1. Towards a Scorecard for HIV Prevention
Geneva, 11 October 2017

2. Overview
Rationale for using scorecards
Main features
Indicators & scores
Preliminary scorecards
Way forward

3. To navigate through complexity there is need for clear signals …
Rationale
To navigate through complexity there is need for clear signals …

4. Context – Three opportunities
For the first time: Global programmatic targets (UN Political Declaration 2016)
Country and Global AIDS Monitoring: wealth of prevention data
Consensus on the need to fast-track HIV prevention
Translate into pragmatic country road map targets
Better use data for comparing & tracking prevention
Real-time monitoring

5. 2020 HIV Prevention Targets & Commitments (2016 UN Political Declaration on Ending AIDS)
Impact
<500,000 new infections (75% reduction against 2010 baseline).
Programme coverage-access to combination prevention
90% of adolescent girls, young and adult women & men in high-prevalence settings
90% of key populations
Outputs
20 billion condoms per year (equal to condoms per male in high- prevalence countries)
3 million people on pre-exposure prophylaxis (10% of persons at risk).
25 (additional) million voluntary medical male circumcisions in 14 countries in Africa (90% coverage among year olds).
Financing and sustainability
Allocate one ‘‘quarter’’ of total HIV budget for prevention on average, e.g % (depending on relative treatment burden).
Ensure that at least 30% of service delivery is community led by 2030

6. Rationale: What the scorecard wants and does not want to …
What it wants to…
What it does NOT want to …
Summarize existing data
Not create new reporting
Provide an orientation & be an entry point for comparison
Not ignore difference in context
Stimulate learning from high-performing programs
Not pass final judgements
Encourage digging deeper: Supply, demand, structural, sub-national
Not be an end in itself

7. A navigation tool to put our own country reality into perspective …
Main features

8. Scorecard - overview

9. Three main sections of scorecard
Target audiences
A big picture overview with overall scores for five priority pillars;
A country summary
Thematic summaries for the five priority pillars
Global decision-makers, country policy makers;
Country policy makers and program leaders
Program leaders and technical experts in- country

10. Current status of score card
Developed template based on programmatic needs & available data
Consultation with global, regional and country experts on format / indicators
Populated from global databases and updated based on 2017 GAM reporting (ongoing validation)
It is work in progress and now needs country validation.

11. Big picture (preliminary version)
Not for citation

12. Indicators

13. Choice of indicators
Each score is based on a combination of two dimensions:
outcome (service utilization/behavior at population-level)
coverage (people covered by programs)
The choice of indicators was informed by
what is most important to measure and
what is realistically available in a majority of countries
what is comparable

14. Core indicators reflected in scores
Area
Coverage
Outcome
Source
Young women
% of priority sub-national areas covered
% of young women in high-HIV incidence settings covered with combination prevention package
Condom use with non-regular partners (young women 15-24)
Access to secondary education
GAM based on DHS and program records, UNICEF
Key populations
% reached twice by combination prevention programs in the past 3 months (disaggregated by key population)
Condom use at last paid sex (sex workers), last anal sex (men who have sex with men)
Use of safe injecting equipment during last injection
GAM based on IBSS and program records
Condoms
Number of condoms distributed (total / per man 15-64)
Condom use at last sex with a non-regular partner (15-49)
GAM based on DHS and program records
VMMC
% of annual VMMC target met
% of 2021 VMMC target achieved (90% of men circumcised)
PrEP
Legal/policy provisions for PrEP introduced and drugs registered
% of needed PrEP sites in place
% of people in need of PrEP who receive PrEP
UNAIDS/ WHO Needs estimation tool tbd

15. Preliminary scorecard

16. Limitations Data not yet validated with countries
Aggregate scores are only indicative: Important to drill down to source indicators
Important to understand social, cultural and other structural factors
Not for citation

17. Large variation in condom use with non-regular partners

18. Key population coverage & outcome summary (preliminary)
Not for citation

19. Way forward: Close data gaps, track at all levels use for programming

20. Main data gaps for prevention tools: Coverage
Condoms: Number of condoms distributed per year (public, social marketing & private)
PrEP: Country needs estimation and targets
VMMC: Alignment with global 2021 target

21. Main gaps for key populations: Coverage
Where missing: Population size estimates (or approximation)
Aggregate coverage of key populations reached through different channels
Double counting: Need for unique identifier codes (in a rights-based programming framework)

22. Main data gaps for young women & male partners: coverage
Consistent differentiation of young women & male partners by level of HIV incidence
Definition of consistent service packages for settings with different incidence levels
Tracking of young women & male partners reached with service packages

23. Population size: Females 15-24
Work on denominators Where are the young women we need to reach? (Sub-national data from 15 countries in Africa)
HIV incidence
Population size: Females 15-24
New HIV infections
Females, 15-24
All, 15-49
Low ( )
20.4 million
9,000
36,000
Moderate ( )
20.1 million
33,000
139,000
High ( )
12.1 million
65,000
264,000
Very high ( )
3.2 million
38,000
136,000
Extremely high (2.00+)
4.5 million
108,000
348,000

24. Sub-national top priority areas for HIV prevention among young women
Country
High incidence ( )
Very high incidence ( )
Extremely high incidence (2+)
South Africa*)
Western Cape, Northern Cape
Limpopo
KZN, EC, MP, FS, NW, GP,
Nigeria
Bayelsa, Benue, Ebonyi, Edo, Imo, Lagos, Ondo, Oyo, Sokoto, Tarabe
Akwa-Ibom, Nasarawa
Mozambique
Inhambane, Manica, Maputo Cidade, Niassa, Sofala, Zambezia
Cabo Delgado, Gaza, Maputo Provincia
Kenya*)
Rift Valley
Nyanza
Zambia
Eastern, Luapula, Muchinga, North Western, Northern
Copperbelt, Lusaka, Southern, Western
Uganda
Mid Eastern, South Western
East Central
Zimbabwe
Bulawayo, Harare, Manicaland, Mashonaland Central / East /West, Masvingo, Midlands
Matebeleland North / South
Malawi*)
Southern region
Cameroon
Centre, Douala, Est, Nord Ouest, Sud, Sud Ouest, Yaoundé
Ethiopia
Gambela
Cote d’Ivoire
Centre-North, Sud-Ouest
Namibia
Hardap, Karas, Kavango, Kunene, Ohangwena, Omaheke, Omusati, Oshikoto, Otjozondjupa
Erongo, Khomas, Oshana, Zambezi
Swaziland
Hhohho
Manzini, Shiselweni, Lubombo
No sub-national estimates: Angola, Lesotho, Tanzania; No high-incidence districts: DR Congo, Ghana
*) Country already has more detailed district estimates in place

25. Next steps Review current inputs (countries)
Estimate 2017 coverage levels (baseline)
Prioritize tracking of existing coverage indicators in GAM for 2018 reporting
2018, 2019, 2020: Peer review of progress: Global, regional, national, sub-national

26. Preliminary Conclusions Country data show that delivering prevention at scale is possible. There are country successes in each pillar of prevention.

27. Thank you!