A Guide to Monitoring and Evaluating HIV/AIDS Care and Support

Process Represents several years of work between various international and national partners. Represents several years of work between various international and national partners. HRSA agreed to co-chair a Care and Support Monitoring and Evaluation (M&E) Workgroup to review core indicators for monitoring and evaluating HIV care and support. HRSA agreed to co-chair a Care and Support Monitoring and Evaluation (M&E) Workgroup to review core indicators for monitoring and evaluating HIV care and support.

Process, cont... The working group is made up of representatives from CDC, FHI, USAID, WHO, Macro/MEASURE, among others The working group is made up of representatives from CDC, FHI, USAID, WHO, Macro/MEASURE, among others The group took the lead in defining a set of indicators, and piloted them in Ethiopia, Kenya, and the Dominican Republic. The group took the lead in defining a set of indicators, and piloted them in Ethiopia, Kenya, and the Dominican Republic.

Process, cont... WHO took the lead in refining and preparing the manual of the revised indicators. WHO took the lead in refining and preparing the manual of the revised indicators. An international meeting was held in March, 2003 to review and revise the indicators and to review the draft content of the guide. An international meeting was held in March, 2003 to review and revise the indicators and to review the draft content of the guide.

Process, cont... A draft was produced and has been reviewed by meeting participants, the original workgroup, and others. A draft was produced and has been reviewed by meeting participants, the original workgroup, and others. Presently, comments received after this meeting are being incorporated. Presently, comments received after this meeting are being incorporated.

The Manual The manual is made up of 6 chapters: The manual is made up of 6 chapters: (1) Introduction (1) Introduction (2) What are HIV care, support and treatment programmes? (2) What are HIV care, support and treatment programmes? (3) A care and support monitoring and evaluation system (3) A care and support monitoring and evaluation system (4) Indicators for monitoring and evaluating care and support programmes (4) Indicators for monitoring and evaluating care and support programmes (5) Operations research, and (5) Operations research, and (6) Related reading (6) Related reading The guide will be accompanied by a CD-Rom containing all the instruments that have been used during the pilots. The guide will be accompanied by a CD-Rom containing all the instruments that have been used during the pilots.

Overview of Indicators Bi-annual Programme reports /modelling CS3 The number and percent of persons with advanced HIV infection receiving ART (UNGASS) Annual Programme reports CS2 The percent of districts with at least one health facility providing ART Annual Programme reports CS1 The number of individuals receiving HIV testing and counselling in the last 12 months a) The number of individuals who received HIV testing b) Percent of those tested who received pre-test counselling c) Percent of those tested who were positive d) Percent of those tested who received their results through post-test counselling services FrequencyMethods Core Indicators

Overview of Indicators, cont... Every other year Interviews / record review CS4 The existence of comprehensive HIV/AIDS care and support policies, strategies and guidelines Every 2-4 years Health facility survey CS7 Percent of health facilities that have the capacity and conditions to provide advanced level HIV care and support services, including provision and monitoring of ART Every 2-4 years Health facility survey CS6 Percent of health facilities that have the capacity and conditions to provide basic level HIV testing and HIV/AIDS clinical management Every 2-4 years Health facility survey CS5 The percent of facilities that either provide comprehensive care and support services onsite for people living with HIV or through an effective referral system FrequencyMethods Core Indicators

Overview of Indicators, cont... To be determined Health facility survey / special lab study CS8 The percent of designated laboratories with the capacity to monitor ART according to national/international guidelines Every 2-4 years Household survey CS10 The percent of orphans and vulnerable children less than 18 years whose households received free basic external support in caring for the child Every 2-4 years Household survey CS9 The percent of persons aged who have been chronically ill for 3 or more months in the last 12 months whose households received free basic external support in caring for the chronically ill person FrequencyMethods Core Indicators

Overview of Indicators, cont... Every other year Interview / record reviews CS-A1 The existence of national monitoring and evaluation capacity for HIV/AIDS care and support programmes Every 2-4 years Health facility survey CS-A2 The percent of health facilities with record keeping systems for monitoring of HIV/AIDS care and support FrequencyMethods Additional Indicators

Measurement To track the multiple levels of care and support, multiple measurement methods are proposed for both M&E. These include: To track the multiple levels of care and support, multiple measurement methods are proposed for both M&E. These include: National program reports review National program reports review Interviews and record review Interviews and record review Health facility surveys Health facility surveys Household surveys Household surveys Special studies Special studies

Districts providing ART This indicator is important to measure the coverage of ART within a country by looking at the number of districts where this treatment is available. Rationale and what it measures: Total number of districts. Denominator: Number of districts with at least one health facility providing ART. Numerator: The percent of districts with at least one health facility providing ART. Definition:

Districts providing ART, cont. The numerator will include different types of NGO or government health facilities (social security, military, etc.), depending on the level of involvement of those sectors in the provision of ART. The following methodologies are recommended: (1) Reco rd reviews of the District Medical office or District AIDS Office, which may have a listing of all facilities providing ART (2) Record reviews of the NAP, or through a national drug management system of the MoH that should also have a listing of the facilities to which ART is being distributed (3) Health facility survey It is useful to have data on district population and the prevalence per district to compare how the availability of services matches the needs. Measurement tools and how to measure it:

Districts providing ART, cont. The method for measuring this indicator will depend strongly on the ability of the national and/or district levels to collect and provide this information. This indicator is particularly useful in countries where ART is first being initiated and/or in places where ART is only available in a few districts. As more districts begin to provide ART, countries should move to measuring the total coverage- the number of people who are receiving ART over the total number of people in need. Therefore, this indicator will need to be adapted as services become widely available in order to be useful. If a health facility survey is employed, it must be noted that purposeful sampling of facilities that provide ART is necessary. Strengths and limitations:

Overall Measurement Challenges Quality of care Quality of care Adapting measures for diverse settings Adapting measures for diverse settings Sampling units, e.g., hospital units, households vs. individuals Sampling units, e.g., hospital units, households vs. individuals Indicator definitions such as paid vs. unpaid services Indicator definitions such as paid vs. unpaid services Measurement issues such as stigma and access to care and treatment of special at-risk populations Measurement issues such as stigma and access to care and treatment of special at-risk populations