Number of people who were tested for HIV and received their results

How to use this indicator

This indicator monitors trends in the use of HIV testing and counseling services within a community, regardless of the location of testing, testing source, or population type. Monitoring this indicator at the community level can provide insight into populations vulnerable to or living with HIV that are not being reached by services at the facility level because of difficulties associated with access. Disaggregation for this indicator exposes the equity or lack thereof of HIV counseling and testing service access and uptake. These data allow an understanding of the number of people in a community that have accessed HIV testing services and know their status and the effectiveness of community-based interventions in linking people to testing. This information also gives community HIV program insight into resource needs, if the programs provide community-based HIV testing services, or whether they should increase efforts to motivate beneficiaries to come to testing. Although facility-based testing typically yields more HIV-positive test results, community-based testing has a positive association with retrieving people testing for the first time and adults with CD4 counts more than 350 cells/mm3. Because combined facility and community-based testing approaches tend to increase HIV testing and counselling coverage, multiple approaches are recommended, including standalone sites, home-based testing, mobile outreach, and multi-disease campaigns.

Numerator

Number of adults and children who accessed HIV testing services and received their HIV test results during the reporting period

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

Data for the indicator are gathered by counting the total number of adults and children who received HIV testing services and know their test results, regardless of the source of testing (facility or community level). As part of case management, community workers should ask beneficiaries this question to assess whether those living with, or vulnerable to, HIV have been tested, are aware of their status, so that they are able to protect themselves and others and seek treatment if they tested positive.

This indicator specifically tracks HIV testing from any source, and not HIV status. If a project beneficiary has received HIV testing, regardless of source or age, they should be counted towards this indicator. HIV testing of HIV-exposed infants, however, should be counted under the early infant diagnosis indicator (see definition here).

HIV diagnosis should be confirmed per country guidelines. HIV rapid testing must be confirmed with a second test prior to enrollment in care or initiating ART. However, any person who was tested and is aware of his or her HIV serostatus should be counted for this indicator. Verification tests should be conducted prior to initiation on ART, but these tests should not be counted towards this indicator. HIV counseling and testing should adhere to WHO guidelines of informed consent, confidentiality, correct test results, and connection (linkage to care, treatment, and other services).

A mandate to do no harm must be the absolute priority whenever community programs engage in data collection and reporting of HIV status. All data must be managed with confidentiality to ensure that the identities of people living with HIV (and their key population status as applicable) are protected, to prevent stigma and discrimination. Confidentiality must be maintained especially when mapping those living with HIV. Codes and unique identifiers are recommended to protect identities, and to account for retesting and avoid double counting if electronic systems are available. Community workers should engage with utmost caution in collecting, managing, and reporting this information and should ensure confidentiality of files.

Data source

Data for this indicator are frequently collected through tools used at the community level by community workers engaged in vulnerable children (VC), key population (KP), and HIV programs. HIV testing information is collected through VC tools at the community level to report provision of comprehensive family care of households supported. Health workers regularly monitor the HIV status of the adults and children of each supported household using HIV risk assessment tools, vulnerable household summary forms, and graduation checklists.

For key population programs, this information is also frequently collected in tools such as HIV testing outreach registers and behavior-change communication activity forms. Other HIV programs typically include HIV testing in forms like HIV counseling and testing client cards, client profiles, antenatal and postnatal client appointment diaries, and family folders.

Disaggregation

  • Age (<1 year, 1–4 years, 5–9 years, 10–14 years, and 15–19 years for children; 20–24 years, 25–49 years, and 50+ years for adults)
  • Sex
  • Pregnancy/lactation status
  • Key population type (sex workers, transgender people, men who have sex with men, people who inject drugs)
  • HIV testing service modality
    • Community—index, mobile, VCT, other community testing platform
    • Facility index, STI, inpatient, emergency, voluntary medical male circumcision (VMMC), voluntary counseling and testing (VCT), tuberculosis (TB), prevention of mother-to-child transmission (PMTCT), pediatric, malnutrition, other
    • Presence of partner (live-in commercial/noncommercial)

Service delivery modalities that apply specifically to the community level are detailed below. A community worker can track community-based testing specifically, by tracking the number of people tested in locations other than facilities. Community workers that cannot provide testing should refer people for facility-based testing and return later to guarantee uptake of testing services and receipt of test results—in which case they can be counted towards this indicator.

Community-based service delivery modalities:

  • Community index case testing: method of testing members of social and sexual networks of people living with HIV at high risk of HIV transmission at the community level. This method can be implemented using incentivized case finding, peer-driven outreach, and partner notification services, which means using this method to identify people for testing in the community, even if they were tested at a facility.
  • Home-based testing: testing done at the household during home visits or door-to-door testing
  • Mobile testing: temporary testing locations excluding VMMC
  • VCT: drop-in center, wellness clinic where HIV testing is provided, site designated for key populations
  • Other community platforms: ad hoc testing campaign and VC testing

If a person occupies more than one category of a key population, this information should be reported by the community worker.

The following information is recommended for data collection by community workers:

  • Retesting status for HIV-positive diagnosis
  • HIV test results
  • Date of HIV test
  • Receipt of HIV test results
  • Previously tested during the reporting period
  • Demographics: unique patient identifier, sex, name, age at the time of testing
  • Date person tested positive and was referred to treatment
  • Community service delivery modality information: name and location

Data quality considerations

The overall number reported for this indicator should be equal to the sum of the numbers of people in each disaggregation type. Recommendations call for only one type of age disaggregation to be used throughout, overlap to be avoided, and service delivery modalities be made mutually exclusive.

Note that people who have been tested and are aware of their status should only be counted once within the allotted time frame, though they may have been tested numerous times or tracked by facility and community workers. Double counting can be avoided by categorizing data by source, the community versus the facility levels, in a centralized database if community data is integrated into the national health information system. Unique patient identifiers can also track patients through the continuum of care. Note that the number of tests administered should not be counted towards this indicator, but rather the number of people tested.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

HIV testing

Category

Key Populations, Vulnerable Children, Home-Based Care, Prevention of Mother-to-Child Transmission

Data use case

To see a data use example for this indicator, please click below.

HIV Testing for Vulnerable Children and Their Families in Côte d’Ivoire

References

The United States President’s Emergency Plan for AIDS Relief. (2018). Monitoring, evaluation, and reporting (MER 2.0) indicator reference guide updated release (Version 2.2). Washington, DC: PEPFAR. Retrieved from https://www.pepfar.gov/documents/organization/274919.pdf

World Health Organization. (2013). 5.1 HIV testing and counselling. Retrieved from http://www.who.int/hiv/pub/guidelines/arv2013/clinical/testingintro/en/index3.html

World Health Organization. (n.d.). HIV/AIDS. Retrieved from http://www.who.int/mediacentre/factsheets/fs360/en/

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