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Operational Guidelines for Monitoring and Evaluation of HIV Programmes for Sex Workers, Men who Have Sex with Men and Transgender People


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Presented by Sharon Weir for a MEET, AIMEnet, and GEMNet-Health virtual event in July 2014.

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Operational Guidelines for Monitoring and Evaluation of HIV Programmes for Sex Workers, Men who Have Sex with Men and Transgender People

  1. 1. Operational Guidelines for Monitoring and Evaluation of HIV Programmes for Sex Workers, Men who Have Sex with Men and Transgender People July 15, 2014 Sharon Weir and William Miller University of of North Carolina
  2. 2. Purpose of the Guidelines To provide operational guidance for M&E of programmes for:  Female, male and transgender sex workers  Men who have sex with men  Transgender people Guidance at 3 levels:  National  Sub-national  Service-delivery
  3. 3. Approach  3 levels  From Size estimation to impact  Involvement of key populations  Simple checklists, decision trees and examples  Provide links to relevant tools and resources  Indicators Illustrative  Guidelines must be adapted to country context
  4. 4. Key Concepts 1. 8 Step Public Health Questions Model 2. Causal Pathway 3. Combination Prevention Programme 4. Programme Impact Pathway IT’S NOT JUST ABOUT INDICATORS!!
  5. 5. Are prevention programmes effective? What activities are we implementing? Are we doing them right? What should we be doing to reduce HIV transmission? 2. Measure Determinants 3. Know your response 4. Input monitoring 5. Quality monitoring 6. Monitoring outputs and coverage 7. Outcome monitoring and evaluation 8. Impact monitoring and evaluation 1. Know your epidemic
  6. 6. Causal Pathway from Programmes to Prevention To illustrate the logic behind indicators and motivate programmes to use indicators Implement Combination Prevention Programme Reduce Biologic Susceptibility and/or Exposure to HIV Prevent transmission of HIV
  7. 7. Combination Prevention Programme Enabling Environment at the Community Level Package of Individual Level High Quality Health Services Biomedical Services • HIV testing and counselling • Linkage to care, viral load reduction • STI screening and treatment • Psychosocial interventions • Harm reduction • HBV Immunization Behaviour Change Services • Condom Promotion and Distribution • Education and Risk Reduction Counselling
  8. 8. I M P A C T Inputs Outcomes: Direct biologic Outputs/ Coverage Combination Prevention Programme Outcomes: Critical enabler PROGRAM IMPACT PATHWAY
  9. 9. Steps 1-3: Plan What should we be doing to reduce HIV transmission among key populations? Step 1 What is the magnitude and geographic distribution of the HIV epidemic over time among key populations? 1. How many people from each key population live in the country, each sub-national area and the local catchment area? How is each population distributed across sub-national areas? 2. What information is available about the extent of HIV infection?
  10. 10. What are the baseline estimates of the direct biologic determinants of HIV transmission and social enablers? 1. Biologic:What are baseline measures of key indicators of biologic exposure, susceptibility and infectiousness? 2. Environment:What are other individual, community and structural factors contributing to the epidemic? Step 2
  11. 11. Survey Data on Biologic Determinants  Number of sexual partners  Extent to which partnerships are overlapping  Number of HIV-discordant partnerships  Age at first sex  Use of condoms during vaginal and anal sex  Use of condom-compatible lubricants during anal sex  Effective treatment of sexually transmitted infections  Among people who use drugs: number of injections with non-sterile needles
  12. 12. Critical Enabler Assessment Structural, community and individual factors that contribute to HIV transmission risk Barrier Strength Structural Level Social Enablers  Stigma and discrimination  Public health policies and availability of comprehensive HIV services  Lack of medical education and training for health professionals in health care concerns of MSM  Punitive laws, policies & practices Social and Community Level Social Enablers  Social norms, beliefs, and values within communities with regard to MSM  Community responses, availability of support in cases of violence, etc.            
  13. 13. How is the Combination Prevention Programme defined and what are the targets for outputs, coverage, outcomes and impact? 1. What Combination Prevention Programme of health services and critical enabler interventions is needed? 2. What are the operational definitions of "a person being reached” with each service? 3. What sub-populations, sub-areas or setting-specific populations should be monitored? 4. What services are currently available in each sub-national area? 5. What are the 2-year targets for impact, outcome and coverage indicators in each sub-national area? 6. Based on the above, what is the national Programme Impact Pathway? Step 3
  14. 14. Steps 4-6: Monitor What activities are we implementing? Are we doing them right? Step 4 What resources are needed to meet targets? What resources are available? What is the gap in resources?
  15. 15. What services and critical enabler interventions are currently implemented?With what quality? 1. Are national quality standards available? Are they updated regularly? 2. What is the quality of each service being provided? Are programme enablers addressed? Step 5
  16. 16. Universal Quality Standards Standards on involving key populations:  The populations identified for targeted prevention services are included in needs assessment, planning, delivery, and evaluation of HIV prevention services Standards on users’ rights:  Users are fully informed of the nature and content of the services as well as the risks and benefits to be expected  Confidentiality and privacy of users is maintained at all times  Guarantee of human rights; removal of legal barriers to access prevention and care  Access to medical and legal assistance for key populations who experience sexual coercion or violence
  17. 17. Are output targets achieved?What proportion of key populations receive services? 1. What outputs will be monitored and aggregated? How will double-counting of users be avoided? 2. How is service coverage (geographic, population) calculated and interpreted? 3. What are the trends over time for outputs, service availability, the enabling environment, coverage and the HIV prevention and treatment cascades? Step 6
  18. 18. HIVTesting andTreatment Cascade 2000 1000 700 500 400 300 200 0 500 1000 1500 2000 2500 NumberofMSM Stage of Engagement in HIV Care
  19. 19. Steps 7-8: Evaluate Are programmes effective? Step 7 1. Outcome Monitoring: Are there changes in biologic determinants of HIV transmission?Are there changes in the environment? 2. Outcome Evaluation: Are the changes in outcomes due to the programme?
  20. 20. Is the combination HIV prevention programme reducing HIV transmission? 1. Has HIV prevalence increased or decreased in these populations? 2. Did the HIV prevention programme decrease new infections? Step 8
  21. 21. Acknowledgements  Keith Sabin, AllisonCrocket, UNAIDS  Jenny Butler, Marleen van der Ree, UNFPA  Abu Abdul-Quader, CDC  Ludo Bok, UNDP  AnnetteVerster,WHO  MaryAnnTorres, ICASO  MariaAu, USAID  Sandra Kuzmanovska,Global Fund  MaryAnnTorres, ICASO  And many others
  22. 22. The research presented here has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement GHA-A-00-08-00003- 00. Views expressed are not necessarily those of PEPFAR, USAID or the United States government. MEASURE Evaluation is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University.