monitoring & evaluation THD Unit, Stop TB department WHO Geneva Indicators for monitoring & evaluation of collaborative TB/HIV activities Alasdair Reid THD Unit, Stop TB department WHO Geneva GLOBAL PARTNERSHIP TO STOP TB

Reasons for M&E Facilitate the most effective and efficient use of human and financial resources to achieve maximum health benefit for the population served Programme management Measure programme performance Ensuring quality & effectiveness Progress to specific objectives Identify problems & solutions Promote a learning culture focused on service improvement Accountability Attract resources

Guide to M&E Interim Policy

Steps in developing an M&E plan Identifying goals and objectives of the programme Developing an M&E framework Defining and selecting relevant indicators Identifying sources and methods of data collection Developing an M&E implementation plan Dissemination and utilization of the results

M&E plan Aim Objectives Activities Indicators Targets

Aim of TB/HIV collaboration To decrease the burden of TB and HIV in populations where HIV is driving the TB epidemic

Objectives A. to establish the mechanisms for collaboration B. to decrease the burden of TB in PLWHA and their communities C. to decrease the burden of HIV in TB patients and their communities.

Steps in developing an M&E plan Identifying goals and objectives of the programme Developing an M&E framework Defining and selecting relevant indicators Identifying sources and methods of data collection Developing an M&E implementation plan Dissemination and utilization of the results

M&E framework CONTEXT Environmental, cultural, political, socio-economic factors external to the programme INPUT Basic resources necessary Policies, people, money, equipment PROCESS Programme activities Training, logistics, management, IEC/BCC OUTPUT Results at programme level (measure of programme activities) Services, service use, knowledge OUTCOME Results at level of target population Behaviour, no. treated, safer practices IMPACT Ultimate effect of project in long term TB incidence, HIV prevalence, morbidity, mortality Outcome / Impact Evaluation Monitoring / Process Evaluation Give examples of each level indicator Input – resources, policies Process coordinating body, availability of IEC at facility, joint planning, number of TB patient HIV tested Output – number started on CPT, IPT, ART Outcome – TB cure rates, weight gain Impact TB incidence, mortality, HIV prevalence. MDGs

Monitoring Routine tracking of input, process and outcome data Ensures resources are utilised, services accessed, activities occur in a timely manner and expected outcomes achieved Problems may indicate need for evaluation Uses routine records & regular reporting systems, as well as health facility observation and client surveys. Collected at facility level, compiled at district level, and aggregated at regional and national level. Feedback of analysed data to district & facility level essential for performance management

Evaluation More extensive analysis of programme data and data not routinely collected, to explore a perceived problem or issue in the programme Do the inputs generate the expected outcomes – outcome evaluation, and will these have the desired impact - impact evaluation? If not, what corrections are necessary? May require more in-depth analysis of additional data sources e.g. staff reports, interviews with staff/clients, focus groups Less frequent than routine monitoring

Steps in developing an M&E plan Identifying goals and objectives of the programme Developing an M&E framework Defining and selecting relevant indicators Identifying sources and methods of data collection Developing an M&E implementation plan Dissemination and utilization of the results

D. Others

A. To establish the mechanisms for collaboration HIV surveillance in TB patients Indicator A.2.1 Number of all registered TB patients who are HIV-positive, expressed as a proportion of all registered TB patients

B.1 Intensified TB case finding Indicator B.1.1 Proportion of PLWHA attending for HIV testing & counselling or HIV treatment & care services who were screened for TB symptoms Indicator B.1.2 Proportion of PLWHA attending for HIV testing & counselling or HIV treatment & care services who are newly diagnosed with TB through screening

B.2 Treatment of latent TB infection (IPT) Indicator B.2.1 Proportion of newly diagnosed HIV-positive clients who are given treatment for latent TB infection

C.1 HIV testing and counselling Indicator C.1.1 Proportion of registered TB patients who are tested for HIV (after giving consent) Indicator C.1.2 Proportion of registered TB patients tested for HIV (after giving consent) who test HIV-positive

C.3 Cotrimoxazole preventive therapy (CPT) Indicator C.3.1 Proportion of HIV-positive TB patients who receive (at least one dose of) co-trimoxazole preventive therapy (CPT) during their TB treatment

C.5.1 Antiretroviral therapy (ART) Indicator C.5.1 Proportion of HIV-positive registered TB patients who are started on ART or continue previously initiated ART, during or at the end of TB treatment

C.5.1 Antiretroviral therapy (ART) Definition - Proportion of HIV-positive registered TB patients who are started on ART or continue previously initiated ART, during or at the end of TB treatment Numerator - All HIV-positive TB patients, registered over a given time period, who receive ART (are started on or continue previously initiated ART) Denominator - All HIV-positive TB patients registered over the same given time period. Purpose - Output indicator to measure commitment and capacity of TB service to ensure that HIV-positive TB patients are able to access ART

C.5.1 Antiretroviral therapy (ART) Methodology - Data collection depends on who provides ART TB programme - a modified TB register or separate TB/HIV register with data reported at end of TB treatment, to include all started on ART during TB treatment. HIV or other care services - requires a system to ensure TB programme is informed of referral outcome & recorded in a modified TB register or TB/HIV register Periodicity - Collected continuously and reported with the quarterly cohort outcome data

C.5.1 Antiretroviral therapy (ART) Strengths and Limitations Diagnosis of TB is a major entry point for ART Important for programme management & individual patient care Measures degree to which ART is part of the package of care for HIV-positive TB patients, accessibility of ART to HIV-positive TB patients, drug availability, degree to which health care providers encourage ART as a part of routine care, strength of the referral process between TB and HIV

C.5.1 Antiretroviral therapy (ART) Strengths and Limitations Does not measure whether patients treated correctly, at what point during TB treatment patients are started on ART adherence quality of treatment impact of ART Expected values will vary depending on national eligibility criteria for ART, CD4 count availability

C.5.1 Antiretroviral therapy (ART) Importance - Core. Data should be collected for this indicator even in settings where ART is not available in the public sector as this information is in itself important Responsibility - NACP and NTP Measurement tools - Modified TB register, modified HIV care register or separate TB/HIV register with referral system (where appropriate)