course of TPT. The cohort reporting year would usually be the last calendar year during which all people who initiate TPT can be assessed for treatment completion. As mentioned above, for the 2021 reporting cycle, the cohort would comprise those initiating TPT during 2019.

This includes all those eligible for TPT who started TPT (including those newly on antiretroviral therapy and currently on treatment) and who completed TPT during the same year or the following year. For programmes using continuous isoniazid therapy (36-month IPT), TPT completion is defined as 6 months of treatment. Completion of TPT should be determined on the basis of national clinical guidelines (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 TPT during the cohort reporting period (2019 for 2021 reporting). If a person who is initiated on TPT dies before TPT completion, they should be recorded in the denominator, but not in the numerator.

This reflect an annual cohort approach where 2021 reporting is based on those who initiated TPT in 2019, regardless of whether they completed in 2019 or 2020.

Illustration of completion cohort

Range of 2021 GAM reporting dates: TPT initiations and TPT completions

Examples of 2021 GAM reporting for TPT completion, with initiation and regimen type

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 TPT regimen).

Disaggregation
  • Gender (female, male, transgender).
  • Age (<5 years, 5-14 years, 15+ years).
  • ART initiation (<12 months on ART, 12+ months on ART).
  • Type of TPT regimen (6 INH, 4R, 3HP, other (HP refers to isoniazid and rifapentine))

Less than 12 months on ART refers to people newly on ART within the same calendar year at the time of TPT initiation. Twelve or more months on ART refers to people already on ART at the time of initiation of TPT.

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 TPT completion, use of different criteria to determine completion and account for TPT interruptions, and suboptimal programme implementation.

Further information

WHO operational handbook on tuberculosis. Module 1: prevention - tuberculosis preventive treatment. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/who-operational-handbook-on-tube...).