Annex 13. Indicators for HIV testing services reference sheet Table 13.1A Programme indicators for HIV testing services WHO/HIV/2015.32 Indicator National indicators Numerator (N)/ denominator (D) Disaggregation Measurement method Programme relevance and interpretation HTS.1 People living with HIV diagnosed % of people living with HIV who have been tested HIVpositive living with HIV who have been diagnosed and received their results D: Number of people living with HIV. Sex, age (<1, 1 4, 5 9, 10 19, 20 24, 25 49, 50+ years 1 ), key populations, other target populations. Best estimate based on available data sources, e.g. 1. Based on facility data: N: Cumulative number of reported new HIV diagnoses minus deaths; D: national PLHIV estimate based on internationally consistent modelled estimates, e.g. Spectrum AIM 2. Based on population based surveys collecting HIV serostatus and with a question to assess whether respondents know their positive status. The indicator will be calculated as PLHIV who report knowing their status 3. Based on population based surveys collecting HIV serostatus without a question to assess whether respondents know their positive status. Construct a plausible range and midpoint based on: the higher value of (the percentage of PLHIV respondents in the survey who have been tested in the past 12 months and received the results) and (the percentage of all PLHIV on care) as the lower end of the range, and the percentage of PLHIV ever tested as the upper end of the range. Critical to determine the proportion of people living with HIV who know their HIV status, as this knowledge is the entry point to the continuum of care Disaggregated estimates can reveal gaps in diagnosing people living with HIV. The proportion of people living with HIV who know their HIV-positive status should also be globally reported for target population where these are collected as national indicators, including: 1. % of key populations 2. % of pregnant women who have been tested in the past 12 months and know their status. Other surveys, related programme data and modelled estimates can be used as additional data sources for developing and triangulating estimates. 1 In many settings key population-specific data cannot be collected from routine programme monitoring; surveys are required.
HTS.2 HTS scale-up Number of people who were tested for HIV and received their results within the past 12 months who were tested for HIV and received their results within the past 12 months. D: n/a. Although not required for this indicator, a denominator may be gauged by using the general population size in generalized epidemics or the sizes of key populations and other priority populations in lowlevel and concentrated epidemics. Test result, sex, age (<1, 1 4, 5 9, 10 14, 15 19, 20 49, 50+ years), key population (where available), other target populations if relevant. D&N: Programme records, e.g. HTS registers Count only people s first test or else subtract retesters to calculate the number of individuals tested. Measures trends in scale-up of HIV testing and counselling. HTS.3 HTS retest Number of people who were retested for HIV within the past 12 months who were tested and received their results more than once within the past 12 months. D: n/a. Although not required for this indicator, a denominator may be gauged by using the general population size in generalized epidemics or the sizes of key populations and other priority populations in lowlevel and concentrated epidemics. Sex, age (<1, 1 4, 5 9, 10 19, 20 49, 50+ years), key population 2 (where available), other target populations if relevant. Type of retester: 1. Retesting (at ongoing risk). 2. Retester after discrepant result. 3. Retester to verify diagnosis. Programme records Quantifying the number of retesters and subtracting retesters from the total number of testers helps to determine the number of individuals tested. Knowing the reasons for retests can help explain retesting patterns. 2 In many settings key population-specific data cannot be collected from routine programme monitoring; surveys are required.
HTS.4 PMTCT Testing coverage % of pregnant women with known HIV Status with PMTCT section MTCT.1 N: Number of pregnant women attending ANC and/or having had a facility-based delivery who were tested for HIV during pregnancy or already knew they were HIV- positive. Population-based denominator: Number of pregnant women who delivered within the past 12 months. Programme-based denominator: Number of pregnant women who attended ANC or had a facilitybased delivery in the past 12 months. HIV status/test results: 1. known HIV infection at ANC entry. 2.tested HIV- positive at ANC during current pregnancy. 3.tested HIV-negative at ANC during current pregnancy. Total identified HIV-positive women = 1 + 2 Optional disaggregation: pregnant women who inject drugs. N: Programme records, e.g. ANC registers, labour and delivery registers. Population-based denominator: Estimates from central statistics office, UN Population Division or vital statistics. Facility-based denominator: Programme records, e.g. ANC registers, labour and delivery registers. Measures coverage of the first step in the PMTCT cascade. High coverage enables early initiation of care and treatment for HIV-infected mothers. The total number of identified HIV-positive women provides the facility-specific number of pregnant women with HIV to start a facility-based PMTCT cascade HTS.5 Coverage of early infant diagnosis % of HIVexposed infants receiving a virological test for HIV within 2 months of birth with PMTCT section MTCT.6 N: Number of HIVexposed infants born within the past 12 months who received an HIV test within two months of birth D: Number of HIVpositive pregnant women who delivered within the past 12 months. Test results: 1. positive 2. negative 3. indeterminate 4. other. N: Programme records, e.g. PMTCT registers, laboratory records. D: Internationally consistent modelling estimates, e.g. Spectrum AIM. Measures early HIV diagnosis in infants, a critical first step toward early treatment. High coverage of early virological testing of infants helps initiate ART early in children with confirmed HIV infection and supports counselling on efforts to prevent seroconversion of those with a negative early test result.
HTS.6 HIV Testing among TB patients % of registered new and relapsed TB patients with documented HIV status with TB/HIV section LINK.15 N: Number of new and relapsed TB patients registered during the reporting period who had an HIV test result (whether positive or negative) recorded in the TB register. D: Number of new and relapsed TB patients registered in the TB register during the reporting period. Sex, age (0 4, 5 14, 15+), HIV status (positive, negative, unknown). N&D: Programme records, e.g. TB treatment card, TB register. Measures the extent to which HIV status of notified TB patients is ascertained. Knowing their HIV status enables linking these people with the appropriate HIV services. HTS.7 HIV testing coverage of key populations % of people from key populations who received an HIV test in the last 12 months and who know the results with Key population section KPOP.1 N: Number of key population respondents previously unaware of their HIV-positive status who were tested for HIV and received their results within the past 12 months D: Number of key population respondents in survey. Key population (men who have sex with men, people in prisons and other closed settings, people who inject drugs, sex workers, transgender), sex, age. N&D: Survey of key population. Measures the programme s effectiveness in encouraging HIV testing, which can serve as both a prevention tool and an entry point for early care and treatment for key populations. Targets for the percentages of key populations that know their status should be higher than for the general population. Additional indicators HTS.8 Retesting to verify diagnosis at ART initiation % of ART initiators who were retested to verify diagnosis with HIV who initiated ART within the past 12 months who had a retest to verify HIV diagnosis. D: Number of people living with HIV who initiated ART within the past 12 months. Facility or geographical area of interest. Programme records, to be recorded in ART monitoring tools. Quality measure to assess whether retesting to verify HIV diagnosis at the time of ART initiation is taking place.
HTS.9 Selftesting % of people who have tested for HIV using a self- test kit who have tested for HIV using a self-test kit. D: Total number surveyed. By specific populations of interest. DHS generic question that can be included in general population surveys: Have you ever tested yourself for HIV using a self-test kit? HTS.10 General annual HTS coverage % of people who have been tested for HIV in the last 12 months and received the results N: Number of adult respondents who have been tested for HIV within the past 12 months and received the results. D: Number of adult respondents (15 years and older). Sex, age (15 19, 20 24, 25 49, 50+). N&D: Population-based survey of the general population. Measures proportion of the general population covered by HTS services in the preceding 12 months. Especially relevant for generalized epidemics, in which broad-based efforts to scale up testing should be assessed. HTS.11 Partner Testing % of HIVpositive adults receiving HIV care whose partner s status is known Crossreferenced with Linkage section LINK.6 N: Number of HIVpositive adults receiving HIV care within the past 12 months whose sexual partner s HIV status is documented in the patient record. D: Number of HIVpositive adults who received HIV care within the past 12 months and who have a sexual partner. By specific population of interest. Measures the programme s ability to identify and test the sexual partners of people receiving HIV care, who are at high risk for HIV infection, in order to: 1. prevent ongoing transmission in sero-discordant couples and 2. identify HIVpositive partners with the aim of enrolling them in HIV care services.
HTS.12 HTS quality improvement activities % of sites with quality improvement (QI) activities with Service availability and quality and Linkage sections RES.4 N: Number of ART sites with quality improvement activities implemented in the last 6 months that address clinical HIV programme processes or outcomes and have documented results. D: Number of health facilities dispensing ARVs in the last 12 months. Site level (community, primary, secondary, tertiary), geography (e.g. region, district), type of site (e.g. general clinic, MCH site, TB site, prison or other closed setting). Facility records and observation, consolidated data from supervisory visits (sampled or exhaustive). Critical component of capacity building for quality service provision. HTS.13 HTSrelated stockouts % of HTS sites with stock-outs of HIV diagnostic tests or reagents with Medical products and technologies section RES.12 N: Number of HTS sites that had a stockout of HIV diagnostic tests or reagents during a reporting period. D: Number of reporting HTS sites. Site level (community, primary, secondary, tertiary), location (e.g. region, district), type of site (e.g. general clinic, MCH site, TB site), type of HIV diagnostic test or reagent. Routine programme management (PM) system. Assesses the ability of the supply chain to prevent stockouts; can serve as a surrogate indicator for the overall functionality of the procurement system. The target is 0% HTS sites that experience stockout i.e. 100% of sites with no stockout.
HTS.14 Laboratory capacity for HIV testing Number of testing facilities (laboratories) with capacity to perform clinical laboratory tests with Service availability and quality and linkage sections RES.5 Number of testing facilities (laboratories) with capacity (i.e. infrastructure, dedicated laboratory personnel and equipment) to perform: HIV diagnosis with rapid test, EIA, Western blot or molecular methods; HIV/AIDS care and treatment monitoring with CD4 count or HIV viral load testing clinical laboratory tests in any of the following areas: haematology, clinical chemistry, serology, microbiology, TB diagnosis and identification, malaria diagnosis, OI diagnosis. Testing facility (e.g. clinical laboratory, POC testing site), type of laboratory test performed, location. Programme records. Provides valuable information on trends in the availability of laboratory services. However, it does not measure the adequacy of coverage of laboratory services because of the different levels of capacity among laboratories. This indicator does not attempt to measure the quality, cost or effectiveness of services provided.
HTS.15 Laboratory performance % of laboratories with satisfactory performance in external quality assurance/ proficiency testing (EQA/PT) with Service availability and quality and Linkage sections RES.6 N: Number of testing laboratories with satisfactory performance in EQA/PT. D: Number of testing laboratories participating in EQA/PT. Type of laboratory, type of test. Laboratory EQA programme records at national reference laboratory. Following standard procedures for EQA/PT, a national or subnational reference laboratory sends pretested samples to laboratory facilities for testing and computes the rate of agreement between participating and reference laboratories. Measures laboratory performance, as determined by the accuracy and reliability of laboratory diagnostics, to monitor whether laboratory quality has kept pace with the expansion of HIV testing services. The aim is to ensure the validity of test results across the biomedical infrastructure, detect low performance and address weaknesses through tighter supervision, verification and upgrading of equipment, timely supply of equipment and reagents.