1. 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

2. 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

3. Guide to M&E
Interim Policy

4. 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

5. M&E plan
Aim
Objectives
Activities
Indicators
Targets

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

7. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

14. D. Others

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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)