2016 indicator reference guide priority pop prevention services

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Prevention Services October 2015
Priority Populations HIV Prevention
Indicator code:
PP_PREV 1
Percentage of individuals from priority populations who completed a standardized HIV
prevention intervention, including the specified minimum components, during the
reporting period
Purpose:
Individual and small-group level prevention interventions have been shown to be effective in reducing HIV transmission
risk behavior, when delivered with fidelity to the intervention design. This indicator shows trends in the reach and depth
of a standardized HIV prevention intervention that includes the specified minimum components. Activities counted
under this indicator focus on promoting safer sexual behaviors and uptake of services.
populations at high risk of acquiring or transmitting HIV
as evidenced by data on HIV prevalence. This indicator should be used to report on achievements in delivering that
package to each of the priority populations.
NGI Mapping: New. Replacing P8.1.D given the significant modification in definition; trend analysis will be
impacted. Data collected for the numerator can be compared to data collected for P8.1.D in
prior years, although trends should be interpreted with care since the new version further
constrains the interventions under which individuals can be counted.
PEPFAR Support
Target/Result Type:
Both Direct Service Delivery (DSD) and Technical Assistance-Service Delivery Improvement (TA-
SDI) targets and results should be reported to HQ
Numerator:
1
Number of individuals from priority populations who completed a standardized HIV
prevention program including the specified minimum components
Denominator: 1 Total number of people in each priority population.
Disaggregation(s):
1
Age/Sex: 10-14 Male, 10-14 Female, 15-19 Male, 15-19 Female, 20-24 Male, 20-24 Female,
25-49 Male, 25-49 Female, 50+ Male, 50+ Female
Data Source: Relevant program monitoring tools. Data collection requires reliable tracking systems that are
designed to count the number of one-on-one interventions or the number of people
participating in small group interventions, as well as age and sex. Tracking systems must be able
to eliminate double-counting of individuals in a reporting period. If possible a unique identifier
can be assigned to program participants or names can be collected to track individual
participation in the prevention interventions/sites.
Data Collection
Frequency:
Data should be collected at every encounter/point of service and aggregated in time for PEPFAR
reporting cycles. Data should be reviewed regularly for the purposes of program management,
to monitor progress towards achieving targets, and to identify and correct any data quality
issues.
Method of Measurement:
Data are generated by counting people who completed a standardized HIV prevention intervention that includes the
minimum specified components during the reporting period. A protocol should be in place to determine the
requirements for completing the intervention.
For calculating the denominator, use the best available size estimate for each priority population. The denominator will
be the size estimate multiplied by the coverage target. See the following example.
Example: Estimating coverage of a priority population
team has chosen four priority populations Sex Workers (for whom activities will be measured under the Key

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Populations indicator), migrant mine workers in three districts, out-of-school girls aged 15-24 in 25 peri-urban
areas, boys 14 25 targeted for VMMC.
Package of interventions: together with the IP, the team designs a set of interventions for each of these groups
that include the minimum components required in this indicator, tailored to the population.
Size estimation: the team also estimates the size of each of the populations in each of the geographic zones where
the IP will implement. Geographic zones are chosen based upon epidemiological data with care to prevent
duplication of service support with other donors. In our example, size estimations for migrant miners might be
10,000 in District 1; 8,000 in District 2; and 4,000 in District 3 (based upon a recent report from the International
Organization for Migration).
Target setting: the team sets a coverage target for each population, with a goal of saturating that population to
reach impact. Using our example of migrant mine workers, the team might decide to shoot for 80% coverage of
each population, making the target for district 1, 8,000 reached; for district 2, 6,400 reached; and district 3 3,200
reached. The total target for this population would be 17,600.
Reporting: At the APR, the team will report a single number to PEPFAR headquarters, which is the sum of all
members of each priority population reached in the reporting period with the full package. So if the programs
reached 18,000 migrant mine workers, 20,000 out of school girls and 33,000 boys, the number would be 71,000.
This total would be disaggregated and reported by sex by age. In the APR narrative, the team would further
disaggregate the results by priority population, and describe progress made toward coverage goals for each one.
Note that sex workers would not be included in this total even though they are a priority population, as they are
Calculating percentage of priority population reached:
Numerator = number of target population reached (for our miner example, this would be 18,000)
Denominator = Total priority population size (for the miner example, 22,000)
Note that it will be important for the team to also perform this calculation for each district or distinct subset of the
population. In our migrant mine worker example, this means calculating coverage for each district, to learn
whether coverage targets were met for each district and adjust performance plans accordingly.
Explanation of Numerator:
The numerator is the number of individuals from each priority population who completed a standardized HIV prevention
program, including the specified minimum components during the reporting period. For the purposes of the APR, the
team will sum the numbers reached in each of the priority populations and report that total. For the purposes of tracking
coverage more meaningfully at the regional, national or sub-national level, the team will track this indicator separately
for each priority population.
Priority population: PEPFAR-funded programs will identify priority populations for HIV prevention in their COPs and will
report on these populations within this indicator. Please note that priority populations will include "Other Vulnerable
Populations." Groups that might be counted in the category of Other Vulnerable Populations include the following and
should always be selected on the basis of available epidemiological data:"
o Clients of sex workers
o Military and other uniformed services
o Incarcerated persons
o Mobile populations (e.g., migrant workers, truck drivers)
o Non-injecting drug users
Delivery of prevention packages for all priority populations will be tracked with this indicator, with the exception of

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packages for key populations as defined by UNAIDS and WHO: sex workers, men who have sex with men/transgender,
KP
Standardized HIV Prevention Intervention is defined as an activity or set of activities designed for a specific priority
population to reduce HIV transmission that is implemented the same way each time. These interventions adhere to
written protocols, include goals and activities tailored to the priority population, typically comprise multiple encounters
with the same individuals or small groups, and have a system for tracking and reporting the completion of every element
of the intervention.
Minimum components:
Every intervention for adult populations must include all of these components:
1. Targeted risk assessment and provision of risk reduction information, education and/or counseling to correctly
identify HIV prevention methods, reject misconceptions about HIV transmission, and accurately gauge and
personalize risk for HIV infection.
2. Condom promotion, condom skills training including negotiation skills and facilitated access to condoms
whether through direct provision, linkages to social marketing outlets or other means (or referrals for condom
promotion, provision and related skill development)9
.
3. Informational sessions on HIV testing and counseling with active referrals to or provision of HTC services.
4. Demand creation to increase awareness, uptake and acceptability of relevant clinical services such as voluntary
medical male circumcision (VMMC), prevention of mother-to-child transmission (PMTCT), HIV care and
treatment, TB testing and treatment and reproductive health.
5. Activities which: promote gender equitable principles; address harmful norms related to sex and gender; and
seek to reduce stigma and discrimination associated with HIV; and prevent gender-based violence.
Every intervention for youth populations must include all of these components:
1. Targeted risk assessment and provision of risk reduction information, education and/or counseling to correctly
identify HIV prevention methods, reject misconceptions about HIV transmission and increase perception of risk
for HIV infection.
2. Curriculum-based, age-appropriate, HIV prevention skills and sexuality education to prevent HIV acquisition and
encourage safer sex strategies for sexually active youth.
3. Informational sessions on HIV testing and counseling with active referrals to or provision of youth-friendly HTC
services.
4. Community programs targeting adults to raise awareness of HIV risks for young people, promote positive
parenting and mentoring practices, and effective adult-child communication about sexuality and sexual risk
reduction.
5. Demand creation to increase awareness, uptake and acceptability of youth-friendly clinical services such as
voluntary medical male circumcision (VMMC), HIV care and treatment, and TB testing and treatment.
6. Condom promotion, condom skills training including negotiation skills and facilitated access to condoms
whether through direct provision, linkages to social marketing outlets or other means (or referrals for condom
promotion, provision and related skill development1
for sexually active youth.
7. Activities which: promote gender equitable principles; address harmful norms related to sex and gender; and
seek to reduce stigma and discrimination associated with HIV and to prevent gender-based violence.
Standardization and documentation allows public health professionals to evaluate program outcomes. The best
interventions are often identified through a series of efficacy reviews. National Efficacy Review Criteria should be
developed for HIV prevention programs in each country. Technical assistance should be provided to national and local
prevention programs to document, evaluate, and standardize HIV prevention interventions designed to reach a specific
9 PEPFAR may fund prevention programs that do not provide or refer for condom promotion and provision. These
programs may not be counted under this indicator.

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target population to ensure efficacious interventions are implemented and reported.
Explanation of Denominator:
The denominator is the estimated number of individuals in the priority population.
Whenever possible, size estimates for the population should be done at the level of implementation to allow for real-
time tracking of coverage. These lower level estimates can be aggregated for national tracking of coverage. See example
earlier in this reference sheet for more detail. The data tracked at the national level should be disaggregated by each
priority population. Success in achieving coverage of each priority population should be described in the narrative
accompanying the reporting of results in the APR.
Interpretation:
When measured over time and disaggregated, this indicator can demonstrate progress towards achieving coverage of
priority populations with a minimum package of validated HIV prevention interventions. In shorter time frames, the
information collected with this indicator can be used to assess progress towards program-specific goals and to make
management decisions to facilitate progress towards those goals.
When calculating the percent of a population who completed a standardized HIV prevention intervention during the
reporting period, the indicator will represent PEPFAR coverage only. National or other donor programs may be
implemented and not represented in this indicator.
This indicator does NOT capture the impact of HIV prevention programs on incidence. Teams are encouraged to conduct
impact evaluations of specific programs using incidence or other contextually appropriate outcome measures to
determine whether programs are reducing transmission of HIV.
PEPFAR Support:
DSD: Individuals will be counted as receiving direct service delivery support from PEPFAR when BOTH of the below
conditions are met: Provision of key staff or commodities AND frequent, at least quarterly, support to improve the
quality of services.
TA-SDI: Individuals will be counted as supported through TA-SDI when the point of service delivery receives support
from PEPFAR that meets the second criterion only: Frequent, at least quarterly support to improve the quality of
services.
1. PEPFAR is directly interacting with the patient or beneficiary in response to their health (physical, psychological,
etc.) care needs by providing key staff and/or essential commodities for routine service delivery. For priority
populations receiving HIV prevention services, this can include ongoing procurement of critical commodities such
as condoms, teaching materials, or community promotion materials, or funding for salaries of personnel who
deliver components of the intervention or paying for transportation of those staff to the point of service delivery.
Staff who are responsible for the completeness and quality of routine patient records (paper or electronic) can
be counted here; however, staff who exclusively fulfill MOH and donor reporting requirements cannot be
counted.
AND/OR
2. PEPFAR provides an established presence at and/or routinized frequent (at least quarterly) support for those
prevention services at the point of service delivery. For HIV prevention among priority populations, this ongoing
support for service delivery improvement can include: site supervision, training or assistance with monitoring
and evaluation, support for quality improvement activities, and development of materials and protocols.
Additional References:
HIV P3, HIV-P4b. The Global Fund to Fight AIDS, Tuberculosis and Malaria Monitoring and Evaluation Toolkit 4th
Edition. November 2011. (http://www.theglobalfund.org/en/me/documents/toolkit/)