Using programme M&E data for Surveillance in Nepal: Challenges and Opportunities Name of Author(s): Biwesh Ojha(1)

Background-1 HIV Testing and Counseling service was first started in Nepal in 1995 by National Centre for AIDS and STD Control (NCASC) HIV Testing and Counseling is the entry point for overall HIV and AIDS care services. It is provided free of cost to the key population at higher risk, including general population from all over the country

Background-2 Routine data are those data which are reported in routine basis from existing service delivery points (HTC, ART, PMTCT reported by the 7th of next months) Nepal currently adopts Second generation surveillance (SGS) system for surveillance activities Strengthening the use of programme monitoring and evaluation data is one of key principles for strengthening the SGS system in Nepal (National Surveillance Guideline 2012)

Background-3 Second generation surveillance system in Nepal Data Management, analysis and used for action Case reports HIV surveillance Behavioral surveillance STI surveillance Size estimation of key population at higher risk programme monitoring and evaluation Second generation surveillance system in Nepal

Background-4 Nepal is regularly conducting Integrated Bio-Behavioral Surveillance surveys on key population at higher risk from 2002 Conducting IBBS requires huge amount of resources (Money, time, Human resource)

Objectives This paper aims to compare the trend of HIV prevalence from the IBBS to Routine reporting(HTC) of People who Inject drug (PWID) from Kathmandu and Pokhara over last three years This paper also aims to analyze the challenges and opportunities using regular M & E data.

Methodology Last three years regular HTC data (Case report) from 6 sites of Kathmandu and 3 sites of Pokhara was captured IBBS findings from Kathmandu and Pokhara were observed Comparison of IBBS prevalence with regular HTC data was done

Findings

Comparison of prevalence of HTC and IBBS Pokhara Year HIV Prevalence from HTC IBBS Prevalence 2009 0.7 3.4 2011 0.4 4.6

Comparison of prevalence of HTC and IBBS of Kathmandu Year HIV Prevalence from HTC IBBS Prevalence 2009 15.8 20.7 2011 3.2 6.3

Discussion

Both comparison shows the difference in HIV prevalence of HTC and IBBS Surveys This demarks the existing gap either from regular reporting data or Some error may have occurred while selecting the samples for IBBS surveys

Challenges of routine M & E data Irregular reporting from the sites No unique identification code to each client thus may lead to double counting of cases Incomplete reporting Passive case reporting The success of a passive reporting system depends on how many HIV-infected individuals have access to HIV testing, get tested, obtain care at a health facility, and get reported

Opportunities of routine M & E data Cost effective Provides disaggregation information (Sex, Age, Risk group, District) to know the epidemic and its response at local, national level Use of data for HIV estimation Can measure the trend of HIV prevalence Can provide information on the current and future need for ART and prevention services

Thank you