Strategic Information For HIV/AIDS Prevention, Treatment, Care and Support

Overview of Presentation  Overall Program Evaluation Vision & Design  Strategies for Data Utilisation  Overview of Methods

Emergency Plan goals and corresponding summary indicators Estimated from program data and program impact models Total number of clients served by ART and PMTCT+ Total number of clients receiving HIV care and support and total number of OVC receiving care and support Treat 2 million with ART Prevent 7 million new infections Care and support for 10 million PLWHA and AIDS orphans

USG/Namibian Emergency Plan goals and corresponding summary indicators Estimated from program data and program impact models Total number of clients served by ART and PMTCT+ Total number of clients receiving HIV Care and support and total number of OVC receiving care and support Treat 23,000 with ART Prevent 72,000 new infections Care and support for 118,000 PLWHA and AIDS orphans

Emergency Plan Indicators  Program Level Indicators  # of programs/services  # of people served/reached  # of people trained, etc.  Program Evaluation Indicators  Individual-Level (Perceptions, Knowledge, Behaviors)  Community-Level (Information/Access Equity, Community Cohesion, Social Norms, Collective Efficacy)  Social/Political Level (Leadership, Policies, Agendas)  Outcome Indicators  DHS  AIS  Facility Survey, etc.

PURPOSE of PROGRAM EVALUATION RESEARCH  To Provide Input into Development of Integrated HIV/AIDS Program (including VCT, PMTCT+ and HAART)  To Monitor and Provide Feedback on Implementation  To Assess Effects of Integrated HIV/AIDS Program on:  Risk Behaviors  Capacity of Communities to mobilize support for OVC, VCT, PMTCT+ and HAART  Capacity of Communities to address the issue of stigma and discrimination

Conceptual Framework Pathways to a Health-Competent Society Domains for Interventions Behavioral / Intermediate Outcomes (targets) Supportive Environment Service Performance Client Behaviors: Community Individual Social Political Environment Service Delivery System Community/ Individual Sustainable Health Outcomes By 2008: 23,000 receiving ART By 2008: 118,000 receiving care and support By 2010: 72,000 infections averted Source: Namibia Emergency Plan COP, 2004

Conceptual Framework Pathways to a Health-Competent Society Domains for Interventions Behavioral / Intermediate Outcomes (targets) Supportive Environment Service Performance Client Behaviors: Community Individual Social Political Environment Service Delivery System Community/ Individual UNDERLYING CAUSES Environment Service Systems Community Beliefs & Norms Individual Beliefs, Needs, Habits Sustainable Health Outcomes By 2008: 23,000 receiving ART By 2008: 118,000 receiving care and support By 2010: 72,000 infections averted Source: Namibia Emergency Plan COP, 2004

Conceptual Framework Pathways to a Health-Competent Society (overall framework) Underlying Conditions Domains for Interventions Program Areas Environment Service Systems Community Individual Behavioral Outcomes Sustainable Health Outcomes Context Disease Burden Social Cultural Economic Communication Technology Political Legal By 2008: 23,000 receiving ART By 2008: 118,000 receiving care and support By 2010: 72,000 infections averted Source: Namibia Emergency Plan COP, 2004 Resources Human and Financial Resources Strategic Plan/Health Priorities Other Development Programs Policies Supportive Environment: Multi-sectoral partnerships Public opinion Institutional performance Resource acquisition Media support Activity level Service Performance: Access Quality Client volume Client satisfaction Community Social Norms Equity Cohesion Collective Efficacy Network Density Individual Delay of sexual debut Faithfulness to partner/reduction of # of sexual partners Condom use Stigma reduction VCT, PMTCT+ use and HAART adherence Political will Resource allocation policy changes Institutional capacity building National coalition National communication strategy Availability Technical competence Information to client Interpersonal communication Follow-up of clients Integration of services Leadership Networks Participation of community members Priority consensus Ownership Social capital Perceived social support/stigma Emotion and values Beliefs and attitudes Perceived risk Self-efficacy Health literacy Social Political Environment Service Delivery System Community/ Individual Program Evaluation Method Supportive Environment: Parliamentarians Survey Analysis of laws/ legislation passed Media support / Public Opinion Service Performance: Health Care Worker Training Evaluations Health Literacy Client interviews Community Network Analysis (quantitative) Community Mobilisation Assessments (qualitative) Individual Representative Household Surveys Ad-Hoc Qualitative Research Underlying Causes

Program Evaluation Research Plan

Audience profile (fact sheets) Set Targets BEHAVIORAL LEVEL COMMUNITY LEVEL ENVIRONMENT/POLITICAL

Using Data – Set Targets & Work Backwards Treat 23,000 with ART Prevent 72,000 new infections Care and support for 118,000 PLWHA and AIDS orphans ULTIMATE GOALS EXAMPLES OF TARGETS (to achieve goals) # of Clients Enrolling & Completing ART Increase Abstinence, Faithfulness, Condoms # of households caring PLWHA and AIDS orphans ADDRESS UNDERLYING CAUSES Perceptions of HCWs Lack Knowledge Lack Susceptibility Lack Efficacy Alcohol Use Stigma Denial of Disease Lack Knowledge

Profiling your Audience  Using the data, determine who is NOT doing the behaviors you desire  Profile them  Demographically – who should you target?  Psychographically – what are their habits, tendencies?  Theory-based variables – what is motivating their behavior, according to theory?  Community – what is happening around them?  Prior experiences/practices – what is their experience with HIV?  Create Chart of Beliefs to target  Develop Programs that specifically address the Underlying Causes of your Targets (in order to achieve goals)

BELIEFS / PRACTICES TO CHANGE BELIEFS / PRACTICES TO REINFORCE BELIEFS / PRACTICES TO INTRODUCE AUDIENCE PROFILE (specific group(s) to target) Category Results of Research From Research, Create Table of Beliefs / Practices Birth control pill prevents HIV infection… HIV is a real threat in Namibia & affects many… Something can be done to Improve PLWA quality of life (not a death sentence). Single women, aged 15-24, who are students

METHODS

SURVEY METHODS  HOUSEHOLD SURVEY – Complete Random Sample of Households in 10 km catchment area around HIV/AIDS focus hospital  exceptions Katutura, Windhoek – standard EAs used  Oshakati, 5km catchment because of overlap  Sample N= 3100, n=300 per site (9 sites, n=200 at two supplemental sites)  NETWORK SURVEY – Complete Census of the households adjacent to the HIV/AIDS focus hospital PLUS health care workers in the focus hospital  Sample N=3763, n=400 per site (10 sites)  Fresh Maps drawn in HIV/AIDS focus hospital area

SURVEY METHODS continued  Sample size determination – effect sizes extracted, power calculated, conventional standard  =.80,  =.05  Persons 15 years and older eligible for participation in study  At selected households, Inventory of all eligible participants, Participant selected by random draw  Call-backs on evenings/weekends (up to three times).  Non-responses replaced by next eligible household (occurred only 5 times).  One person per household interviewed (privately).

Data Collection Sept/Oct 2003 Oshikuku Oniipa (Onandjokwe) Rehoboth May/June 2004 Andara Nyangana Rundu Aug-Oct 2004 Katutura Keetmanshoop Oshakati Walvis Bay Windhoek (supplemental, household only) Walvis Bay Keetmanshoop Katutura Rehoboth Windhoek Onandjokwe Oshikuku Oshakati Andara Nyangana Rundu

FRESH MAP EXAMPLE

Instrument Development  Complete literature search, data base search, solicitation from partners, conducted.  All items developed according to theory, based on validated and reliable items used in previous studies  Both surveys reviewed and vetted by partners twice.  Translated and backtranslated until connotative (“meaning”) equivalence occurred.  Piloted and refined to fit Namibian culture

Instrument Development continued Quantitative Surveys –Open and close-ended items –4 or 5-point Likert-type scales used Strongly Strongly Disagree Agree –Respondents adapted easily to response format –Item analysis indicated valid and reliable scales

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