ART & PreP Module Guide

 

The Health Services Report captures information on PSI’s antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) service delivery on a monthly basis. All service data are disaggregated by Channel: Franchise Facility, Service Delivery Partner, or PSI Direct Service Provision. For franchise facilities and service delivery partners, only services that meet PSI’s criteria for service delivery through partners can be reported. For detailed definitions of these channels and channel types, please click here: https://helppsi.freshdesk.com/support/solutions/articles/14000014984-common-data-element-definitions


Why collect these data?

The tables compile data based on PEPFAR indicators. Most of the attributes by which the data elements are disaggregated are required by PEPFAR and are used to evaluate whether prioritized services have been successful at reaching the targeted populations. This data is useful for a variety of programmatic and reporting applications:

 

Internally , these data provide important information about global trends in service delivery, informing quality assurance measures and facilitating identification of platform-to-platform technical assistance opportunities for programmatic improvement. These data are also key for proposals, further ensuring program advancement through continued and additional funding.

 

Externally , these data allow PSI to leverage its network to contribute to global discussions about prevention and linkage to care. PSI is often asked to share global data related to PEPFAR indicators.

 

Impact Estimation  (e.g. DALYs averted, HIV infections averted): In each table, we have noted where data will be used to estimate impact.

 

The table below outlines the module’s section, tables, and their corresponding data elements:


Section 1: ART

Data Elements

Table 1: ART clients by channel
Newly enrolled on ART (TX_NEW)

Clients currently receiving ART (TX_CURR)

Clients known to be alive and on treatment 12 months after initiation of ART (TX_RET)

Section 2: PrEP

Data Elements

Table 1: PrEP clients by channel
Number of users of PrEP

Section 3: Client Age

Data Elements

Table 1: Clients treated with ART by age and sex
Newly enrolled in treatment by age and sex (TX_New)

Clients currently enrolled in treatment by age and sex (ART) (TX_CURR)
Table 2: Clients provided PrEP by age and sex
Users of PrEP, by age and sex


Each table and data element are described in further detail below.


Section 1: ART

Data Elements

Table 1: ART clients by channel
Newly enrolled on ART (TX_NEW)

Clients currently receiving ART (TX_CURR)

Clients known to be alive and on treatment 12 months after initiation of ART (TX_RET)


Data Element: Newly enrolled on ART (TX_NEW) by channel
Purpose: This data element measures the number of individuals initiating ART within PSI treatment programs.
Precise Definitions:
 
This data element measures the number of individuals initiating ART within PSI programs.
 
Patients who receive linkage support and are confirmed linked into non-PSI care and treatment (i.e. public sector) should be recorded in the effective referrals module.
 
NEW is a state defined by an individual’s initiating life-long ART for the first time and are naive to lifelong treatment.

It is expected that the characteristics of new clients are recorded at the time they newly initiate life-long ART. For example patients who received post-exposure prophylaxis (PEP) or short term ART only for prevention of mother-to- child transmission (PMTCT) in the past would still be counted as “new” on ART once they initiate lifelong ART.

Patients who transfer in from another facility, or who temporarily stopped therapy and have started again should not be counted as new patients.
 
For a detailed definition of “channel” see the common data elements definition page.
Unit of Measure: individuals newly enrolled  
Disaggregated by:  channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision)
Justification/Management Utility: The data element measures the ongoing scale-up and uptake of ART programs within PSI. This measure is critical to monitor along with number of patients currently on ART in relation to the number of PLHIV that are estimated to be eligible for treatment and to demonstrate our effectiveness at linking patients to care.


Data Element: Clients currently receiving ART (TX_CURR) by treatment channel
Purpose: Measures the number of clients currently receiving treatment through a PSI treatment program.
Precise Definitions:
This data element counts all clients enrolled in a treatment program through PSI who were enrolled in a month previous to the reporting period and who are not considered lost to follow-up. (i.e. not seen for 3 months from last visit, unless they are enrolled in a multi-month scripting program which could extend longer than 3 months).

Clients who have been linked to out-of-network providers (such as the public sector) should be recorded under effective referrals.

Current on ART should equal the number of adults and children with HIV who ever started ART minus those patients who are not currently on treatment (due to non-adherence, transfer out, or death) during the reporting period. The following calculation should include:
  • Patients who transferred-in during the reporting period or who were previously on ART but stopped for a period (and have re-initiated) should be counted.
  • The count should include clients who attended their last visit and picked up multi-month supply of ARVs. Patients do not need to attend the facility during the reporting period to be counted.
  • Records must be keep current to identify patients lost to follow-up (LTFU) (i.e. not seen at their last expected appointment).
  • HIV-positive pregnant women who are eligible and receiving ARV for their own treatment are included.
  • Patients excluded from the Current on ART count are patients who died, stopped treatment, transferred out, or are lost to follow-up.
  • Patients who enrolled in treatment during the reporting period should be also be counted under “Newly enrolled on ART (TX_NEW) by channel”
 For a detailed definition of “channel” see the common data elements definition page.
Unit of Measure: individuals previously enrolled and not lost to follow-up or transferred to another facility
Disaggregated by:  channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision)
Justification/Management Utility: The data element measures the ongoing scale-up and uptake of ART programs within PSI. This measure is critical to monitor the total scale of PSI programs. DALYs and HIV infections averted will be calculated based on the confirmed number of patients enrolled in care (i.e. not dead or lost to follow-up). Therefore enrollment records must be kept current.


Data Element: #  Clients known to be alive and on treatment 12 months after initiation of ART (TX_RET)
Purpose: This data element measures retention which is a proxy for adherence. This is important to know as it aligns with the “third 90”, viral suppression. It also shows the extent to which PSI programs provide a full treatment program
Precise Definitions:
The numerator is defined as the number of adults and children who are still alive and on treatment within PSI treatment programs twelve months after initiating lifelong ART.
 
Patients who have transferred in with a known treatment initiation date that falls within the reporting period should be counted. Conversely, patients who transferred out of should not be counted.
For reporting in November 2016, all clients who initiated in the previous 12 months (November 2015-October 2016) or transferred in during that period and are still enrolled in care (haven’t died, transferred, or been lost to follow-up) are counted.
 
Only programs which have been operating for more than 12 months should report on this.
 
Patients known to be alive and on treatment outside of PSI networks (i.e. public sector) should not be included in this count.
 
For a detailed definition of “channel” see the common data elements definition page.
Unit of Measure: clients retained in care
Disaggregated by:  channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision)
Justification/Management Utility: This data element measures the proportion of individuals who have retained on antiretroviral therapy (ART). ART is viewed by the scientific community and PEPFAR not only as essential for decreasing morbidity and mortality, but also as a highly effective approach to prevent HIV transmission. High retention is one important measure of program success, specifically in reducing morbidity and mortality, and is a proxy for overall quality of the ART program.



Section2: PrEP

Data Elements

Table 1: PrEP clients by channel
Number of users of PrEP

Data Element: Number of users provided with PrEP
Purpose: The data element measures the ongoing growth of PrEP services and impact of this intervention. This measure is critical to assess progress in the program’s response to the epidemic in specific geographic areas, and the uptake and utility of PrEP among persons at substantially increased risk of HIV infection.
Precise Definitions:
This data element the total number of clients who are currently using PrEP, regardless of their user status (i.e. This data element counts new users of PrEP as well as continuing users or those who have used in the past, stopped, and re-started).

In order to report this data element, programs should keep a “PrEP register” to record clients who have been prescribed PrEP. The register must indicate when the client is due back for a follow-up consultation or HIV testing. The client should be recorded each month as a “user of PrEP” until they no longer return for an expected follow-up. For example, Client X is given PrEP in January and asked to return in March for follow-up testing. Client X should be recorded as a “user of PrEP” in January and February. If the client doesn’t return in March, they should no longer be counted as a “users”. Therefore, clients do not have to physically receive services each month to be counted.

Pre-exposure prophylaxis (PrEP) is the use of prescription drugs by people who do not have HIV/AIDS as a strategy for the prevention of HIV/AIDS. It is an optional treatment which may be taken by people who are HIV negative, but who have substantial, higher-than-average risk of contracting an HIV infection.
 
For a detailed definition of “channel” see the common data elements definition page.
Unit of Measure: People provided with PrEP
Disaggregated by:  channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision)
Justification/Management Utility: This measure is critical to assess progress in the program’s response to the epidemic in specific geographic areas and the uptake and utility of PrEP among persons at substantially increased risk of HIV infection.

Section 3: Client Age

Data Elements

Table 1: Clients treated with ART by age and sex
Newly enrolled in treatment (TX_New)

Clients currently enrolled in treatment (ART) (TX_CURR)
Table 2: Clients provided PrEP by age and sex
Users of PrEP

Data Element: Newly enrolled on ART (TX_NEW) by age/sex
Purpose: This data element measures the number of individuals initiating ART within PSI treatment programs by age and sex.
 
Precise Definitions:
 
This data element measures the number of individuals initiating ART within PSI programs.
 
Patients who receive linkage support and are confirmed linked into non-PSI care and treatment (i.e. public sector) should be recorded in the effective referrals module.
 
NEW is a state defined by an individual’s initiating life-long ART for the first time and are naive to lifelong treatment.
It is expected that the characteristics of new clients are recorded at the time they newly initiate life-long ART. For example patients who received post-exposure prophylaxis (PEP) or short term ART only for prevention of mother-to- child transmission (PMTCT) in the past would still be counted as “new” on ART once they initiate lifelong ART.
Patients who transfer in from another facility, or who temporarily stopped therapy and have started again should not be counted as new patients.
 
Unit of Measure: individuals newly enrolled
Disaggregated by: age (<1, 1-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-49, 50+) and sex (M/F)
Justification/Management Utility: The data element measures the ongoing scale-up and uptake of ART programs within PSI. This measure is critical to monitor along with number of patients currently on ART in relation to the number of PLHIV that are estimated to be eligible for treatment and to demonstrate our effectiveness at linking patients to care. Tracking uptake by age helps PSI track which groups are reached with treatment and which populations may still need further support.

Data Element: Clients currently receiving ART (TX_CURR) by by age/sex
Purpose: Measures the number of clients currently receiving treatment through a PSI treatment program by age and sex.
Precise Definitions:
 
This data element counts all clients enrolled in a treatment program through PSI who were enrolled in a month previous to the reporting period and who are not considered lost to follow-up. (i.e. not seen for 3 months from last visit, unless they are enrolled in a multi-month scripting program which could extend longer than 3 months).
 
Clients who have been linked to out-of-network providers (such as the public sector) should be recorded under effective referrals.
 
Current on ART should equal the number of adults and children with HIV who ever started ART minus those patients who are not currently on treatment (due to non-adherence, transfer out, or death) during the reporting period. The following calculation should include:
 
  • Patients who transferred-in during the reporting period or who were previously on ART but stopped for a period (and have re-initiated) should be counted.
  • The count should include clients who attended their last visit and picked up multi-month supply of ARVs. Patients do not need to attend the facility during the reporting period to be counted.
  • Records must be keep current to identify patients lost to follow-up (LTFU) (i.e. not seen at their last expected appointment). 
  • HIV-positive pregnant women who are eligible and receiving ARV for their own treatment are included.
  • Patients excluded from the Current on ART count are patients who died, stopped treatment, transferred out, or are lost to follow-up. 
  • Patients who enrolled in treatment during the reporting period should be also be counted under “Newly enrolled on ART (TX_NEW) by channel”
 
For a detailed definition of “channel” see the common data elements definition page.
Unit of Measure: individuals previously enrolled and not lost to follow-up or transferred to another facility
Disaggregated by: age (<1, 1-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-49, 50+) and sex (M/F)
Justification/Management Utility: The data element measures the ongoing scale-up and uptake of ART programs within PSI. Tracking uptake by age helps PSI track which groups are reached with treatment and which populations may still need further support.

Data Element: Number of users provided with PrEP by age/sex
Purpose: The data element measures the ongoing growth of PrEP services and impact of this intervention. This measure is critical to assess progress in the program’s response to the epidemic in specific geographic areas, and the uptake and utility of PrEP among persons at substantially increased risk of HIV infection.
Precise Definitions:
 
This data element the total number of clients who are currently using PrEP, regardless of their user status (i.e. This data element counts new users of PrEP as well as continuing users or those who have used in the past, stopped, and re-started).
 
In order to report this data element, programs should keep a “PrEP register” to record clients who have been prescribed PrEP. The register must indicate when the client is due back for a follow-up consultation or HIV testing. The client should be recorded each month as a “user of PrEP” until they no longer return for an expected follow-up. For example, Client X is given PrEP in January and asked to return in March for follow-up testing. Client X should be recorded as a “user of PrEP” in January and February. If the client doesn’t return in March, they should no longer be counted as a “users”. Therefore, clients do not have to physically receive services each month to be counted.
 
Pre-exposure prophylaxis (PrEP) is the use of prescription drugs by people who do not have HIV/AIDS as a strategy for the prevention of HIV/AIDS. It is an optional treatment which may be taken by people who are HIV negative, but who have substantial, higher-than-average risk of contracting an HIV infection.
 
For a detailed definition of “channel” see the common data elements definition page.
 
Unit of Measure: People provided with PrEP
Disaggregated by: age (<1, 1-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-49, 50+) and sex (M/F)
Justification/Management Utility: This measure is critical to assess progress in the program’s response to the epidemic in specific geographic areas and the uptake and utility of PrEP among persons at substantially increased risk of HIV infection. Tracking uptake by age helps PSI track which groups are reached with treatment and which populations may still need further support.