CHAPTER 6: HIV/AIDS INDICATORS’ REFERENCE PAGES (cont.)

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HIV counseling and testing

Prevention of Mother-to-Child Transmission (PMTCT)

Universal Precautions (UP) and Post-Exposure Prophylaxis (PEP)

Availability of services

HIV counseling and testing

Prv16: Individuals receiving HIV counseling and testing

Definition
Number of individuals receiving HIV counseling and testing in the last 12 months:

(a) Number of individuals who received pre-test counselling,

(b) Percent of those counselled who received HIV testing,

(c) Percent of those tested who were positive,

(d) Percent of those tested who received their results through post-test counselling services, and

(e) Percent of those who tested HIV-positive who were referred to care and support services

(disaggregated by type of service (voluntary/diagnostic), age, sex, region and urban/rural)

Purpose

To get an idea of the reach of HIV counseling and testing services

Measurement tool

Program report (from VCT centers) and Health facility survey (HFS)

Frequency

Annual for Program Report; Every 3 years for HFS

Responsible body

MoH/HAPCO

Method of measurement

The indicator will be collected through program report from all functional VCT sites (integrated and stand-alone). The same indicator will also be collected through HFS every three years from randomly selected health facilities that provide HIV testing and counseling. Through program report and HFS, the following will be measured:

a) Number of individuals who received pre-test counseling in the last 12 months

b) Percent of those counselled who received HIV testing

Numerator: Number of individuals who received
HIV testing

Denominator: Number of individuals who received
pre-test counseling

c) Percent of those tested who were positive

Numerator: Number of individuals tested HIV-
positive

Denominator: Number of individuals who received
HIV testing

d) Percent of those tested who received their results through post-test counselling services

Numerator: Number of individuals who received
their results through post-test counselling
services

Denominator: Number of individuals who received
their test results

e) Percent of those who tested HIV-positive who were referred to care and support services

Numerator: Number of individuals who tested HIV-
positive and referred to care and support
services

Denominator: Number of individuals who received
their test results

Note:

Each component (a-e) should be disaggregated by type of service (voluntary/diagnostic), age, sex, region and urban/rural)

Remark

Prevention of Mother-to-Child Transmission (PMTCT)

Prv17: HIV-infected pregnant women receiving ARV prophylaxis

Definition
Percentage of HIV-infected pregnant women receiving a complete course of antiretroviral prophylaxis to reduce the risk of PMTCT in accordance with nationally approved treatment protocol in the last 12 months (disaggregated by region)

Purpose

To assess progress in preventing mother-to-child transmission

Measurement tool

Program report and estimates

Frequency

Annual

Responsible body

MoH/HAPCO

Method of measurement

The number of HIV-infected pregnant women provided with antiretroviral prophylaxis to reduce the risk of MTCT in the last 12 months is obtained from program report. Only those women who completed the full course should be included. (ARV prophylaxis is considered fully completed when the women as well as her child each took the specified one dose).

The number of HIV-infected pregnant women to whom antiretroviral prophylaxis to reduce the risk of MTCT could potentially have been estimated by multiplying the total number of women who gave birth in the last 12 months (from MoH/CSA) by the most recent national estimate of HIV prevalence in pregnant women (HIV Sentinel Surveillance)

Numerator: Number of HIV-infected pregnant women
provided with a full course of antiretroviral
prophylaxis to reduce MTCT according to a
nationally approved treatment protocol in the
last 12 months

Denominator: Estimated number of HIV-infected pregnant
women

Remark

UNGASS indicator

Prv18: Infants born to HIV-infected women

Definition
Percentage of HIV-infected infants born to HIV-infected mothers (disaggregated by region)

Purpose

To assess progress towards eliminating mother-to-child HIV transmission

Measurement tool

Estimated based on program coverage

Frequency

Annual

Responsible body

MoH/HAPCO

Method of measurement

The indicator is measured by taking the weighted average of the probabilities of MTCT for pregnant women receiving and not receiving antiretroviral therapy, the weights being the proportions of women receiving and not receiving ARVs. Expressed in a mathematical formula:

Indicator score = {T*(1-e) + (1-T)}*v

Where:

T = Proportion of HIV-infected pregnant
women provided with ARV treatment
(from Prv17)

v = MTCT rate in the absence of any
treatment

e = Efficacy of treatment provided

In the case of Ethiopia, the following estimates of v and e are suggested:

v = 35%

e = 50%

Remark

UNAIDS and WHO indicator

Prv19: Health facilities providing services to prevent HIV infection in women and children

Definition
Percentage of all possible public, private, missionary and workplace health facilities (family planning and primary health care clinics, ANC/MCH, and maternity hospitals) providing the minimum package of services to prevent HIV infection in women and infants in the past 12 months (disaggregated by region)

Purpose

To measure the extent to which health facilities are providing services to prevent HIV infection in women and infants

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Public, private, missionary and workplace health facilities (family planning and primary health care clinics, ANC/MCH, and maternity hospitals) are randomly selected and assessed on availability of the following package of services:

1. For all women

HIV counseling and testing

2. For HIV positive women:

2.1 ARV prophylaxis (or referral to services where this is provided)

2.2 Counseling on infant feeding

2.3 Counseling on risk reduction

2.4 Referral to or provision of FP for post-partum contraception (including methods to prevent future pregnancies)

2.5 Referral to or provision of long-term care and support

2.6 Referral to or provision of attended delivery services where safe obstetric practices are observed

3. For HIV negative women:

Referral to or provision of FP for post-partum contraception and prevention of future HIV infection (i.e., counseling on dual protection)

Numerators:

Number of health facilities where individual items from each component exits

Number of health facilities where 1, 2 and 3 exit

Number of health facilities where 1, 2 or 3 exit

Number of health facilities where 2.1, 2.2, 2.3, 2.4, 2.5, and 2.6 exit

Number of health facilities where 2.1, 2.2, 2.3, 2.4, 2.5, or 2.6 exit

Denominator:

Total number of health facilities surveyed

Remark

Adapted from WHO

Prv20: ANC visit and HIV testing and counseling

Definition
Percentage of pregnant women that:

a. Attend at least one ANC visit

b. Attend at least one ANC visit that is a PMTCT site

c. Receive pre-test counseling on HIV

d. Receive testing for HIV

e. Receive post-test counseling on HIV

f. Receive HIV results

Purpose

To measure to what extent ANC visitors complete the entire process of HIV counseling and testing

Measurement tool

Program report

Frequency

Annual

Responsible body

MoH/HAPCO

Method of measurement

Method of measurement

Health facilities providing ANC services and health facilities that are PMTCT sites report monthly on the number of women who attended at least one ANC visit and ANC visit that is a PMTCT site; number of women who received pre-test/post-test counseling and women who received test results to the Woreda Health Office or to RHBs (which ever is appropriate).

a. % of pregnant women who attend at least one ANC visit

Numerator: Number of pregnant women who
attended at least one ANC visit

Denominator: Estimated number of all pregnant
women to be using the selected health
facilities

b. % of pregnant women who attend at least one ANC visit that is a PMTCT site

Numerator: Number of pregnant women who
attended at least one ANC visit that is a
PMTCT site

Denominator: Estimated number of all pregnant
women to be using the selected health
facilities which are PMTCT sites

c. % of pregnant women who received pre-test counseling on HIV

Numerator: Number of pregnant women who
received pre-test counseling on HIV

Denominator: Number of pregnant women who
attended at least one ANC visit

d. % of pregnant women who received testing for HIV

Numerator: Number of pregnant women tested for
HIV

Denominator: Number of pregnant women who
received pre-test counseling

e. % of pregnant women who received post-test counseling on HIV

Numerator: Number of pregnant women tested and
received post-test counseling

Denominator: Number of pregnant women tested for
HIV

f. % of pregnant women who received HIV test results

Numerator: Number of pregnant women who
received HIV test results

Denominator: Number of pregnant women who
received HIV test

Note:

For this indicator b-f will also be calculated using the denominator “Estimated number of all pregnant women to be
using the selected health facilities”

Remark

WHO indicator

Prv21: Health Facilities providing PMTCT Services

Definition
Number of health facilities providing PMTCT services in the past 12 months (disaggregated by region)

Purpose

To measure geographic coverage of availability of PMTCT services

Measurement tool

Program report

Frequency

Annual

Responsible body

MoH/HAPCO

Method of measurement

MoH will keep a record of health facilities providing PMTCT services and annually report to HAPCO

Remark

Universal Precautions (UP) and Post-Exposure Prophylaxis (PEP)

Prv22: Prevention of nosocomial transmission of HIV

Definition
Percentage of health facilities that have guidelines to prevent nosocomial transmission of HIV, adequate sterilization procedures, and protective materials and equipment such as syringes, gloves, antiseptics in stock at the time of the survey(disaggregated by region)

Purpose

To measure the proportion of health care facilities fulfilling the minimum conditions for the reduction of nosocomial transmission of HIV

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Method of measurement

At randomly selected health facilities the following assessments are carried out:

a. Observe availability of written guidelines for avoiding nosocomial transmission of HIV

b. A stock check for protective materials and equipment such as syringes, gloves, antiseptics and sterilization equipment

c. Sterilization practices are observed to see that they conform to existing guideline. In the absence of written guideline, sterilization practices should conform to national (and, failing that, international) standards. If there is no opportunity to observe sterilization practices, health workers can be asked.

d. Adequate trained personnel on UP and PEP

Numerator: Number of health facilities with written
guideline on safe practices, with
protective materials and equipment such
as syringes, gloves, and sterilization
equipment in stock, adequate
sterilization practices and adequate
trained personnel on UP and PEP

Denominator: Number of all health facilities surveyed

Note:

“d” will be measured for PEP once national guideline is disseminated and people trained

Remark

UNAIDS indicator modified to National need

Availability of services

Prv23: Woredas with VCT center

Definition
Percentage of Woredas with at least one VCT center in the last 12 months (disaggregated by region)

Purpose

To measures VCT services coverage in the Country

Measurement tool

Program report

Frequency

Annual

Responsible body

MoH/HAPCO

Method of measurement

Together with MoH, RHBs and others, a list is constructed of all centers (private, public or NGO) offering VCT services in each Woreda of the County. The list will also include VCT services that are integrated into hospitals or primary health care services.

Numerator: Number of Woredas with at least one VCT center
in the last 12 months

Denominator: Number of all Woredas in the Country

Note:

It is useful if the number of VCT centers per 100,000 population is indicated

Remark

Method of measurement adapted from UNAIDS

Prv24: Woredas with PMTCT center

Definition
Percentage of Woredas with at least one health facility providing PMTCT (disaggregated by region)

Purpose

To measure the coverage of PMTCT within the Country

Measurement tool

Program report

Frequency

Annual

Responsible body

MoH/HAPCO

Method of measurement

MoH should have the list of all Woredas with health facilities providing PMTCT

Numerator: Number of Woredas with at least one health
facility providing PMTCT

Denominator: Number of all Woredas in the country

Note:

It is useful to have population and HIV/AIDS prevalence data per Woreda so that it is possible to compare how the availability of services matches the needs.

Remark

WHO indicator adapted to National need

Prv25: Woredas with ART center

Definition
Percentage of Woredas with at least one health facility providing ART (disaggregated by region)

Purpose

To measure the coverage of ART within the Country

Measurement tool

Program report

Frequency

Annual

Responsible body

MoH/HAPCO

Method of measurement

MoH should have the list of all Woredas with health facilities providing ART

Numerator: Number of Woredas with at leas one health
facility providing ART

Denominator: Number of all Woredas in the country

Note:

It is useful to have population and HIV/AIDS prevalence data per Woreda so that it is possible to compare how the availability of services matches the needs.

Remark

WHO indicator adapted to National need

Prv26: HIV/AIDS resource centers

Definition
Number of Regions/Woredas who have established HIV/AIDS resource center

Purpose

To measure peoples’ easy access to HIV/AIDS information

Measurement tool

Program report

Frequency

Annual

Responsible body

HAPCO

Method of measurement

Regional HAPCOs will keep record of HIV/AIDS resource centers established in their Region. The reports should be sent to the Federal HAPCO.

Resource center is established to make HIV/AIDS information easily accessible to all users in need. In this regard, the center can have books, brochures, leaflets, other reading materials as well as Internet connection.

Remark


Prv16: Individuals receiving HIV counseling and testing
Definition	Number of individuals receiving HIV counseling and testing in the last 12 months: (a) Number of individuals who received pre-test counselling, (b) Percent of those counselled who received HIV testing, (c) Percent of those tested who were positive, (d) Percent of those tested who received their results through post-test counselling services, and (e) Percent of those who tested HIV-positive who were referred to care and support services (disaggregated by type of service (voluntary/diagnostic), age, sex, region and urban/rural)
Purpose	To get an idea of the reach of HIV counseling and testing services
Measurement tool	Program report (from VCT centers) and Health facility survey (HFS)
Frequency	Annual for Program Report; Every 3 years for HFS
Responsible body	MoH/HAPCO
Method of measurement	The indicator will be collected through program report from all functional VCT sites (integrated and stand-alone). The same indicator will also be collected through HFS every three years from randomly selected health facilities that provide HIV testing and counseling. Through program report and HFS, the following will be measured: a) Number of individuals who received pre-test counseling in the last 12 months b) Percent of those counselled who received HIV testing Numerator: Number of individuals who received HIV testing Denominator: Number of individuals who received pre-test counseling c) Percent of those tested who were positive Numerator: Number of individuals tested HIV- positive Denominator: Number of individuals who received HIV testing d) Percent of those tested who received their results through post-test counselling services Numerator: Number of individuals who received their results through post-test counselling services Denominator: Number of individuals who received their test results e) Percent of those who tested HIV-positive who were referred to care and support services Numerator: Number of individuals who tested HIV- positive and referred to care and support services Denominator: Number of individuals who received their test results Note: Each component (a-e) should be disaggregated by type of service (voluntary/diagnostic), age, sex, region and urban/rural)
Remark


Prv17: HIV-infected pregnant women receiving ARV prophylaxis
Definition	Percentage of HIV-infected pregnant women receiving a complete course of antiretroviral prophylaxis to reduce the risk of PMTCT in accordance with nationally approved treatment protocol in the last 12 months (disaggregated by region)
Purpose	To assess progress in preventing mother-to-child transmission
Measurement tool	Program report and estimates
Frequency	Annual
Responsible body	MoH/HAPCO
Method of measurement	The number of HIV-infected pregnant women provided with antiretroviral prophylaxis to reduce the risk of MTCT in the last 12 months is obtained from program report. Only those women who completed the full course should be included. (ARV prophylaxis is considered fully completed when the women as well as her child each took the specified one dose). The number of HIV-infected pregnant women to whom antiretroviral prophylaxis to reduce the risk of MTCT could potentially have been estimated by multiplying the total number of women who gave birth in the last 12 months (from MoH/CSA) by the most recent national estimate of HIV prevalence in pregnant women (HIV Sentinel Surveillance) Numerator: Number of HIV-infected pregnant women provided with a full course of antiretroviral prophylaxis to reduce MTCT according to a nationally approved treatment protocol in the last 12 months Denominator: Estimated number of HIV-infected pregnant women
Remark	UNGASS indicator


Prv18: Infants born to HIV-infected women
Definition	Percentage of HIV-infected infants born to HIV-infected mothers (disaggregated by region)
Purpose	To assess progress towards eliminating mother-to-child HIV transmission
Measurement tool	Estimated based on program coverage
Frequency	Annual
Responsible body	MoH/HAPCO
Method of measurement	The indicator is measured by taking the weighted average of the probabilities of MTCT for pregnant women receiving and not receiving antiretroviral therapy, the weights being the proportions of women receiving and not receiving ARVs. Expressed in a mathematical formula: Indicator score = {T(1-e) + (1-T)}v Where: T = Proportion of HIV-infected pregnant women provided with ARV treatment (from Prv17) v = MTCT rate in the absence of any treatment e = Efficacy of treatment provided In the case of Ethiopia, the following estimates of v and e are suggested: v = 35% e = 50%
Remark	UNAIDS and WHO indicator


Prv19: Health facilities providing services to prevent HIV infection in women and children
Definition	Percentage of all possible public, private, missionary and workplace health facilities (family planning and primary health care clinics, ANC/MCH, and maternity hospitals) providing the minimum package of services to prevent HIV infection in women and infants in the past 12 months (disaggregated by region)
Purpose	To measure the extent to which health facilities are providing services to prevent HIV infection in women and infants
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement	Public, private, missionary and workplace health facilities (family planning and primary health care clinics, ANC/MCH, and maternity hospitals) are randomly selected and assessed on availability of the following package of services: 1. For all women HIV counseling and testing 2. For HIV positive women: 2.1 ARV prophylaxis (or referral to services where this is provided) 2.2 Counseling on infant feeding 2.3 Counseling on risk reduction 2.4 Referral to or provision of FP for post-partum contraception (including methods to prevent future pregnancies) 2.5 Referral to or provision of long-term care and support 2.6 Referral to or provision of attended delivery services where safe obstetric practices are observed 3. For HIV negative women: Referral to or provision of FP for post-partum contraception and prevention of future HIV infection (i.e., counseling on dual protection) Numerators: Number of health facilities where individual items from each component exits Number of health facilities where 1, 2 and 3 exit Number of health facilities where 1, 2 or 3 exit Number of health facilities where 2.1, 2.2, 2.3, 2.4, 2.5, and 2.6 exit Number of health facilities where 2.1, 2.2, 2.3, 2.4, 2.5, or 2.6 exit Denominator: Total number of health facilities surveyed
Remark	Adapted from WHO


Prv20: ANC visit and HIV testing and counseling
Definition	Percentage of pregnant women that: a. Attend at least one ANC visit b. Attend at least one ANC visit that is a PMTCT site c. Receive pre-test counseling on HIV d. Receive testing for HIV e. Receive post-test counseling on HIV f. Receive HIV results
Purpose	To measure to what extent ANC visitors complete the entire process of HIV counseling and testing
Measurement tool	Program report
Frequency	Annual
Responsible body	MoH/HAPCO
Method of measurement Method of measurement	Health facilities providing ANC services and health facilities that are PMTCT sites report monthly on the number of women who attended at least one ANC visit and ANC visit that is a PMTCT site; number of women who received pre-test/post-test counseling and women who received test results to the Woreda Health Office or to RHBs (which ever is appropriate). a. % of pregnant women who attend at least one ANC visit Numerator: Number of pregnant women who attended at least one ANC visit Denominator: Estimated number of all pregnant women to be using the selected health facilities b. % of pregnant women who attend at least one ANC visit that is a PMTCT site Numerator: Number of pregnant women who attended at least one ANC visit that is a PMTCT site Denominator: Estimated number of all pregnant women to be using the selected health facilities which are PMTCT sites c. % of pregnant women who received pre-test counseling on HIV Numerator: Number of pregnant women who received pre-test counseling on HIV Denominator: Number of pregnant women who attended at least one ANC visit d. % of pregnant women who received testing for HIV Numerator: Number of pregnant women tested for HIV Denominator: Number of pregnant women who received pre-test counseling e. % of pregnant women who received post-test counseling on HIV Numerator: Number of pregnant women tested and received post-test counseling Denominator: Number of pregnant women tested for HIV f. % of pregnant women who received HIV test results Numerator: Number of pregnant women who received HIV test results Denominator: Number of pregnant women who received HIV test Note: For this indicator b-f will also be calculated using the denominator “Estimated number of all pregnant women to be using the selected health facilities”
Remark	WHO indicator


Prv21: Health Facilities providing PMTCT Services
Definition	Number of health facilities providing PMTCT services in the past 12 months (disaggregated by region)
Purpose	To measure geographic coverage of availability of PMTCT services
Measurement tool	Program report
Frequency	Annual
Responsible body	MoH/HAPCO
Method of measurement	MoH will keep a record of health facilities providing PMTCT services and annually report to HAPCO
Remark


Prv22: Prevention of nosocomial transmission of HIV
Definition	Percentage of health facilities that have guidelines to prevent nosocomial transmission of HIV, adequate sterilization procedures, and protective materials and equipment such as syringes, gloves, antiseptics in stock at the time of the survey(disaggregated by region)
Purpose	To measure the proportion of health care facilities fulfilling the minimum conditions for the reduction of nosocomial transmission of HIV
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement Method of measurement	At randomly selected health facilities the following assessments are carried out: a. Observe availability of written guidelines for avoiding nosocomial transmission of HIV b. A stock check for protective materials and equipment such as syringes, gloves, antiseptics and sterilization equipment c. Sterilization practices are observed to see that they conform to existing guideline. In the absence of written guideline, sterilization practices should conform to national (and, failing that, international) standards. If there is no opportunity to observe sterilization practices, health workers can be asked. d. Adequate trained personnel on UP and PEP Numerator: Number of health facilities with written guideline on safe practices, with protective materials and equipment such as syringes, gloves, and sterilization equipment in stock, adequate sterilization practices and adequate trained personnel on UP and PEP Denominator: Number of all health facilities surveyed Note: “d” will be measured for PEP once national guideline is disseminated and people trained
Remark	UNAIDS indicator modified to National need


Prv23: Woredas with VCT center
Definition	Percentage of Woredas with at least one VCT center in the last 12 months (disaggregated by region)
Purpose	To measures VCT services coverage in the Country
Measurement tool	Program report
Frequency	Annual
Responsible body	MoH/HAPCO
Method of measurement	Together with MoH, RHBs and others, a list is constructed of all centers (private, public or NGO) offering VCT services in each Woreda of the County. The list will also include VCT services that are integrated into hospitals or primary health care services. Numerator: Number of Woredas with at least one VCT center in the last 12 months Denominator: Number of all Woredas in the Country Note: It is useful if the number of VCT centers per 100,000 population is indicated
Remark	Method of measurement adapted from UNAIDS


Prv24: Woredas with PMTCT center
Definition	Percentage of Woredas with at least one health facility providing PMTCT (disaggregated by region)
Purpose	To measure the coverage of PMTCT within the Country
Measurement tool	Program report
Frequency	Annual
Responsible body	MoH/HAPCO
Method of measurement	MoH should have the list of all Woredas with health facilities providing PMTCT Numerator: Number of Woredas with at least one health facility providing PMTCT Denominator: Number of all Woredas in the country Note: It is useful to have population and HIV/AIDS prevalence data per Woreda so that it is possible to compare how the availability of services matches the needs.
Remark	WHO indicator adapted to National need


Prv25: Woredas with ART center
Definition	Percentage of Woredas with at least one health facility providing ART (disaggregated by region)
Purpose	To measure the coverage of ART within the Country
Measurement tool	Program report
Frequency	Annual
Responsible body	MoH/HAPCO
Method of measurement	MoH should have the list of all Woredas with health facilities providing ART Numerator: Number of Woredas with at leas one health facility providing ART Denominator: Number of all Woredas in the country Note: It is useful to have population and HIV/AIDS prevalence data per Woreda so that it is possible to compare how the availability of services matches the needs.
Remark	WHO indicator adapted to National need


Prv26: HIV/AIDS resource centers
Definition	Number of Regions/Woredas who have established HIV/AIDS resource center
Purpose	To measure peoples’ easy access to HIV/AIDS information
Measurement tool	Program report
Frequency	Annual
Responsible body	HAPCO
Method of measurement	Regional HAPCOs will keep record of HIV/AIDS resource centers established in their Region. The reports should be sent to the Federal HAPCO. Resource center is established to make HIV/AIDS information easily accessible to all users in need. In this regard, the center can have books, brochures, leaflets, other reading materials as well as Internet connection.
Remark