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Strengthening Systems for the Monitoring and Evaluation of HIV Status of Orphans and Vulnerable Children

by on March 27, 2019

Strengthening Systems for the Monitoring and Evaluation of HIV Status of Orphans and Vulnerable ChildrenIn fiscal year 2017, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) introduced a new Monitoring, Evaluation, and Reporting (MER) indicator to collect information on the HIV status of orphans and vulnerable children (OVC). This was done to help gauge the contributions of OVC to the 90-90-90 goals.1 The new indicator is called OVC_HIVSTAT. The United States Agency for International Development (USAID)- and PEPFAR-funded MEASURE Evaluation conducted a mixed methods study in three countries to collect qualitative data about the monitoring and evaluation (M&E) systems in place for the collection, management, and use of OVC_HIVSTAT data. Performance, data quality, and contextual factors were considered when choosing the three countries for the in-depth study. The countries selected were Côte d’Ivoire, South Africa, and Zimbabwe. Six implementing partners (IPs) across the three countries were visited between November 2017 and February 2018; 32 qualitative interviews were conducted with IP staff and more than 60 community workers participated in workshops on data collection related to HIV risk assessment. MEASURE Evaluation collected and reviewed HIV risk assessments, indicator reference sheets, and standard operating procedures from each IP. Transcripts and notes were analyzed, and preliminary findings were disseminated during a global webinar for the six OVC IPs and their stakeholders on March 14, 2018.

This summary report describes the challenges that the IPs are facing. For example, several OVC programs visited have been slow to adopt the rationale for universal HIV risk assessment as a prerequisite for testing. Although a range of implementation strategies were observed, stigma related to asking questions about HIV risk often prevents community workers from conducting formal HIV risk assessments inside the households. The data collection forms were often problematic, poorly understood by community workers, and open to multiple interpretations by data entry clerks. The guardians of newly detected HIV-positive children were reluctant to report the test results to the community workers. Moreover, once the HIV test results were reported, weak data management protocols contributed to inconsistent documentation of the results. Last, OVC programs faced challenges reporting updated antiretroviral therapy (ART) retention status at regular intervals.

Our analysis of these challenges led to a series of recommendations both for USAID missions and IPs to strengthen M&E systems related to the collection, management, and use of OVC_HIVSTAT data.

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