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Handbook of Indicators for HIV/AIDS/STI Programs Is the Product of a Lengthy and Participatory Process

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Handbook of Indicators for HIV/AIDS/STI Programs Is the Product of a Lengthy and Participatory Process Handbook of Indicators for HIV/AIDS/STI Programs First Edition March 2000 Bureau for Global Programs, Field Support and Research Center for Population, Health and Nutrition Office of Health and Nutrition Bureau for Africa Office of Sustainable Development This document was developed with support from the Bureau for Global Programs, Field Support and Research, Center for Population, Health and Nutrition, Office of Health and Nutrition HIV–AIDS Division, and the Bureau for Africa, Office of Sustainable Development, United States Agency for International Development under Contract Number HRN-A-00-0018-00 and Contract Number HRN-C-00-99-0005-00. The opinions expressed herein are those of the contributors and do not necessarily reflect those of USAID. Additional copies of this report may be obtained by writing to: 1101 Vermont Avenue NW, Suite 900 Washington, DC 20005 (202) 842-2939 (202) 842-7646 (Fax) or via e-mail at [email protected]. ACKNOWLEDGMENTS This first edition of the USAID Handbook of Indicators for HIV/AIDS/STI Programs is the product of a lengthy and participatory process. Drafts were submitted between July 1998 and February 2000 to the HIV-AIDS Division of the Bureau for Global Programs, Field Support and Research, Center for Population, Health, and Nutrition, Office of Health and Nutrition (G/PHN/HN/HIV-AIDS), under United States Agency for International Development (USAID) Contract Number HRN-A-00-0018-00. The MEASURE Evaluation and Synergy projects collaborated with Family Health International (FHI)/IMPACT, Population Services International (PSI)/AIDSMark, Population Council/HORIZONS, The International HIV/AIDS Alliance, Peace Corps, Bureau of the Census, and the HIV-AIDS Division to complete this handbook. Lisanne Brown of the USAID MEASURE Evaluation Project was instrumental in the preparation, revision and updating of the 1999 drafts, with important contributions from John Novak (G/PHN/HN/HIV-AIDS), as well as the research and evaluation staff at the collaborating agencies, including Tobi Saidel, Christine Kolars Sow, Thomas Rehle, Jan Hogle, Joseph Amon, and Gina Dallabetta (IMPACT Project); Kerry Richter, Dominique Meekers, Sohail Agha, and Guy Stallworthy (AIDSMark Project); Ana Coghlan and Ruth Mota (Peace Corps); and, Jeffrey O’Malley and Kathyrn Carovano (The International HIV/AIDS Alliance). Naomi Rutenberg (HORIZONS Project) provided important information on measuring the success of programs that aim to reduce mother-to-child transmission. John Stover and colleagues (Futures Group/POLICY Project) developed the AIDS Program Effort Index (API). Messaye Girma (The Synergy Project) and Paurvi Bhatt (G/PHN/HN/HIV-AIDS) provided leadership in the development of the interim and final indicators for private sector capacity building. Comments on earlier drafts were also provided by the USAID Gender Working Group. Ties Boerma (MEASURE Evaluation) provided oversight and technical advice throughout the development and review process, together with Bernhard Schwartlander (UNAIDS/Geneva), in the adoption of the terminology and measurement foci of the global indicators in the design of this first edition. Saha AmaraSingham (The Synergy Project), in consultation with John Novak and Lisanne Brown, completed the final review process and incorporation of relevant information from the January 2000 review draft of the manual, Monitoring and Evaluation Guide and Methods Packages for National AIDS Programmes, that has been under development and field testing by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), USAID, and MEASURE Evaluation for adoption in national AIDS programs. In addition to the draft UNAIDS guide, several sources of information on existing indicators and measurement approaches were consulted, including the WHO Global Programme on AIDS Prevention Indicators, The Evaluation Project Reproductive Health Indicators, the AIDS Control and Prevention (AIDSCAP) Project, the Centers for Disease Control and Prevention/U.S. Department of Health and Human Services, and the Bureau of the Census. ACRONYMS AIDS Acquired immune deficiency syndrome AIDSCAP AIDS Control and Prevention Project ANC Antenatal care API AIDS Program Effort Index ARV Antietroviral BSS Behavioral surveillance survey CA Cooperating agency CDIE Center for Development Information and Evaluation (USAID) DHS Demographic and Health Survey DOSA Discussion-oriented self-assessment FHI Family Health International FP Family planning GPA Global Programme on AIDS (WHO) G/PHN Bureau for Global Programs, Field Support and Research, Center for Population, Health and Nutrition (USAID) HIV Human immunodeficiency virus IEC Information, education and communication IR Intermediate Result M&E Monitoring and evaluation MTCT Mother-to-child-transmission of HIV OCAT Organizational capacity assessment tool ORS Oral dehydration solution PSI Population Services International PVO Private voluntary organization R4 Results Review and Resource Request RF Results Framework RH Reproductive health RPR Rapid plasma reagin SDP Service delivery point SSO Strategic Support Objective SSOT Strategic Support Objective team STI Sexually Transmitted Infection UNAIDS Joint United Nations Programme on HIV/AIDS USAID United States Agency for International Development VCT Voluntary counseling and testing WHO World Health Organization CONTENTS Page I. INTRODUCTION................................................................................................................ 1 Purpose of Handbook............................................................................................................. 1 Definitions of Key Evaluation Terms and Concepts.............................................................. 8 Selecting and Using Indicators............................................................................................... 11 HIV/AIDS/STI Program Evaluation ..................................................................................... 13 Methodological Challenges in Monitoring and Evaluating HIV/AIDS/STI.......................... 14 Guide to Using the Indicators................................................................................................. 15 II. SSO 4 INDICATORS........................................................................................................... 16 SSO Level Indicators ............................................................................................................. 16 IR Level Indicators................................................................................................................. 24 Reduction of Sexual Risk................................................................................................. 24 Improved STI Services..................................................................................................... 50 Reduction of Contextual Constraints ............................................................................... 58 Improved Private Sector Response .................................................................................. 68 Strengthened Data Collection for Monitoring and Evaluation......................................... 71 Effective Program Implementation.................................................................................. 74 III. ADDITIONAL INDICATORS........................................................................................... 75 Sexual Behavior among Young People.................................................................................. 76 Voluntary Counseling and Testing (VCT)............................................................................. 83 Mother-to-Child Transmission of HIV ................................................................................. 89 Injecting Drug Use................................................................................................................. 97 Blood Safety...........................................................................................................................100 Care and Support for the HIV Infected and their Families....................................................105 APPENDICES I. Monitoring and Evaluation Instruments by Methods Package II. USAID Handbook and UNAIDS M&E Guide Methods Packages III. Indicators by Program Area, Methods Package, Level of Measurement, and Stage of Epidemic IV. Second Generation Surveillance Systems FIGURES 1. SSO 4 Strategic Framework 2. AFR/SD SO 9 HIV/AIDS Results Framework I. INTRODUCTION PURPOSE OF HANDBOOK In 1996, the HIV-AIDS Division of the USAID Bureau for Global Programs, Field Support and Research, Center for Population, Health and Nutrition, Office of Health and Nutrition (G/PHN/HN/HIV-AIDS), redesigned its HIV/AIDS Strategic Support Objective (SSO) and Results Package to better reflect the experience gained to date in prevention activities and to respond more effectively to the growing and changing worldwide epidemic. The new HIV/AIDS Results Package selected by the stakeholders during the participatory redesign process represents those programming areas in which the Center for Population, Health, and Nutrition (Global Bureau) has the greatest comparative advantage and/or leadership responsibility, including continuing to focus on the prevention of sexual transmission of HIV through behavioral change interventions and a wide range of operational and service delivery areas, such as sexually transmitted disease prevention, HIV/AIDS care and support,
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