HIV epidemics driven in part by injecting cocaine,

Estimation of antiretroviral therapy coverage: methodology and trends.

HIV epidemics driven in part by injecting cocaine,

The purpose of this review was to present the methodology used to calculate coverage of antiretroviral therapy and review global and regional trends in antiretroviral therapy coverage. There has been a steady increase in antiretroviral therapy coverage over the last decade with a more rapid increase in recent years. Current estimates of antiretroviral therapy coverage are 43% for adults and 38% for children (ages 0-14 years). Methods for calculating coverage rely on good-quality patient monitoring systems in countries, and well informed models are needed to estimate the number of people in need of treatment. The estimated coverage rates show that antiretroviral therapy programs have improved over the past 8 years; however, approximately 58% (53-60%) of those people in need of antiretroviral therapy are still not on treatment. High quality data are needed to accurately measure changes in antiretroviral therapy coverage.

Antiretroviral treatment coverage is defined as the percentage of people on treatment (the numerator) among those in need of treatment (the denominator). Few countries, notably Brasil and Zambia, have a monitoring system based on individual information. Elsewhere facility-based reporting of aggregated data based on patient and pharmacy monitoring is compiled to produce a national level estimate. In 2008, 91% of 149 low- and middle-income countries reported the number of people on antiretroviral treatment and 64% reported disaggregating data by sex. The estimated 9.5 million (8.6-10 million) people currently in need of antiretroviral treatment will be joined by many million more as countries begin to adopt the new WHO antiretroviral treatment guidelines. Therefore, although the numerator (those on treatment), estimated at over 4 million (3.7-4.4 million) in 2008, is steadily growing, the denominator is set to rise dramatically. Regardless of whether the old or the new denominator or both are used to determine coverage, the focus should be on accelerating the growth of the numerator!