People living with HIV with active tuberculosis disease
The burden of active TB among people living with HIV who are newly enrolled in HIV treatment. It also indirectly measures efforts to detect HIV-associated TB early.
The primary aims of intensified TB case-finding in HIV care settings and provider-initiated HIV testing and counselling for TB patients are early detection of HIV-associated TB and prompt provision of antiretroviral therapy and TB treatment. Although intensified TB case-finding should be implemented among all people living with HIV at each visit to HIV care and treatment facilities, it is particularly important at the time of enrolment, since the risk of undetected TB is higher among newly enrolled patients than among those already receiving antiretroviral therapy. Furthermore, newly enrolled people living with HIV may be less aware of TB symptoms and the importance of early detection and treatment, and they may not seek care for general or specific TB symptoms. Intensified TB case-finding offers an opportunity to educate people living with HIV and to detect TB early. All people living with HIV detected with TB disease should start anti-TB treatment immediately and antiretroviral therapy within eight weeks (if they are not already receiving antiretroviral medicine).
Total number of people living with HIV newly enrolled in HIV treatment who have active TB disease during the reporting period
Total number of people newly enrolled in HIV treatment (i.e., those who registered for antiretroviral therapy during the reporting period)
The outcome of TB investigations among people living with HIV presumed to have TB should be recorded on the HIV antiretroviral therapy card (in the "Investigations" column in the Encounters section) and in the antiretroviral therapy registers (the monthly and quarterly follow-up sections, respectively). Similarly, TB patients who are found to be HIV-positive should be enrolled into HIV treatment promptly and their TB status recorded on the antiretroviral therapy card and registers.
For the numerator. At the end of the reporting period, count the total number of people living with HIV newly enrolled in HIV treatment who have active TB disease. Data should be drawn from TB- and HIV-sided services and data sources.
For the denominator. Count the total number of people living with HIV who are newly enrolled in HIV treatment (i.e., those who started antiretroviral therapy during the reporting period).
The information on TB status in the antiretroviral therapy registers should be updated and reconciled with the TB registers in relevant basic management units before consolidation and reporting to higher levels.
See Annex 5 for further understanding of the indicator (Annex 5 of the 2022 Global AIDS Monitoring (GAM) guidelines).
Data should be recorded daily and reported to the national or subnational level as part of routine quarterly reporting. Data should also be submitted annually to UNAIDS.
Reviewing the trends in TB among people living with HIV who are newly enrolled in treatment over a period of time may provide useful information on: (a) the TB burden among them; and (b) the effectiveness of efforts to detect and treat HIV-associated TB early.
This indicator may underestimate the actual burden of HIV-associated TB, since it may exclude: (a) patients who were detected through provider-initiated HIV testing and counselling, but who were not enrolled in HIV treatment; or (b) those who have disseminated forms of TB, remain asymptomatic and were missed during routine TB screening. A high indicator value may mean high TB rates or effective TB screening and HIV testing programmes, whereas a low value may reflect poor TB screening and HIV testing or successful TB control efforts. The indicator value, therefore, needs to be interpreted carefully.
A guide to monitoring and evaluation for collaborative TB/HIV activities: 2015 revision. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/handle/10665/150627/9789241508278_eng...).
TB.4 PLHIV with active TB disease, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).