Total attrition from ART
This indicator measure progress towards promoting retention on ART and mitigating loss, that is, ART attrition.
- WHO currently recommends treatment for all people living with HIV to achieve viral suppression. ART retention analyses by category are essential to achieving this goal.
- This indicator is central to understanding total attrition (loss) from ART during a reporting period and to understand net progress towards reaching the second 90/95 target.
- This indicator is closely related to AV.1 People living with HIV on ART and is measured by using the same methods and programmatic outcome classification categories.
Number of people living with HIV reported on ART at the end of the last reporting period who were not on treatment at the end of the current reporting period (including those who died, stopped treatment, and were lost to follow-up).
Number of people living with HIV newly initiated on ART during the current reporting period who were not on treatment at the end of the current reporting period (including those who died, stopped treatment, or were lost to follow-up).
(for calculation of total attrition rate)
Number of people reported on ART at the end of the last reporting period plus new on ART during the current reporting period.
For the numerator. The number of people living with HIV on ART at the end of the previous reporting period, plus the number of people living with HIV started on ART during the current reporting period, who are classified as having died, stopped treatment and/or been lost to follow-up by the end of the current period. These classification categories should be reported separately to the national level and used for calculation of indicator AV.1 People living with HIV on ART.
Definitions of treatment outcomes should remain consistent with established standards (1), with the following exception: The recommended threshold for designation of people living with HIV on ART as LFU is 28 days after last scheduled appointment (rather than the previous 90-day standard). This is the most conservative definition that, when combined with patient tracing capacity at facility and community levels, can facilitate maximally responsive and person-centred services to promote retention on ART and, thus, adherence and VLS. In settings relying on paper-based data collection and reporting, LFU may be defined by longer intervals after last scheduled appointment or according to national guidelines, as appropriate. Multi-month prescribing and dispensing of ARVs should be taken into account in the classification.
(1) Consolidated guidelines on person-centred HIV patient monitoring and case surveillance. Geneva: WHO; 2017 (https://www.who.int/hiv/pub/guidelines/person-centred-hiv-monitoring-guidelines/en/).
For the denominator. The number of people living with HIV who are on ART at the end of the previous reporting period plus the number of people living with HIV newly initiated on ART during the reporting period.
The recommended maximum reporting period is 12 months. Shorter reporting intervals, for example, three months, are recommended where feasible.
- Gender (male, femaie, transgender)
- Age (0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+)
- Key populations (men who have sex with men, people living in prisons and other closed settings, people who inject drugs, sex workers, transgender people)
- Treatment outcome category (died, stopped treatment, lost to follow-up).
Additional or alternative disaggregations may be appropriate in some settings, depending on HIS capacity.
WHO Strategic Information Guidelines, 2020 (https://indicatorregistry.unaids.org/sites/default/files/9789240000735-eng.pdf)
TX_ML, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf).