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Preventing HIV among Guyana’s Key Populations: Guidelines

Preventing HIV among Guyana’s Key Populations: GuidelinesThese guidelines are designed to outline the public health response to HIV among key populations (KPs) in Guyana. The specific objectives are to:

  • Define the populations of interest
  • Define the combination prevention package for KPs
  • Update guidance on the operationalization of interventions
  • Define programme monitoring and evaluation (M&E) for KP prevention activities

The focus of these guidelines is on HIV prevention for KPs and priority populations. To meet the HIVision 2020 goal of eliminating HIV in Guyana, a multi-pronged approach that goes beyond prevention will be required. These guidelines highlight the approaches needed before care and treatment are given and linking with treatment for people who have HIV.

Family Planning Indicators Assessment and Data Quality Audit in Selected Health Facilities across Nigeria

Family Planning Indicators Assessment and Data Quality Audit in Selected Health Facilities across NigeriaPromoting family planning (FP) is an important strategy for preventing high-risk births and infant deaths, reducing unplanned pregnancies and unsafe abortions, and decreasing the burden of infant and maternal mortality globally. To be successful, FP programs must use information systems to accurately track FP use and trends. Although use of District Health Information Software, version 2 (DHIS2) to manage and aggregate health information is becoming the norm across Nigeria, issues still confound the operationalization, availability, accuracy, consistency, timeliness, completeness, and integrity of FP data at health facilities and in DHIS2 by extension. The purpose of this study was to assess FP data quality in select health facilities in Nigeria.

The study used a mixed-methods approachA total of 114 (103 public and 11 private) health facilities in six states (Bauchi, Delta, Enugu, Kano, Osun, and Nasarawa) were selected across Nigeria.

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Engendering Evidence-Based Policy for Young People’s Reproductive Health in India

Engendering Evidence-Based Policy for Young People's Reproductive Health in IndiaYoung people, defined by the World Health Organization as people 10–24 years old, account for more than a quarter of India’s population (2014). The country has the opportunity to harvest economic and social gains from its young, working-age population if it invests in human capital development and overcomes such challenges as poor education and healthcare, gender discrimination, and lack of access to adolescent and youth reproductive health care.

This paper presents evidence for policymakers on the strengths and weaknesses of the health policy framework; service delivery mechanisms; and knowledge, attitudes, and practices of 10- to 24-year-olds related to reproductive health in India.

The research incorporated exploratory and descriptive approaches, using qualitative and quantitative data from primary and secondary sources.

Understanding “the Last 90” in Guyana’s HIV Treatment Cascade: A Facility-Based Assessment of the Viral Loads of Key Populations

Understanding “the Last 90” in Guyana’s HIV Treatment Cascade: A Facility-Based Assessment of the Viral Loads of Key PopulationsAccording to the National Guidelines for Management of HIV-Infected and HIV-Exposed Adults and Children (Ministry of Public Health [MOPH], 2015), viral load testing began in Guyana in 2009. It is indicated for adults at six months after initiation of antiretroviral therapy (ART) and every six to 12 months thereafter for clients who are virally suppressed. This supports what the midterm evaluation of Guyana’s HIVision 2020 reports is the ultimate goal of the HIV treatment cascade (the steps a client takes from testing through viral suppression): “viral load suppression” (MOPH, 2017). One strategy outlined in the document is to “increase the proportion of people with HIV (on HAART [highly active antiretroviral therapy]) who have viral load suppression to 90% by 2020.” That strategy is in line with other global goals to ensure that 90 percent of people enrolled in care have a viral load that is below standard limits or even undetectable. Implementing the strategy in Guyana is particularly important in the era of treatment as prevention, to ensure that the virus is undetectable in clients and therefore untransmittable.

The most recent HIV treatment cascade analysis for Guyana, from 2016, reports that 68 percent of people on ART are virally suppressed (MOPH, 2017). These cascade data come from routine reports from health facilities. Although the information is valuable, it is incomplete, because that same cascade reports that 83 percent of clients on ART have a current viral load test.

MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—realized that filling this gap would be essential to a full understanding of the HIV cascade in Guyana. If the sample of clients who were missing VL measures could be assumed to represent all clients missing VL measures, then we could leverage estimates of viral suppression from a sample of clients who were missing VL data to obtain a more accurate, representative estimate of viral suppression among a larger population in the care and treatment program. Answering these questions would contribute to USAID’s goal of controlling the HIV/AIDS epidemic and the global 90-90-90 targets that PEPFAR has adopted.

The results of the study will help inform MOPH programs both for HIV-positive clients who are KP members and those who are not. It will illuminate gaps in data and show how viral load estimation can be improved at the health facility and national levels.

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Monthly Malaria Bulletins Contribute to Improving Data Use for Malaria Control in Mali

Monthly Malaria Bulletins Contribute to Improving Data Use for Malaria Control in MaliAs a close partner of the National Malaria Control Program (NMCP) in Mali for the past 10 years, MEASURE Evaluation has supported malaria control and prevention activities that have made a difference in collective efforts to combat the epidemic. Together, MEASURE Evaluation and the NMCP have improved the quality of malaria data available, in part by strengthening the capacity of NMCP staff in monitoring and evaluation.

Although the disease is preventable and curable, consistent and high-quality malaria data to guide program implementation and to measure achievements are in short supply. In response to the acute need for reliable malaria data at national and subnational levels, the NMCP, with the support of MEASURE Evaluation, created a monthly malaria bulletin to provide nationwide updates. This brief describes how the bulletin is helping improve data use for malaria control.

Access the brief in English or French.

Strengthening Health Information Systems in Nigeria—Building an OVC Information System

Strengthening Health Information Systems in Nigeria—Building an OVC Information SystemMEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in Nigeria since 2005 to improve the availability of high-quality data to support decision making at all levels of the health system. This work fulfilled two main objectives:

1) Support the Department of Health Planning, Research and Statistics of Nigeria’s Federal Ministry of Health to develop a master facility list to improve data quality and ultimately lead to better coordination of health services

2) Work with the Federal Ministry of Women’s Affairs and Social Development to develop a directory of orphans and vulnerable children (OVC) service providers and build capacity to use OVC data collection tools for the National OVC Management Information System (NOMIS)

We have mapped the HIS strengthening interventions to support each objective in two separate fact sheets. Each fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support HIS performance in meeting the specific objective. By displaying key interventions across the HISSM, we see their strategic interaction, and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system.

This fact sheet documents MEASURE Evaluation’s work to support development of a directory of orphans and vulnerable children (OVC) service providers and capacity building to use OVC data collection tools for the National OVC Management Information System (NOMIS).

View the related document Strengthening Health Information Systems in Nigeria—Developing a Master Facility List

Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Round 2

In 2014, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) introduced the monitoring, evaluation, and reporting (MER) essential survey indicators (ESIs) to help track changes over time in the well-being of orphans and vulnerable children (OVC) project beneficiaries and their households.

In 2018, the OVC team of PEPFAR in Kenya requested assistance from the United States Agency for International Development (USAID) and the USAID- and PEPFAR-funded MEASURE Evaluation project to conduct three panel studies and one cross-sectional survey for three ongoing PEPFAR OVC projects in western Kenya: Making Well-Informed Efforts to Nurture Disadvantaged Orphans & Vulnerable Children (MWENDO), a USAID-funded project of Catholic Relief Services; the Timiza 90 project of the United States Centers for Disease Control and Prevention (CDC); and the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) HIV project funded by the United States Department of Defense. This was the second round of data collection. MEASURE Evaluation completed the first round in 2016. One of the implementing partners whose beneficiaries were assessed in 2016 was AIDS, Population and Health Integrated Assistance Plus Program, Western Kenya (APHIAplus). APHIAplus has since ended, and its beneficiaries now receive services from the MWENDO project.

In the three panel studies (one for each project) the same beneficiary households who were interviewed in 2016 were again interviewed. The main objective for the repeat survey was to evaluate the progress of the OVC projects over the two-year period. In addition, an independent cross-sectional survey (conducted for MWENDO only) was designed to provide a snapshot of the current status of MWENDO beneficiaries in areas not included in the 2016 survey. Fieldwork for the surveys was undertaken in October and November 2018.

The following materials present our findings.

Reports and Posters

Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Dissemination Workshop

Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Dissemination WorkshopIn 2016, the orphans and vulnerable children (OVC) team of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/Kenya requested assistance from MEASURE Evaluation (which is funded by the United States Agency for International Development [USAID] and PEPFAR) to conduct outcome monitoring surveys for three of its ongoing OVC projects in western Kenya: USAID’s AIDS, Population and Health Integrated Assistance plus Western Kenya (APHIAplus) project; the United States Centers for Disease Control and Prevention’s Timiza 90 project; and a project of the United States Department of Defense led by the Walter Reed Program/Henry M. Jackson Foundation Medical Research International. The first round of these household surveys collected data for the nine PEPFAR OVC Essential Survey Indicators and other related information. Reports for the three surveys can be found online here. Round 2 of the surveys occured in  2018.

On May 30–31, 2018, MEASURE Evaluation conducted a workshop in Kisumu, Kenya, to disseminate the first round of survey results and facilitate development of project management responses to the findings. This report presents a summary of the two-day workshop.

Male Case-Finding Assessment in Namibia: Final Report

Male Case-Finding Assessment in Namibia: Final ReportThe 2017 Namibia Population-Based HIV Impact Assessment (NAMPHIA) report and other country reports have indicated that men 20 to 39 years of age have the lowest coverage of antiretroviral therapy in the country. The objective of this study, conducted by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—was to explore the factors affecting barriers to and facilitators of HIV testing and prevention services among young men in Namibia. In keeping with the USAID and PEPFAR goals of controlling the epidemic, the study aimed to determine the right places, the right times, and the right ways to engage young men in these services, and to make recommendations on improving this engagement based on the primary data collected.

Access the report.

Assessment of Drivers of HIV Outcomes

Assessment of Drivers of HIV OutcomesIn Mozambique, more than a million children are HIV-positive or otherwise vulnerable because of HIV. In response to this crisis, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) funds programs that serve orphans and vulnerable children (OVC) affected by HIV. These programs employ caseworkers who provide services to OVC and their families to their reduce vulnerability to HIV—such as by linking OVC to HIV testing services and HIV-positive children and adults to HIV care. PEPFAR seeks to understand how the operationalization of case management can be improved to increase knowledge of HIV status and encourage retention on antiretroviral therapy.

The COVida program was the context of this study. COVida supports roughly 300,000 OVC and caregivers per year to access high-quality comprehensive services nationally.

The purpose of this study was to learn more about the features of the COVida case management system and to make recommendations for improving the effectiveness and efficiency of case management in improving beneficiary outcomes. The study also estimated costs of conducting case work and identified the cost drivers of case management. It produced evidence-informed, actionable recommendations to programs in Mozambique on how to shift their strategies, and ultimately, their resources, to optimally balance quality and cost.

Access the report.

Role of Male Sex Partners in HIV Risk of Adolescent Girls and Young Women in Mozambique

Role of Male Sex Partners in HIV Risk of Adolescent Girls and Young Women in MozambiqueAdolescent girls and young women (AGYW) ages 15–24 years are disproportionately affected by HIV/AIDS, particularly in East and Southern Africa. One strategy to reduce HIV among AGYW, proposed through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Initiative, is to prevent and manage HIV among their male sexual partners. To implement this strategy and reach men, programs need information about AGYW’s potential sexual partners at the local level.

To support DREAMS programming in Mozambique, we undertook a study to characterize this population of men in 3 districts with ongoing DREAMS programming. In mid-2017 we conducted 15 focus group discussions with AGYW (N=102) and a venue-based intercept survey of men (N=1,140). Male sexual partners of AGYW who took the survey were diverse in age, education level, and socioeconomic status. Older AGYW focus group participants sought partners who could provide for them financially. Multiple sexual partnerships and inconsistent condom use were widely reported, with AGYW emphasizing that gender norms disempowered them from negotiating condom use. Reported condom use varied by AGYW and male-partner demographic characteristics, as well as by their relationship type. Condom use rates were much higher than national and regional estimates. AGYW who were less educated/not-in-school, were pregnant, or single mothers were particularly disempowered in sexual relationships. Less educated men were less likely to use condoms than educated men, and condom use was least likely in marriage.

Study findings underscore the importance of reaching the diversity of male sexual partners of AGYW with HIV services as part of a strategy to reduce HIV risk among AGYW. They also support an enhanced focus on female-controlled HIV prevention methods that do not require negotiation with a male partner and special efforts to reach out-of-school/less educated AGYW, as well as pregnant AGYW and single mothers.

Access the journal article.

Rwanda’s Improved Services for Vulnerable Populations Project: Impact Evaluation. End Line Report

Rwanda’s Improved Services for Vulnerable Populations Project: Impact Evaluation. End Line ReportMEASURE Evaluation, funded by the United States Agency for International Development, conducted a cluster-randomized impact evaluation of the “Improved Services for Vulnerable Populations” (ISVP) project, led by Global Communities in Rwanda.

There were three treatment groups:

  1. Household economic strengthening (HES-only) group, which provides a core platform of financial interventions
  2. Full ISVP group, which supplements the core platform of HES interventions with health, education, and skills-building services
  3. Control group, receiving no ISVP interventions

The evaluation covered 12 districts. Initial data collection took place in mid-2017 and end line data collection in late 2018/early 2019. Methods were quantitative surveys at both time points of the same households and key informant interviews at end line with 36 community leaders and eight program staff.

Final household survey sample sizes were 1,374 for full ISVP, 1,270 for HES-only, and 1,169 for control. We estimated program impact using difference-in-differences estimation and conducted qualitative thematic analysis.

Results showed that, despite contamination and data collection timing limitations, the program was still able to effect significant change in health and economic strengthening. Each program group saw positive impact for seven outcomes and negative impact for one; the full ISVP also trended positive for an eighth outcome. If initial data collection had taken place prior to program start, the full ISVP likely would have shown impact on at least two other outcomes, outperforming HES-only.

Access the full report and a related summary report.

An Assessment of the Actionable Drivers of HIV Outcomes: A Study of the COVida Case Management System in Three Provinces in Mozambique

An Assessment of the Actionable Drivers of HIV Outcomes: A Study of the COVida Case Management System in Three Provinces in MozambiqueIn Mozambique, more than a million children are HIV-positive or otherwise vulnerable because of the virus. In response to this crisis, the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) fund programs that serve orphans and vulnerable children (OVC) affected by HIV. These programs employ case workers who provide services to OVC and their families to reduce their vulnerability to HIV, such as linking OVC to HIV testing services and HIV-positive children and adults to HIV care. PEPFAR seeks to understand how case management can be improved to increase knowledge of HIV status and encourage retention on antiretroviral therapy.

COVida is a USAID-funded OVC program in Mozambique that supports roughly 300,000 OVC and caregivers per year to access high-quality comprehensive services nationally. The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a study of COVida in 2019 to learn more about the features of the program’s case management system, with a view to making recommendations on how to improve the system’s effectiveness and efficiency and—ultimately—beneficiary outcomes. The study also estimated the costs of conducting casework and identified the cost drivers of case management. It produced evidence-informed, actionable recommendations for programs in Mozambique on how to shift their program implementation strategies and, ultimately, their resources to optimally balance quality and cost.

This brief shares more.

Helpful Hints: Expedited Data Quality Assessment

Helpful Hints: Expedited Data Quality AssessmentAn expedited data quality assessment (EDQA) is a novel method of organizing patient records and cleaning data found in patient files and health facility registers. Its advantages are that it can be done in five to six weeks rather than several months, and can serve as an intervention by allowing for correction of the data when source documents are found to be incomplete or inconsistent.

This new method has been used when stakeholders (researchers, implementing partners, etc.) need to clean patient files and to use these files to determine what patients may have been lost to follow-up for completing HIV treatment and care.

EDQA is similar to standard data quality assessments (DQAs) but is more rapid and intense. An EDQA is conducted in two stages: a pilot or “mini” DQA in selected health facilities to diagnose data quality issues, followed by a data-cleaning intervention to address those issues. An EDQA also assesses the quality of select indicators and diagnoses data reporting challenges. During an EDQA, facility registers are compared to source documents, such as patient files, electronic medical records, and laboratory records.

Results from an EDQA can be used to inform strategies for decreasing patient loss to follow-up (LTFU), for improving site-level data quality, and for strengthening data management practices, such as supportive supervision and routine data quality. To decrease LTFU, an EDQA can identify patients who should be contacted through community outreach to encourage them to return for treatment. So far, EDQA has been applied in several countries to an HIV indicator (TX_CURR) that shows the number of adults and children currently receiving antiretroviral therapy. It could be adapted and applied to other HIV indicators, such as continuity of care, prevention of mother-to-child transmission, or similar indicators requiring data from multiple sources.

To help implementers know what to expect in an EDQA and to offer help on selecting sites for investigation, this briefshares recommendations.

Evaluating Programs for Prevention of Mother-to-Child Transmission of HIV Using Process Tracing: Guide and Sample Protocol

Evaluating Programs for Prevention of Mother-to-Child Transmission of HIV Using Process Tracing: Guide and Sample ProtocolThis guide offers the following resources:

  • Information and references on previous evaluations of the Partnership for HIV-Free Survival (PHFS) conducted by MEASURE Evaluation
  • Background information on our concept and rationale for using the process tracing method to evaluate the PHFS approach
  • Information about the process tracing method as we understand it to be applied to public health evaluations
  • A sample protocol that can be adapted to evaluate prevention of mother-to-child transmission (PMTCT) of HIV programs in other countries using process tracing, including specific language from our protocol on evaluating PHFS using process tracing

Natural audiences for this guide are evaluators or researchers interested in the innovative method of process tracing in public health evaluations, in partnership with other stakeholders, such as government and nongovernmental implementers of PMTCT programs. We highly recommend that investigators develop protocols in a participatory manner, involving partners at the local, national, and international levels, and in conjunction with donors. It is essential to have input from key stakeholders, and to follow their guidance, particularly in designing procedures to inform and contact study participants in a culturally appropriate way. Careful planning and participation will help facilitate use of the generated evidence to improve programs and policies.

Helpful Hints: PLACE

Helpful Hints: PLACEThe Priorities for Local AIDS Control Efforts (PLACE) method is a rapid assessment tool to improve HIV prevention and treatment coverage in areas where HIV transmission is most likely to occur. It was developed for local HIV program managers in resource-poor settings who want to know where to target resources to prevent new infections. The focus of the PLACE method is to identify gaps in current programs and assess whether people most likely to acquire and transmit HIV have been reached with appropriate prevention and treatment services.

The PLACE protocol has five steps:

  1. To identify high-transmission areas in a given geographic location
  2. To identify sites in high-transmission areas where people meet new sexual partners
  3. To visit, map, and characterize sites in each area
  4. To describe the characteristics of people socializing at these sites
  5. To use findings to inform interventions and resource allocation

This brief shares recommendations to consider when planning and carrying out a PLACE assessment. Access additional PLACE resources at https://www.measureevaluation.org/resources/tools/hiv-aids/place.

Best Practices for Gender in the Monitoring and Evaluation of HIV Programs

Best Practices for Gender in the Monitoring and Evaluation of HIV ProgramsGender is a critical component of efforts to control the HIV epidemic. Gender influences who is vulnerable to HIV and able to seek and access care and treatment, as well as norms around HIV prevention, treatment, and stigma. To reach epidemic control effectively, gender must be considered in HIV programs and policies, and thus in monitoring and evaluation (M&E).

MEASURE Evaluation, which is funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), created this brief to share best practices in gender M&E for HIV programming. We recommend including gender at every step of monitoring and evaluating the clinical cascade; using qualitative and quantitative gender data to inform and adapt HIV programming; paying special attention to priority populations; and keeping gender-based violence and structural considerations in the forefront of planning and interpretation to ensure advancement toward HIV epidemic control. This brief shares more.

Helpful Hints: Routine Data Quality Assessment

Helpful Hints: Routine Data Quality AssessmentThe routine data quality assessment (RDQA) tool has two components:

  1. The systems assessment is a qualitative approach to examining the overall structure and functions of a data management and reporting system.
  2. The data verification process gauges the timeliness, completeness, and accuracy of data that are collected and reported in the system.

The tool’s user manual can be found here: https://www.measureevaluation.org/resources/publications/ms-17-117.

This brief shares practical tips on using the tool, based on MEASURE Evaluation’s application of RDQA since 2007 in scores of countries. These hints chiefly apply to the data verification component of the tool.

The Importance of Gender in HIV Health Information Systems

The Importance of Gender in HIV Health Information SystemsAddressing gender while strengthening HIV health information systems (HIS) ensures equity in access and benefits for women, men, girls, boys, and transgender people. This brief establishes the importance of addressing gender in HIS activities and suggests a series of action points that will promote the integration of gender in HIV HIS and ultimately improve HIV outcomes.

Access more briefs in this series.

Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: User Manual for the DHIS2 PMTCT Tracker

Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: User Manual for the DHIS2 PMTCT TrackerThis manual is intended for users of MEASURE Evaluation’s DHIS2 Tracker for Prevention of Mother-to-Child Transmission of HIV (PMTCT) (hereafter called the PMTCT Tracker). Before using this manual, the PMTCT Tracker must be installed. A download link for the sample PMTCT tracker can be found at https://www.measureevaluation.org/resources/pmtct-tracker/

This manual is intended as a reference document for staff using the PMTCT Tracker for data capture, supervision, and reporting. It is also intended to be a training resource for staff who train others on how to use the PMTCT Tracker. Basing the training around the User Manual will ensure that trainees become very familiar with it, making it more likely that the manual is used as a reference after they have returned to their own clinic or facility.

Although it is important for a PMTCT Tracker user to work through and become familiar with the entire User Manual during the initial training, the User Manual has also been designed as a “how to” guide for quick reference after training participants become active users of the system. Each “how to” section provides self-contained, step-by-step guidance on carrying out a specific task. This is particularly important in cases in which a user may not be accessing the PMTCT Tracker on a regular basis and thus may need to be refreshed on how to carry out a given task.

Section 2 of the User Manual provides background on the PMTCT Tracker and introduces key concepts. Section 3 provides guidance on how to access and navigate the PMTCT Tracker, and Section 4 introduces key aspects of the data capture and audit function. Sections 5 and 6 guide the user through the steps for capturing and reviewing data about the PMTCT care for the mother and child. Section 7 guides the user through the steps for tracking and following up on PMTCT patients, and Section 8 explains how to view the PMTCT dashboards.

Although this User Manual is designed for the sample PMTCT Tracker it has been made available as a Word document, as well as a PDF file, so that it can be adapted and tailored for use with specific local implementations of the PMTCT Tracker.

The manual is also available for download in Word.

Additional guidance on how to establish a PMTCT tracker in a given country is available in MEASURE Evaluation’s Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: Guidance (Version 2) at https://www.measureevaluation.org/resources/publications/ms-18-127

Access the PMTCT tracker resources at https://www.measureevaluation.org/resources/pmtct-tracker/