Proportion of all registered TB patients who are tested and are HIV-positive
To assess the prevalence of HIV among TB patients. Measuring the proportion of HIVpositive TB patients gives important information for targeting of resources, strategic planning of activities and monitoring the effectiveness of HIV prevention interventions over time.
Total number of all TB patients registered over a given time period who test HIV-positive (after giving consent) during their TB treatment
Total number of TB patients registered over the same given time period who are tested for HIV (after giving consent)
In settings where HIV is driving the TB epidemic, all TB patients should be offered and encouraged to have an HIV test. National protocols for HIV counselling, testing and confirmation of results should be followed. It is preferable that HIV testing takes place early in the course of TB treatment so that TB patients receive optimal care depending on their HIV status. Some patients may not be prepared to have an HIV test immediately after being diagnosed with TB, and staff will need to encourage HIV testing at each follow-up visit for those who have not yet been tested. It is important, therefore, that the system is able to capture the results of an HIV test occurring at any time during a patient's TB treatment. TB patients who consent to HIV testing may be tested within the TB service or, if HIV testing and counselling are not available within the service, be referred to a separate HIV testing and counselling service. In the latter situation, a mechanism for reporting HIV results back to the TB service will need to be established. It is crucial that the results of the HIV test are known to both the health care staff in charge of TB care and the patient. HIV status will influence patient care plans (e.g. referral to PLWHA support group, CPT, ART, avoidance of streptomycin injections or thiacetazone), and the risk of ongoing HIV transmission can be reduced with appropriate post-test counselling for the patient. Confidentiality of patient information must be maintained and patient HIV status must be accessible only to health care staff directly responsible for an individual's care. HIV status can be recorded in facility and district TB registers. These TB registers should already be maintained confidentially as they contain patient specific health information; the addition of HIV status should therefore not require any change in the way the registers are maintained. Facility-level staff and the district TB coordinator should be responsible for ensuring the confidentiality of this information.
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All TB patients and the health care workers directly involved in their care should be aware of patients HIV status so that the most appropriate information, risk behaviour counselling, treatment, care and support can be provided throughout and after their TB treatment. This indicator will measure the proportion of TB patients consenting to HIV testing who test HIV positive. This defines an important population for specific interventions aimed at reducing the burden of HIV among TB patients and their communities, such as CPT and ARV. It will be used as the denominator for indicators that measure the uptake of these interventions (see indicators C.3.1, C.4.1 and C.5.1). Used in conjunction with national estimates for the prevalence of HIV in TB patients, it may assist in identifying variations in practice or the epidemiology of HIV in TB patients at more local levels. A high value relative to the national average may suggest that the true HIV prevalence among TB patients is higher in that particular area or may indicate that only patients with a higher risk of HIV infection are being encouraged to have a test. Any variation from expected results should stimulate further investigation. In countries where a high and representative proportion of all TB patients accept and undergo HIV testing (>80%), the value of this indicator will provide a robust estimate of the true HIV prevalence among TB patients1 as well as the data necessary for indicator A.2.1. This information is useful for targeting of resources, planning of activities and monitoring the effectiveness of collaborative TB/HIV activities over time. It can be a powerful tool to raise both political and professional awareness of HIV-related TB and the need for a collaborative approach to the problem. It is also helpful to corroborate surveillance data on HIV prevalence in the general population obtained from other sources. If HIV-positive TB patients are stigmatized by health care workers or by their communities, HIV testing may have a negative impact. This indicator does not capture whether patients are made aware of their HIV status and should be used in conjunction with indicator C.1.3 to ensure that all TB patients who are tested for HIV are also given post-test counselling.
Note: All references to other indicators are from the WHO A guide to monitoring and evaluation for collaborative TB/HIV activites