0. 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

1. 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

2. 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

3. MAXIMIZE IMPACT AGAINST HIV, TB AND MALARIA
The why and what of the Global Fund 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

4. PROTECT AND PROMOTE HUMAN RIGHTS AND GENDER EQUALITY
The why and what of the Global Fund 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

5. 2017-2022 Strategic KPI Framework
Target Status
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

6. 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.

7. 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 )

8. 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)

9. 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

10. Thank you