HIV service cascade analysis among key populations: data use for coverage monitoring and program quality Dr Ade Fakoya, Senior Disease Coordinator- HIV July 24th 2017, Paris 2017 IAS Conference on HIV Science

Outline The Global Fund Strategy emphasizes the Key Populations Specific Key Performance Indicator (KPI5) Building up data systems: surveys and programmatic reporting Strengthen HIV service cascade for program quality

The Global Fund Strategy 2017-2022: Investing to End Epidemics MAXIMIZE IMPACT AGAINST HIV, TB AND MALARIA A world free of the burden of AIDS, Tuberculosis and malaria with better health for all. To attract, leverage and invest additional resources to end the epidemics of HIV, tuberculosis and malaria and to support the attainment of the Sustainable Development Goals. Vision BUILD RESILIENT AND SUSTAINABLE SYSTEMS FOR HEALTH PROTECT AND PROMOTE HUMAN RIGHTS AND GENDER EQUALITY Mission MOBILIZE INCREASED RESOURCES STRATEGIC ENABLERS: Innovate and differentiate along the development continuum + Support mutually accountable partnerships

MAXIMIZE IMPACT AGAINST HIV, TB AND MALARIA The why and what of the Global Fund 2017-2022 Strategy SO 1: Maximize impact against HIV, TB and Malaria 1 MAXIMIZE IMPACT AGAINST HIV, TB AND MALARIA SUB-OBJECTIVES Scale-up evidence-based interventions with a focus on the highest burden countries with the lowest economic capacity and on key and vulnerable populations disproportionately affected by the three diseases. Evolve the allocation model and processes for greater impact, including innovative approaches differentiated to country needs. Support grant implementation success based on impact, effectiveness, risk analysis and value-for-money. Improve effectiveness in challenging operating environments through innovation, increased flexibility and partnerships. Support sustainable responses for epidemic control and successful transitions. 10

PROTECT AND PROMOTE HUMAN RIGHTS AND GENDER EQUALITY The why and what of the Global Fund 2017-2022 Strategy SO 3: Promote and protect human rights and gender equality 1 SUB-OBJECTIVES Scale-up programs to support women and girls, including programs to advance sexual reproductive and health rights Invest to reduce health inequalities including gender and age-related disparities Introduce and scale-up programs that remove human rights barriers to accessing HIV,TB and malaria services Integrate human rights considerations throughout the grant cycle and in policies and policy-making processes Support meaningful engagement of key and vulnerable populations and networks in Global Fund-related processes PROTECT AND PROMOTE HUMAN RIGHTS AND GENDER EQUALITY 12

2017-2022 Strategic KPI Framework Target Status 2017-2022 Strategic KPI Framework Validation requested 13 Incomplete 21 Proposal to postpone 3 Strategic Targets Performance against impact targets Performance against service delivery targets Strategic Objectives Maximize Impact Against HIV, TB and malaria Build resilient & sustainable systems for health Promote and protect human rights & gender equality Mobilize increased resources Strategic vision Invest funds to maximize portfolio impact Improve the performance of strategically important components of national systems for health Reduce human rights barriers to service access; & Reduce gender and age disparities in health Increase available resources for HIV, TB & Malaria; & Ensure availability of affordable quality-assured health technologies Strategic KPIs Alignment of investment & need Strengthen systems for health Gender & age equality Resource mobilization Investment efficiency Human rights Domestic investments Service coverage for key populations Availability of affordable health technologies Fund utilization 1 2 3 6 8 10 Procurement Supply chains Financial management HMIS coverage Results disaggregation NSP alignment a) 4 b) 9 11 c) d) 5 e) 12 f) 7

Service coverage for key populations KPI 5 Strategic Targets Maximize Impact Against HIV, TB and malaria Build Resilient & Sustainable Systems for Health Promote and Protect Human Rights & Gender Equality Mobilize Increased Resources Service coverage for key populations KPI 5 Strategic Vision Measure Reduce the number of new infections in key and vulnerable populations disproportionately affected by the three diseases Coverage of key populations reached with evidence-informed package of treatment and prevention services appropriate to national epidemiological contexts Limitations & mitigation actions Aim of indicator There is no current consensus on how to measure a comprehensive combination prevention service package. Therefore the measure will assess coverage of an evidence-informed package of services appropriate to national epidemiological contexts A number of KPI implementation issues are currently being addressed with technical partners: methodology of coverage measurement; how to bridge data gaps between surveys; potential risk of harm to these populations through data collection and minimization of that risk; the potential for community based monitoring systems Positive discussions indicate that implementation issues can be successfully addressed – but they also stress that it may take three years before data is available to detect change in coverage levels Indicator focuses on HIV only New Global Plan for TB has a focus on key populations, but work remains at an early stage of development Indicator will track provision of evidence-informed HIV prevention services and treatment access to specified key population groups. These groups face the double burden of low coverage of services and high rates of infection. Increased coverage of prevention and treatment services will be essential to accelerate the end of the epidemic. Indicator builds on work undertaken during the current strategy to measure the size of key populations in 55 countries. Proposal has close links to the strategic objectives in SO3 on gender and removing barriers to accessing services, and SO2 on data systems.

Joint efforts with partners to improve population size estimation, as denominator for program coverage measurement Specific KPI 2g: 55 countries have nationally adequate size estimation Special Initiative for Country Data Systems: US$ 6 million for key population size estimation and mapping Regional capacity building workshops: 155 national program and CBO staff trained in 5 regions (AP, EECA, LAC, SE Africa, WCA )

Joint improve the reporting systems for better numerator for program coverage Joint work with LINKAGES Alignment of service package Alignment of reporting systems, including UIC Jointly address common issues The Global Fund internal guidance to Country Teams on coverage monitoring Triangulate the programmatic results with survey findings for coverage monitoring (UNAIDS, WHO, CDC)

HIV service cascade assessments for program quality Joint GF-PEPFAR/LINKAGES cascade assessment Jointly identify programmatic issues and opportunities Jointly identify cross-cutting issues and good practices Jointly plan and address issues and replicate good practices Country specific cascade assessment Care and Treatment cascade in High Impact Countries: national or subnational, annual or quarterly (WHO) Prevention Cascade (WHO/UNAIDS) Key Population group-specific cascade (prevention through treatment): a few selected countries Use of findings for program quality improvement Package design Service delivery model (differentiate testing model, community/peer-led service delivery, etc) Reduce leakages across service steps and among providers, aiming at higher yield

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