An appraisal of indicators used to monitor the treated population in antiretroviral programmes in low-income countries.
Monitoring the progress of HIV programmes is vital, as services are scaled up to include increasing numbers in need of care. Globally, the presence of multiple donors at all levels of HIV care has produced vast monitoring systems. Within HIV-treatment programmes in low and middle-income countries, directly assessing long-term outcomes such as survival is problematic, so indicators are used to monitor the progress of the treated population. However, the internal, external, construct validity and predictive value of current indicators have never been evaluated. Although the burden on facility staff compiling routine monitoring reports is vast, there is uncertainty as to which indicators best monitor patient progress. This burden will grow as increasing numbers of life-cohorts are created for monitoring purposes leading to data inaccuracies and compromising the internal validity of reported indicators. Furthermore, a number of fundamental indicators, including survival and retention, may not capture the construct they intend to measure, compromising the ability of programme managers to obtain reliable estimates regarding the welfare of their population in care. It is not known which indicators can predict the longer-term outcome of the patient population, and as such, can enable managers to respond to predictors of failure early. An evaluation of current indicators is urgently needed to ensure that reported facility-level data accurately reflect the welfare of the treated population and comparisons of programme performance are meaningful.
Hoskins
Susan
S
Medical Research Council Clinical Trials Unit, UK. sjh@ctu.mrc.ac.uk
Weller
Ian
I
Jahn
Andreas
A
Kaleebu
Pontiano
P
Malyuta
Ruslan
R
Kirungi
Wilford
W
Fakoya
Ade
A
Porter
Kholoud
K
D023241:Antiretroviral Therapy, Highly Active; D003906:Developing Countries / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D015497:HIV-1; D006305:Health Status Indicators; D006801:Humans