This indicator permits monitoring trends in enrolment in HIV care (pre-ART and ART) but does not attempt to measure the quality nor retention in HIV care.

Additional considerations:
Most countries report the number of people newly initiated on ART as part of the number newly enrolled in pre-ART; then those needing ART are transferred from the pre-ART register to the ART register.
If people starting ART are not recorded in the pre-ART register, then one possible way to calculate the numerator is by adding the number newly enrolled in pre-ART with the number newly enrolled in ART and subtracting the number of people who transferred from pre-ART to ART in a given year. However, in many settings with paper-based monitoring systems, it may not be feasible to easily know the number of people who transferred from pre-ART to ART at the national level unless the national cross-sectional reporting form is set up to report up this information.

Data utilization: Reviewing the number of people newly enrolled in HIV care (initiating pre-ART/ ART) with the number of people newly diagnosed HIV+ can provide an indication of uptake of HIV care among those diagnosed HIV+.

Other references: This is a new indicator for global reporting, and is the numerator of indicator D-1 in the HIV testing and counselling M&E guide (field-test version).

This indicator permits monitoring trends in enrolment in pre-ART but does not attempt to measure the details nor the quality of pre-ART care provided. It also does not capture retention during the pre-ART period.

Additional considerations:

People on the ART 'waiting list', i.e. patients eligible for ART and not initiated, are often listed in the pre-ART register. The number of people retained on pre-ART is also important to review when possible, to ensure people with HIV are engaged in care even if ART has not been initiated.
Some countries record all patients in pre-ART even if they are eligible to start ART by enrolling them, and then transferring them to the ART register; in other cases, patients eligible for ART may be immediately recorded only in ART registers, for example if pre-ART registers do not exist. This is important to keeping in mind when reviewing related data.

Data utilization:
Reviewing the number of people initiating pre-ART with the number of people diagnosed HIV+, and the number of people initiating ART (previous question) provides information on trends in initiation to pre-ART and ART programmes.

This indicator permits monitoring trends in initiation but does not attempt to distinguish between different forms of antiretroviral therapy or to measure the cost, quality or effectiveness of treatment provided. These will each vary within and between countries and are liable to change over time.
The degree of initiation of ART will depend on factors such as cost relative to local incomes, service delivery infrastructure and quality, availability and uptake of voluntary counselling and testing services, and perceptions of effectiveness and possible side effects of treatment.

Additional considerations:
This indicator should be analysed in view of the 'waiting list' i.e. patients eligible for ART and not initiated.

Data utilization: In addition to the number of old patients retained on ART (retention on ART) the number of patients newly initiated is necessary for accurate planning of resources and drug stocks (avoiding shortage and wastage)

Other references: PEPFAR indicator and guidelines

Although WHO has provided a global case definition, actual case definition may vary between and within countries. Furthermore, clinical diagnostic capacity may vary between and within countries. Although underreporting of this indicator may occur, in the absence of changes in case definition or major changes in screening practices, these data can generally be used for following trends over time within a country.

Additional considerations: It is important that countries when reporting on genital ulcer disease communicate on the extent to which the data are felt to be representative of the national population.
Countries should conduct periodic assessments of the etiology of genital ulcer disease in order to ensure appropriate drug selection for syndromic management and to understand the extent to which genital ulcer disease reflects incident infection due to recurrent HSV infection versus acute infection with syphilis, chancroid, or HSV.

Data utilization: Look at trends in comparable groups over time.

Although WHO has provided a global case definition, actual case definition may vary between and within countries. Furthermore, clinical diagnostic capacity may vary between and within countries. Although underreporting of this indicator may occur, in the absence of changes in case definition or major changes in screening practices, these data can generally be used for following trends over time within a country.

Additional considerations: It is important that countries when reporting on urethral discharge communicate on the extent to which the data are felt to be representative of the national population.
Following trends in urethral discharge is a feasible means to monitor incident STI in a population. Data on vaginal discharge among women, although useful for monitoring purposes at a local and national level, are not requested at the global level because in many settings the majority of vaginal discharge cases are not due to sexually transmitted infections.
Countries should conduct periodic assessments of the etiology of urethral discharge syndrome in order to understand the predominant causes of urethral discharge and therefore appropriate therapy.

Data utilization: Look at trends in comparable groups over time.

Although WHO has provided a global case definition, actual case definition may vary between and within countries. Furthermore, diagnostic capacity may vary between and within countries. Although underreporting of this indicator may occur, in the absence of changes in case definition or major changes in screening practices, these data can generally be used for following trends over time within a country.

Additional considerations: It is important that countries when reporting on gonorrhoea communicate on the extent to which the data are felt to be representative of the national population.
Data on gonorrhoea among women, although useful for monitoring purposes at a local and national level, are not requested at the global level because the majority of women infected with Neisseria gonorrhoeae are asymptomatic and sensitive diagnostic tests for gonorrhoea in women are not widely available in developing countries. Therefore data on gonorrhoea among women are felt to be too dependent on diagnostic resources and screening practices to be monitored appropriately at the global level.

Data Utilization: Look at trends in comparable groups over time.

Diagnosis of congenital syphilis is most reliable when using specific diagnostic tests that are seldom available in developed countries. Therefore, in most countries diagnosis of congenital syphilis relies on clinical history and examination, making surveillance challenging. Although WHO has a global case definition for surveillance purposes, actual case definition may vary between and within countries and regions.

Additional considerations: It is important that countries when reporting on syphilis communicate on the extent to which the data are felt to be representative of the national population.

Data utilization: Given the difficulties in diagnosing congenital syphilis, and depending on the case definition used, either underreporting or overreporting can be a problem. The likely magnitude of such reporting errors should always be considered when looking at rates of congenital syphilis. However, with use of a consistent case definition, trends over time may be useful.

Although WHO has provided a global case definition, actual case definition may vary between and within countries. Furthermore, diagnostic capacity may vary between and within countries. Although underreporting of this indicator may occur, in the absence of changes in case definition or major changes in screening practices, these data can generally be used for following trends over time within a country.

Additional considerations: It is important that countries when reporting on syphilis communicate on the extent to which the data are felt to be representative of the national population.

Data utilization: Look at trends in comparable groups over time.

Despite national policy, CTX prophylaxis is not always fully implemented. In addition low coverage might reflect potential bottlenecks in the system such as poor management of CTX supply, poor data collection and inadequate distribution system.

Additional considerations: This indicator that reflects coverage should also be interpreted in view of the
national recommendations for CTX.

Data utilization: General idea of whether those who require CTX are receiving it. Explore disaggregated value to see whether there are patterns at individual facility of a sub-national level (e.g. stock outs in specific places) which can be addressed.