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Know Your HIV/AIDS Response: a Pilot Test of a New Service Mapping Tool Kit in Greater Accra, Ghana

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Know Your HIV/AIDS Response: A Pilot Test of a New Service Mapping Tool Kit in Greater Accra, Ghana Elizabeth Sutherland Amos Laar 1 Ghana KYR Study Group This research has been supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement GHA-A-00-08-00003-00, which is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this publication do not necessarily reflect the views of PEPFAR, USAID, or the United States government. August 2014 TR-14-106 1 The study group’s membership and institutional affiliations are listed within the report. Know Your HIV Response: A Pilot Test of New Service Mapping Tools i ii Contents List of Tables and Figures ............................................................................................................................. iv List of Acronyms ........................................................................................................................................... v Executive Summary ..................................................................................................................................... vii Introduction ........................................................................................................................................... 1 Approach and Methods ................................................................................................................................ 3 KYR Tools Development ............................................................................................................................ 3 KYR Tools Administration .......................................................................................................................... 4 Results ........................................................................................................................................... 9 Strategic Information and Policy Checklists .............................................................................................. 9 MMDA Level Response by the Health and Non-health Sectors ............................................................. 10 Program Implementer Questionnaires ................................................................................................... 12 Qualitative Debriefs and FGDs with Respondents .................................................................................. 17 Discussion ......................................................................................................................................... 18 References ......................................................................................................................................... 20 Ghana KYR Study Group .............................................................................................................................. 21 Acknowledgements ..................................................................................................................................... 21 Appendix A: Summary of KYR Tools ............................................................................................................ 22 Appendix B: KYR Tools ................................................................................................................................ 23 Policy Questionnaire ............................................................................................................................... 23 Strategic Information Questionnaire ...................................................................................................... 94 Program Implementer’s Questionnaire (Core) ..................................................................................... 130 Program Implementer’s Questionnaire (Key Populations Module) ..................................................... 192 Health Sector Government Questionnaire ........................................................................................... 241 Non-Health Sector Government Questionnaire ................................................................................... 274 Appendix C: Directory of HIV Prevention Program Implementers in Greater Accra, Ghana ................... 298 Appendix D: Maps illustrating the distribution of Key Population Interventions in Greater Accra, Ghana ....................................................................................................... 489 iii List of Tables and Figures Table 1. Number of MMDAs (n=14) Reporting on Whether No, Some, Most, or All of Their Facilities Offer a Given HIV Prevention Intervention ............................................................................ 11 Figure 1. Map illustrating the number of implementing partners working in each of the MMDAs of Greater Accra, Ghana. ............................................................................................................ 14 Figure 2a. Key Populations served by Program Implementers, by MMDA. ........................................... 15 Figure 2b. Key Populations served by program implementers, by MMDA. ........................................... 16 iv List of Acronyms ARVs antiretroviral medications CBOs community-based organizations CCM Country Coordinating Mechanism CEO chief executive officer CERSGIS Centre for Remote Sensing and Geographic Information Services DHS Demographic and Health Survey eTWG Expanded Technical Working Group FGD focus group discussion FSW female sex worker GAC Ghana AIDS Commission GIS geographic information system IBBSS Integrated Biological, Behavioral Surveillance Survey KYER Know Your Epidemic, Know Your Response KYR Know Your HIV Response MARP most-at-risk population MICS Multi-Indicator Cluster Survey MMDA Metropolitan, Municipal, and District Assembly MoE Ministry of Education MoFA Ministry of Food and Agriculture MOH Ministry of Health MoI Ministry of Information MoWAC Ministry of Women and Children Affairs MoYS Ministry of Youth and Sports MSM men who have sex with men NACP National AIDS and STIs Control Programme NGO nongovernmental organization NSP National Strategic Plan OP operational plan PEPFAR U.S. President’s Emergency Plan for AIDS Relief PLHIV people living with HIV PMTCT prevention of mother-to-child transmission of HIV SI strategic information TB tuberculosis TWG technical working group UG-SPH University of Ghana School of Public Health UNAIDS Joint United Nations Programme on HIV/AIDS USAID U.S. Agency for International Development v vi Executive Summary “Knowing” an HIV response in a country is a complex undertaking. This effort requires knowing to the level of a district (or similar local administrative unit) what key implementers in all sectors (government, nongovernment, public, and private) are working against HIV, what populations they serve, what is the reach of these programs, and what specific types of interventions they are implementing. We pilot tested a set of newly developed data collection tools (referred to as the Know Your HIV Response or KYR) in the Greater Accra region of Ghana at the request of the government of Ghana. Data were collected on HIV programming being undertaken in each of the 16 metropolitan, municipal, and district assemblies (MMDAs) in the Greater Accra region of Ghana. As a prevention tool, the KYR tools address three key concepts that are critical for an improved understanding of the HIV-prevention response (location, scale, and needs). Analysis and dissemination of data includes the production of maps of HIV services using geographic information system technology. Overall, the data generated from this pilot exercise allows for mapping and understanding of the scope and scale of the HIV-prevention response at the regional level and identifies challenges and opportunities for scaling the exercise nationally. Ultimately, the study provides information needed to guide prioritization, and/or adjustment of the national HIV-prevention programs and interventions being carried out in the Greater Accra region. vii viii Introduction As knowledge on the global HIV response continues to accumulate both globally and locally, there is general awareness that individual countries must prioritize among many interventions in order to use their resources most effectively to combat the epidemic. These prioritizations take into account country specific epidemiological and social contexts. The Know Your Epidemic, Know Your Response (KYER) concept has emerged in the global HIV community to describe this process of matching a national response to the local disease context. “Knowing” an HIV response in a country is a complex undertaking. This effort requires knowing to the level of a district (or similar local administrative unit) what key implementers in all sectors (government, nongovernment, public, and private) are working against HIV, what populations they serve, what is the reach of these programs, and what specific types of interventions they are implementing. We pilot tested a set of newly developed data collection tools (referred to as the Know Your HIV Response or KYR tools) in the Greater Accra region of Ghana at the request of the government of Ghana. The tools facilitated data collection on HIV programming being undertaken in the 16 metropolitan, municipal,
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