MAP presentation cs indicators

MONITORING AND EVALUATING HIV/AIDS CARE AND SUPPORT : 

MONITORING AND EVALUATING HIV/AIDS CARE AND SUPPORT Development and Piloting of Indicators Eric van Praag Wuleta Lemma HIV/AIDS Institute Family Health International MAP 2002 Barcelona

Monitoring and Evaluation Care and Support Indicators Pilot Study A collaborative process : 

Monitoring and Evaluation Care and Support Indicators Pilot Study A collaborative process Partners CDC – D. Rugg; G. Bicego MACRO/MEASURE – R. Bessinger; T. Boersma UNAIDS – M. Carael Synergy – S. AmaraSingham L. Salins Funding agency USAID – J. Novak, A. Gibbons, L. Sussman Coordination HRSA – K. Marconi, C. Wolf Implementation FHI – E.v. Praag, W. Lemma, A. Mammo, Jennifer Rubin MOH and NAC, Kenya – K. Chebet University of Nairobi – V. Kimani MOH, NAC, RAC, Ethiopia – Mr. Nigatu WHO – V. Habiyambere, K. O’Reilly

Why monitoring and evaluation of care and support for HIV/AIDS?: 

Why monitoring and evaluation of care and support for HIV/AIDS? To assist national, regional and local level planners and implementers to identify progress and gaps in care and support service provision To plan, prioritize, and allocate resources To learn lessons for expansion and scale up of existing services To monitor the impact of HIV/AIDS on health care systems and communities To respond to funder requirements

Slide4: 

PEOPLE, CHILDREN AND FAMILIES AFFECTED BY HIV/AIDS Elements of Comprehensive Care and Support Socioeconomic Support e.g.: Material support Micro-credit Food support Human Rights and Legal Support e.g.: PLHA participation Succession planning Stigma reduction Medical & Nursing Care e.g.: VCT Preventive therapy OI treatment and HAART Palliative care Psychosocial Support e.g.: Counseling Spiritual support Follow-up counseling Community support

Slide5: 

The HIV Care Continuum

Indicators: Care and Support Related Set of Indicators: 

Indicators: Care and Support Related Set of Indicators Care, support and treatment Orphans and vulnerable children Stigma and discrimination Prevention of mother-to-child transmission

Care, Support and Treatment Indicators: 

Care, Support and Treatment Indicators Areas chosen for pilot Policy Development and Implementation Development of human resources needs for care and support Strengthening health facilities capacity Strengthening home and community-based care capacity Improving access to HAART Strengthening the referral system Capacity-building for monitoring and evaluation of HIV/AIDS care and support programs

Indicators: Care and Support: 

Indicators: Care and Support Coverage CS1 Number of PLWHA cared for by health facilitieS in the past 12 months (admitted/number of days) CS2 Number of individuals receiving VCT in past 12 months (percent positive) Source and Frequency: Programme reports; Annual

Indicators: Care and Support: 

Indicators: Care and Support Coverage CS3 Number of households that received external help in providing medical and social support for a person who has been ill for three or more months (frequency/type of service) CS4 The number and percent of districts with at least one health facility providing HAART Source and Frequency: Programme reports; Annual

Indicators: Care and Support: 

Indicators: Care and Support Coverage CS5 The percent of persons with advanced HIV infection receiving HAART (Core UNGASS) Source and frequency: Programme reports/modelling; biannual

Indicators: Care and Support: 

Indicators: Care and Support Coverage CS6 Number of persons trained for monitoring and evaluating HIV/AIDS care programs at the district level in the past 12 months) Source and frequency: Programme reports

Indicators: Care and Support : 

Indicators: Care and Support Guidance CS7 Existence of comprehensive HIV/AIDS care and support policies, strategies and guidelines in line with current WHO or international standards Source and Frequency: Interviews with NACP and document review; biannual

Indicators: Care and Support: 

Indicators: Care and Support Human Resource Capacity CS8 Percent of medical and paramedical training institutions providing training on HIV diagnosis, care, support and treatment, and percent of graduates in the last year of these institutions receiving this training. Source and Frequency: Interviews and record review at medical and allied health institutions; biannual

Indicators: Care and Support: 

Indicators: Care and Support Health Facility Capacity CS9 Percent of health care facilities at different levels of the health care system that have the guidance, facility conditions, trained staff, medical supplies and equipment, and drugs to deliver appropriate care and support for HIV-infected persons (Additional UNGASS). Numerator: Number of health facilities who meet defined standard of care under 5 domains (NB: standard of care to be defined) Source and Frequency: Health Facilities surveys; every 2-4 years

Health Facility Capacity: Construction of Indicator Through Scoring Box: 

Health Facility Capacity: Construction of Indicator Through Scoring Box

Indicators: Care and Support: 

Indicators: Care and Support Referral Systems CS10 Percent of health facilities including VCT sites, with appropriate referral linkages to comprehensive care and support services for people with HIV Source and Frequency: Health facility surveys; every 2-4 years

Indicators: Care and Support : 

Indicators: Care and Support Home Based Care Capacity CS11 The percent of households that received external help in providing medical and psychological/social support for a person who has been ill for three or more months during the last year Source and Frequency: Household surveys

Indicators: Care and Support: 

Indicators: Care and Support Access to HAART CS12 Percent of HIV patient records with ARV prescriptions in line with national/international guidelines Source and Frequency: Health facility surveys with record review; every 2-4 years

Indicators: Care and Support: 

Indicators: Care and Support Access to HAART CS13 Percent of health facilities who provide ARVs that meet minimum WHO requirements for the provision of ARVs Source and Frequency: Health facilities surveys; every 2-4 years

Indicators: Care and Support : 

Indicators: Care and Support Access to HAART CS14 The number and percent of laboratories within each of the 4** categories defined above to monitor HAART according to national/international guidelines ** Categories defined as: absolute minimum tests; basic tests; desirable tests; optional tests Source and Frequency: Health facilities surveys; every 2-4 years

Indicators: Care and Support : 

Indicators: Care and Support Access to HAART CS15 Percent of people discontinuing ARV therapy Source and Frequency: Health facilities surveys with record review, special studies; every 2-4 years

Indicators: Care and Support : 

Indicators: Care and Support Monitoring and Evaluation Capacity CS16 Existence of national monitoring and evaluation capacity for HIV/AIDS care and support programmes Source and Frequency: Interviews and record/document review with NACP

Indicators: Care and Support : 

Indicators: Care and Support Monitoring and Evaluation Capacity CS17 Percent of health facilities with adequate capacity to monitor HIV/AIDS care and support services Source and frequency: Health Facilities surveys; every 2-4 years

Indicators: Orphans and Vulnerable Children: 

Indicators: Orphans and Vulnerable Children Coverage CS18 Number of orphans and other vulnerable children receiving care/support in the past 12 months (types of sevices/frequency) CS19 Number of community initiatives or community organizations receiving support to care for orphans and other vulnerable children in the past 12 months.

Indicators: Orphans and Vulnerable Children: 

Indicators: Orphans and Vulnerable Children External support CS20 Percent of households that received external support for orphans and vulnerable children in the last year Source and frequency: Household survey, every 2-4 years

Indicators: Orphans and Vulnerable Children: 

Indicators: Orphans and Vulnerable Children Education CS21 Ratio of orphaned to non-orphaned children aged 10-14 who are currently attending school Source and frequency: Household survey; every 2-4 years

Indicators: Stigma and Discrimination: 

Indicators: Stigma and Discrimination Rights of patients CS22 Percentage of health facilities with HIV testing that includes informed consent and respect for confidentiality Stigma among health workers CS23 Percentage of health care workers with accepting attitudes toward people living with HIV/AIDS Source and frequency: Health facilities survey, health worker interview; every 2-4 years

Care and Support Pilot Study: The Instruments: 

Care and Support Pilot Study: The Instruments Three Levels Policy/Admin. Nat./Reg./District Health Facility Health Facility Survey Health Worker Interview Household Household survey Focus group discussions: PLHA, carers, orphans

The Instruments: Health Facility Survey: 

The Instruments: Health Facility Survey Departments Interviewed Medical Superintendent: Overview of HIV/AIDS services Out-patient department In-patient department Voluntary counseling and testing Pharmacist Laboratory Health Information Officer

The Instruments: Health Facility: 

The Instruments: Health Facility Overview: what instrument measures Existence of policies or guidelines HIV-related care and support services offered and referral linkages Facility conditions, biosafety and universal precaution measures Confidentiality practices Record keeping system At IP, OPD, ANC, Lab., Pharm., VCT, HMI.

The Instruments: Health Worker Interview: 

The Instruments: Health Worker Interview What it measures Pre-service and in-service training in HIV care and support Specific training in PMTCT and obstetric practices Actual service activities Attitudes

The Instruments: Health Worker Interview: 

The Instruments: Health Worker Interview Providers Interviewed: In charges of health facility Doctor/clinical officer Registered nurse, enroled nurse Trained counsellor Laboratory technician Nurse/Midwife

OBJECTIVES OF PILOT STUDY : 

OBJECTIVES OF PILOT STUDY To test the feasibility of care and support indicators to measure progress To assess the feasibility of the instruments to measure the indicators To assess the capacity of programs to monitor HIV/AIDS care and support at the program level

Care and Support Pilot Study: Countries and sites: 

Care and Support Pilot Study: Countries and sites Three Countries Kenya Ethiopia Uganda

Care and Support Pilot Study: Countries and sites: 

Care and Support Pilot Study: Countries and sites Sites in Kenya Kakamega District Kakamega Provincial General Hospital St. Mary’s Mission Hospital, Mumias 2 Health centers 2 Dispensaries 1 VCT stand-alone St. Mary’s Mission Hospital, Diocese and SWAA Home Based Care Programs

Care and Support Pilot Study: Timeline: 

Care and Support Pilot Study: Timeline Kenya Training – August Pilot – September Ethiopia Training – Oktober Pilot – October Uganda Training and Pilot - September