Percentage of people living with HIV on antiretroviral therapy who completed a course of tuberculosis preventive treatment among those who initiated tuberculosis preventive treatment
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.
TB preventive treatment reduces the risk of developing active TB 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 active TB 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.
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.
Number of people on antiretroviral therapy who completed TB preventive treatment among those who initiated any course of TB preventive treatment during the previous year e.g., 2020 cohort for 2022 reporting (Figures 1 and 2).
Number of people on antiretroviral therapy who initiated any course of TB preventive treatment during the previous year (insert same cohort year as numerator: e.g., 2020 for 2022 reporting).
Numerator/denominator (expressed as %)
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 2022 reporting cycle, the cohort would comprise those initiating TB preventive treatment during 2020.
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. For programmes using continuous isoniazid preventive therapy (36-month IPT), TB preventive treatment completion is defined as 6 months of treatment. Completion of TB preventive treatment 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 TB preventive treatment during the cohort reporting period (2020 for 2022 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 reflect an annual cohort approach where 2022 reporting is based on those who initiated TB preventive treatment in 2020, regardless of whether they completed in 2020 or 2021.
Illustration of completion cohort
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)
- 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).
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.
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...).