TBHIV Diagnostic and Care Cascade Division of Global HIV and TB TB Preventive Treatment Unit Intended EndUsers CDC or other USG agency headquartersbased staff providing technical assistance CDC or other USG agency country team programmatic staff CDC or other USG agency country team st ID: 1042226
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1. MER and WHO TB/HIV Indicator Reference Guide: TB/HIV Diagnostic and Care CascadeDivision of Global HIV and TBTB Preventive Treatment Unit
2. Intended End-User(s): CDC or other USG agency headquarters-based staff providing technical assistance, CDC or other USG agency country team programmatic staff, CDC or other USG agency country team strategic information staff, and other donor agencies and implementing partnersGoals of Tool: 1. Provide TB/HIV cascade visual mapped with relevant PEPFAR and WHO indicators, potential data sources, and country example 2. Provide definitions for all TB/HIV cascade indicators 3. Provide details for recommended custom indicators 4. Provide data entry screen visuals for PEPFAR TB/HIV indicators 5. Provide detailed indicator guidance for relevant PEPFAR/WHO indicatorsDescription: This document was developed as a reference for all TB/HIV PEPFAR Monitoring, Evaluation, and Reporting (MER) and WHO indicators to support understanding for TPT program reporting. This document includes details for how to define, collect, and report on these indicators. It also provides comparisons to show changes in the indicators from FY17 to FY18, as well as provides explanations of the disaggregates of the indicators.Instruction to end-users: Use these slides as a reference and/or training tool.
3. Data Source(s): TB/HIV Full Diagnostic CascadeTB_STAT (d)TB_ART(n)TB_STAT (n)TB_STAT_ POS (n+)TX_CURR / TX_NEWTX_TB (d)TX_TB (d+)TX_TB (d+)TB_PREV (d) FY18TB_PREV (n)TX_TB (d)Ruled out for TBWHO core (n): started on TPTWHO core (d): eligible PLHIV new on ARTWHO recommended indicator: completed over started TPTHIV Clinic TB Clinic*Repeat variable; ^FY17 MER indicator for newly started on TPT regardless of ART status, FY18 MER indicator for expected to complete TPT stratified by ART status, WHO indicator for new ART started on TPT; (n) = MER indicator numerator; (d) = MER indicator denominator; (+) = captured via disaggregated MER indicator; TX_TB (d) and TB_PREV stratification by ART status only available starting FY18.TX_TB (n)TB register, HIV testing registerTB register, lab registerTB register, ART registerART reg, pres TB/screen reg, health card ART reg, health card, pres TB, scrnLab/Xpert, pres TB, ART regIPT register, ART register, TB screening register, health card, pharm register, TB registerART registerTB register, HIV testing registerTB register, pre-ART/ART registerART reg, health card, pres TB, scrnLab/Xpert reg, health card, TB regTX_TB (d+)TB_PREV (d) FY17TB treatment registerHealth card, screen reg, lab/ Xpert, IPT regART reg, pres. TB/screen reg, health card
4. Data SourcesPLHIV on ART (TX_CURR/TX_NEW)Facility ART registers/databases, Program monitoring tools, Drug supply management systems, PharmaciesPLHIV on ART screened for TB (TX_TB denominator)ART registers, Facility-based TB screening registers, Presumptive TB registers, Patient passports/health cardsPLHIV on ART screened negative for TB (TX_TB denominator NEG)ART registers, Facility-based TB screening registers, Presumptive TB registers, Patient passports/health cardsEligibility for TPT (depends on country guidelines, contraindications)Patient passports/health cards, Facility-based TB screening registers, lab registers, GeneXpert data collection systems, IPT registersPLHIV on ART started on TPT (WHO numerator)ART register or from separate TB screening or IPT register, Patient passports/health cards, Pharmacy registers; Screen positive/test negative for TB (TB specimen registers, lab registers, TB microscopy registers, GeneXpert data collection systems)PLHIV on ART expected to complete TPT (TB_PREV denominator)ART register or from separate TB screening or IPT register, Patient passports/health cards, Pharmacy registers; Screen positive/test negative for TB (TB specimen registers, lab registers, TB microscopy registers, GeneXpert data collection systems)PLHIV on ART completing a course of TPT (TB_PREV numerator)ART register or from separate TB screening or IPT register, Patient passports/health cards, Pharmacy registers
5. Data Source(s): TB/HIV Full Diagnostic Cascade – Country X Example(PEPFAR: FY17; WHO: 2016)TB_STAT (d)TB_ART(n)TB_STAT (n)TB_STAT_ POS (n+)TX_CURR / TX_NEWTX_TB (d)TX_TB (d+)TX_TB (d+)TB_PREV (d) FY18TB_PREV (n)TX_TB (d)Ruled out for TBWHO core (n): started on TPTWHO core (d): eligible PLHIV new on ARTWHO recommended indicator: completed over started TPTHIV Clinic TB Clinic*Repeat variable; ^FY17 MER indicator for newly started on TPT regardless of ART status, FY18 MER indicator for expected to complete TPT stratified by ART status, WHO indicator for new ART started on TPT; (n) = MER indicator numerator; (d) = MER indicator denominator; (+) = captured via disaggregated MER indicator; TX_TB (d) and TB_PREV stratification by ART status only available starting FY18.TX_TB (n)TB registerTB register?? TB register, ART register?? ART reg, screen reg, health card ?? Health card, screen regePMS Only (not NIP)IPT register, ART booklet, health passport, pharm registerART registerTB register?? TB register, pre-ART/ART register?? Health card, Screen reg?? Lab/Xpert reg, health card, TB regTX_TB (d+)TB_PREV (d) FY17?? TB treatment register?? Health card, screen reg, lab/ Xpert, IPT reg?? ART reg, screen reg, health card NO DATANO DATANO DATANO DATANO DATANO DATANO DATA
6. Current Indicator Cheat Sheets
7. TB_STATDescriptionNew and relapse TB cases with documented HIV status within reporting periodReported semi-annually (Q2 and Q4)Sum across Q2 and Q4 for annual totalDescriptionDisaggregatesNumeratorThe number of new and relapse TB cases with documented HIV statusKnown HIV positives: (<15F, <15M, 15+F, 15+M); Newly tested HIV positives: (<15F, <15M, 15+F, 15+M); New negatives:(<15F, <15M, 15+F, 15+M)DenominatorThe number of new and relapse TB cases<15F, <15M, 15+F, 15+M
8. TB_ARTDescriptionHIV-positive new and relapse TB cases on ART during reporting periodReported semi-annually (Q2 and Q4)Sum across Q2 and Q4 for annual totalDescriptionDisaggregatesNumeratorThe number of TB cases with documented HIV-positive status who start or continue ARTNew on ART; previous on ART<1, 1-9, 10-14F, 10-14M, 15-19F, 15-19M, 20-24F, 20-24M, 25-29F, 25-29M, 30-34F, 30-34M, 35-39F, 35-39M, 40-49F, 40-49M, 50+F, 50+M
9. TX_CURRDescriptionAdults and children currently receiving ARTReported quarterlySnapshot indicator (do not sum quarters, use Q4 for annual total)FY17 and FY18 DataDisaggregatesNumeratorThe number of adults and children currently receiving ART<1, 1-9, 10-14F, 10-14M, 15-19F, 15-19M, 20-24F, 20-24M, 25-29F, 25-29M, 30-34F, 30-34M, 35-39F, 35-39M, 40-49F, 40-49M, 50+F, 50+M
10. TX_NEWDescriptionAdults and children newly enrolled on ARTReported quarterlySum across all quarters for annual totalFY17 and FY18 DataDisaggregatesNumeratorThe number of adults and children newly enrolled on ARTPregnant; BreastfeedingConfirmed diagnosis of TB<1, 1-9, 10-14F, 10-14M, 15-19F, 15-19M, 20-24F, 20-24M, 25-29F, 25-29M, 30-34F, 30-34M, 35-39F, 35-39M, 40-49F, 40-49M, 50+F, 50+M
11. TX_TBDescriptionART patients screened for TB within reporting period who are receiving TB treatmentReported semi-annually (Q2 and Q4)Sum across Q2 and Q4 for annual totalDescriptionDisaggregates* (FY17 Data)Disaggregates* (FY18 Data)NumeratorThe number of ART patients who were started on TB treatmentNew on ART; Previous on ARTNew on ART; Previous on ARTDenom-inatorThe number of ART patients who were screened for TB at least onceScreen positive; Screen negativeNew ART – screen positive; New ART – screen negative; Previous ART – screen positive;Previous ART – screen negativeSpecimen sentSpecimen sent*Numerator disaggregates also include age/sex (<15F, <15M, 15+F, 15+M); Denominator disaggregates also separately include specimen sent, diagnostic test, and age/sex (<15F, <15M, 15+F, 15+M)
12. TB_PREVDescriptionART patients who completed a standard course of TPT within reporting periodReported semi-annually (Q2 and Q4)Snapshot indicator (do not sum quarters, use Q4 for annual total)Description (FY17 Data)Description (FY18 Data)Disaggregates*(FY17 Data)Disaggregates*(FY18 Data)Numer-atorThe number of ART patients who completed a course of TPT or at least 6 months of IPTThe number of ART patients who completed a course of TPT or at least 6 months of IPTType of therapy:6-12 mo. IPT; Continuous IPT; Alternative TPT;New ART – IPT;New ART – Alt. TPT;Previous ART – IPT;Previous ART – Alt TPTDenom-inatorThe number of ART patients who were newly started on TPTThe number of ART patients who are expected to complete a course of TPTType of therapy by start of therapyNew ART – IPT;New ART – Alt. TPT;Previous ART – IPT;Previous ART – Alt TPT*Disaggregates also separately include age/sex (<15F, <15M, 15+F, 15+M)
13. WHO: PLHIV starting TPTDescriptionEligible PLHIV newly enrolled in care started on TPT during the reporting periodRequired core global indicatorRecorded daily, reported quarterly, consolidated annually for WHOData since 2015NumeratorThe number of eligible PLHIV newly enrolled in HIV care who started TPTDenominatorThe number of eligible PLHIV newly enrolled in HIV care
14. WHO: PLHIV completing TPTDescriptionEligible PLHIV who completed a course of TPT during the reporting periodRecommended core national indicatorRecorded daily, reported quarterly to national or sub-national levelInformation that affects recording, reporting, and interpretation of this indicatorIndividuals who have adhered to and completed at least 80% of the dose within the recommended time frame are classified as completedData since 2015NumeratorThe number of eligible PLHIV who completed a course of TPTDenominatorThe number of eligible PLHIV who started TPT
15. Recommended Custom Indicators
16. Eligibility for TPTDescriptionART patients eligible for initiation of TPTReport semi-annually (Q2 and Q4)DescriptionDisaggregatesNumeratorThe number of ART patients eligible for TPTNew ARTEligible for TPT;<15F/M, 15+F/MIneligible for TPT (active TB, contraindications)<15F/M, 15+F/MPrevious ART Eligible for TPT;<15F/M, 15+F/MIneligible for TPT (active TB, contraindications, previous TPT completion)<15F/M, 15+F/MDenomi-natorThe total number of ART patients both eligible and ineligible for TPTNew ART (<15F, <15M, 15+F, 15+M); Previous ART (<15F, <15M, 15+F, 15+M)
17. TPT initiationDescriptionART patients who initiated a standard course of TPT within reporting periodReport semi-annually (Q2 and Q4)DescriptionDisaggregatesNumeratorThe number of ART patients who were newly started on TPTNew ART (<15F, <15M, 15+F, 15+M); Previous ART (<15F, <15M, 15+F, 15+M)
18. Cumulative PLHIV with at least 6 months TPTDescriptionART patients who have ever completed a standard course of TPT as of the reporting periodReport semi-annually (Q2 and Q4)DescriptionDisaggregatesNumeratorThe number of ART patients who ever completed at least 6 months of TPTNew ART (<15F, <15M, 15+F, 15+M); Previous ART (<15F, <15M, 15+F, 15+M)
19. TB diagnosis among PLHIV DescriptionART patients diagnosed with TB within reporting period Report semi-annually (Q2 and Q4)DescriptionDisaggregates NumeratorThe number of ART patients who were diagnosed with TBNew ART (<15F, <15M, 15+F, 15+M); Previous ART (<15F, <15M, 15+F, 15+M)DenominatorThe number of ART patients who screened positive for TB at least once and had a specimen sent for diagnosis (TX_TB DEN SPEC)New ART (<15F, <15M, 15+F, 15+M); Previous ART (<15F, <15M, 15+F, 15+M)
20. MER Data Entry Screens
21. TB_STAT Data Entry Screens: DenominatorTotal number of new and relapse TB casesFY17 Results FY18 Results
22. TB_STAT Data Entry Screens: NumeratorNumber of new and relapse TB cases with documented HIV statusFY17 Results FY18 Results*Includes TB_STAT_POS
23. TB_ART Data Entry Screens: NumeratorNumber of TB cases with documented HIV-positive status who start or continue ARTFY17 Results FY18 Results
24. TX_CURR Data Entry ScreensNumber of adults and children currently receiving ARTFY17 Results FY18 Results
25. TX_NEW Data Entry ScreensNumber of adults and children newly enrolled on ARTFY17 Results FY18 Results
26. TX_TB Data Entry Screens: NumeratorThe number of ART patients who were started on TB treatmentFY17 Results FY18 Results
27. TX_TB Data Entry Screens: DenominatorThe number of ART patients who were screened for TB at least onceFY17 Results FY18 Results*Includes screen results and specimen testing.
28. TB_PREV Data Entry Screens: NumeratorNumber of ART patients who completed a course of TPTFY17 Results FY18 Results
29. TB_PREV Data Entry Screens: DenominatorNumber of ART patients who have started (FY17) / are expected to complete (FY18) a course of TPTFY17 Results FY18 Results
30. Indicator Guidance Details
31. TB_STAT: FY17 Guidance (v.2.1)
32. TB_STAT: FY17 Guidance (v.2.1) - continued
33. TB_STAT: FY18 Guidance (v.2.2)
34. TB_STAT: FY18 Guidance (v.2.2) - continued
35. TB_ART FY17 Guidance (v.2.1)
36. TB_ART FY17 Guidance (v.2.1) - continued
37. TB_ART FY18 Guidance (v.2.2)
38. TX_CURR FY17 Guidance (v.2.1)
39. TX_CURR FY17 Guidance (v.2.1) - continued
40. TX_CURR FY18 Guidance (v.2.2)
41. TX_CURR FY18 Guidance (v.2.2) - continued
42. TX_NEW FY17 Guidance (v.2.1)
43. TX_NEW FY17 Guidance (v.2.1) - continued
44. TX_NEW FY17 Guidance (v.2.1) - continued
45. TX_NEW FY18 Guidance (v.2.2)
46. TX_NEW FY18 Guidance (v.2.2) - continued
47. TX_TB FY17 Guidance (v.2.1)
48. TX_TB FY17 Guidance (v.2.1) - continued
49. TX_TB FY18 Guidance (v.2.2)
50. TX_TB FY18 Guidance (v.2.2) - continued
51. TB_PREV FY17 Guidance (v.2.1)
52. TB_PREV FY17 Guidance (v.2.1) - continued
53. TB_PREV FY18 Guidance (v.2.2)
54. TB_PREV FY18 Guidance (v.2.2) - continued
55. TB_PREV FY18 Guidance (v.2.2) - continued
56. WHO LTBI Indicator Guidance
57. WHO LTBI Indicator Guidance