Viral suppression among people living with HIV engaged in differentiated service delivery antiretroviral therapy models
Export Indicator
Percentage of people living with HIV engaged in differentiated service delivery (DSD) antiretroviral therapy models who have virological suppression during the reporting period.
What it measures
Viral suppression among people enrolled in DSD antiretroviral therapy models. This is a measure of antiretroviral therapy efficacy and indicates treatment adherence and risk of transmitting HIV.
Rationale
This indicator enables monitoring of viral load suppression among people living with HIV enrolled in DSD models for antiretroviral therapy. Since viral suppression is a key treatment outcome, it is important to monitor and assess whether people enrolled in DSD antiretroviral therapy models have better or similar viral suppression to people receiving standard of care to ensure quality of services. Viral load suppression is also the best available measure of adherence to antiretroviral therapy.
Numerator
Number of people living with HIV enrolled in a DSD antiretroviral therapy model with at least one routine viral load test during the reporting period who have virological suppression (<1000 copies/mL).
Denominator
Number of people living with HIV enrolled in a DSD antiretroviral therapy model with at least one routine viral load result in a medical or laboratory record during the reporting period.
Calculation
Numerator / denominator.
Method of measurement
Patient monitoring tools (electronic or paper), such as antiretroviral therapy registers or electronic medical records. DSD is a person-centred approach that simplifies and adapts HIV services across the cascade in ways that serve the needs of people living with or vulnerable to HIV and optimize available resources in the health system. DSD for HIV treatment should consider clinical needs and adapt services for people with advanced HIV disease and high viral load, for people from specific populations, and in different contextual settings.
DSD for HIV treatment is based on four building blocks: when (frequency), where (location), what (type/package) and who (provider). In any given DSD model for HIV treatment, the building blocks must be defined separately for clinical consultations, antiretroviral therapy refills and psychosocial support. Both less intensive and more intensive models should be reported under this indicator. Broadly speaking, these models can be described within four categories:
- Group models managed by health-care workers, such as adherence clubs, teen clubs, and advance HIV disease care packages.
- Group models managed by clients, such as community antiretroviral therapy adherence groups and client-led antiretroviral therapy delivery.
- Individual models based at facilities, such as multimonth antiretroviral medicine refills and fast-track antiretroviral therapy pick-up.
- Individual models not based at facilities, such as community antiretroviral therapy distribution points, antiretroviral medicine lockers, home antiretroviral medicine delivery, and mobile clinics.
Measurement frequency
Annually.
Disaggregation
- Gender (female, male, other) (“Other” includes transgender and gender-diverse people who choose an identity other than male or female)
- Age (0–14 years, ≥15 years).
Strengths and weaknesses
Several challenges may arise in accurately monitoring viral suppression among people engaged in DSD antiretroviral therapy models. There may be limited viral load monitoring capacity in low-income settings despite efforts invested in scale-up. In some settings, viral load testing may be performed selectively to confirm suspected treatment failure, or it may be prioritized for people from specific populations—as a result, it may underestimate levels
of viral suppression among all people enrolled in DSD antiretroviral therapy models.
There may be challenges in the ability of the reporting system to identify clients enrolled in DSD antiretroviral therapy models. Data quality challenges may lead to underreporting due to missing data or delays in reporting of facility data to the national level, or overreporting if clients are reported by both facilities and community or private settings. Challenges in linkages and flow of data between health facilities and community-delivered services may lead to delays in data transmission and underreporting.
Countries should adapt monitoring tools such as antiretroviral therapy registers or electronic medical records to track and monitor clients enrolled in DSD antiretroviral therapy models and their treatment outcomes at the service delivery and national levels.
Further information
Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240055315, accessed 6 November 2023).
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization; 2021 https://www.who.int/publications/i/item/9789240031593, accessed 6 November 2023).