Presented by Brittany Schriver Iskarpatyoti at the 2016 AEA conference.

1. Assessing HIV Service
Use and Information
Systems for Key
Populations in Namibia
Brittany Schriver Iskarpatyoti, MPH
MEASURE Evaluation
University of North Carolina, Chapel
Hill
October 27, 2016
American Evaluation Association

2. The Request
Namibia Mission:
Assess Key Populations
HIV Case Management
Program

3. The Context: Namibia
Southern Africa
Independence in 1990
Population: 2.3 million
PLHIV: 210,000
Adult HIV prevalence: 13.3%
Higher in KPs

4. The Context: Program
• IP: Society for Family Health
(SFH)
2 local clinical partners:
• Walvis Bay Corridor Group
(WBCG)
• Namibia Planned Parenthood
Association (NAPPA)
• 6 program sites
• Case management
approach (as of October
2015)
Katima Mulilo
Keetmanshoop
Windhoek
Walvis Bay/
Swakopmund
Oshakati
Oshikango

5. The Context: Program
Other/private
providers
MoHSS and other
testing sites
Outreach
sites
KP-led
orgs/CHWs
WBCG and
NAPPA clinics
CASE WORKER
Non-KP: Link to
general services
Assessment
KP HIV+: Enroll in CM
and link to care
KP HIV-: Enroll in CM and
follow for sero-conversion
All KPs (known)
All HIV-positive
All HIV-negative with any
risk factor
• Violence/ GBV
• Transactional sex
• Poor condom use
• Alcohol/substance
abuse
• Sexually transmitted
infection
• Discordancy
• Young, female
• No support
• Homelessness/
transient locations
• Untreated/unstable
mental illness

6. The Original Proposal
Assess CM approach to link HIV positives to treatment,
retention and viral suppression
(PEPFAR 2nd & 3rd 90’s) using program data

7. Challenge: Data
Plan: Use program data
Can we rely on program data as is?
• New program, new data
• Unclear quality
RHIS/HIS data
• Multiple sources (HTC, ART, pharmacy, patient files)
• Unclear quality
• Unclear interoperability

8. Data Assessment
New Plan:
Assess the data available and the
feasibility of accessing and triangulating
program data with:
• Patient files and health passports,
• The national HIV testing and counseling (HTC) register
• The national ART patient management system (e.g.
Electronic Patient Management System [ePMS]) and/or
• The national pharmacy database (e.g., Electronic
Tool [EDT])

9. Data Assessment

10. Challenge: Denominator
Possible to assess all three
‘90’s?
• No official KP size
estimate to determine
first ‘90’
• Dearth of information on
key populations in
Namibia
• IBBS conducted
recently—data not
available
Plan: Assess linkage to treatment,
retention, and viral suppression

11. Size Estimate
New Plan:
Estimate the size of key populations to
establish a denominator for determining
the reach of KP programs (the 1st ‘90’).

12. Size Estimate
1. Identify priority areas
2. Within priority areas, locate public
venues where KPs meet sexual
partners
3. Visit, map, and characterize each
venue
4. Create size estimates of KPs in the
sampled area
The Priorities for Local AIDS Control Efforts
(PLACE) method

13. Challenge: PrEP
Plan: Assess HIV-
positive individuals
The Namibian MoH has agreed
to roll-out pre-exposure
prophylaxis (PrEP) to HIV-
negative individuals most at risk
of HIV. This will include KP
served by SFH.
Can we include HIV- to assess
PrEP?

14. Multiple Cohorts
New Plan:
Key populations identified by or referred
to case managers will be enrolled in one
two cohorts: HIV-positive or HIV-

15. Multiple Cohorts
HIV-positive
• Analyzed for linkage to treatment, retention, and viral
suppression
HIV-negative
• Analyzed for rates of sero-conversion
Cohorts monitored by case managers for
12-18 months

16. Leveraging Opportunities
• New tools for measuring the HIV cascade
among key populations
• Facilitated HIV prevention data planning
among priority populations

17. MEASURE Evaluation is funded by the U.S. Agency
for International Development (USAID) under terms
of Cooperative Agreement AID-OAA-L-14-00004 and
implemented by the Carolina Population Center, University
of North Carolina at Chapel Hill in partnership with ICF
International, John Snow, Inc., Management Sciences for
Health, Palladium, and Tulane University. The views
expressed in this presentation do not necessarily reflect
the views of USAID or the United States government.
www.measureevaluation.org