Global Monitoring & Evaluation of HIV Prevention Among Most-at-Risk Populations: Update on existing guidance Priscilla Akwara, PhD Senior Advisor, Statistics & Monitoring UNICEF, New York Consultation on Strategic Information and HIV Prevention among Most-at-Risk Adolescents September 2-4, 2009 UNAIDS, Geneva 1

2OVERVIEW Coordination and harmonization of global HIV- related M&E activities Existing M&E guidance on most-at-risk populations Challenges and opportunities of M&E of most- at-risk populations Summary & conclusions 2

Coordination & Harmonization of Global HIV M&E Activities HIV/AIDS Monitoring & Evaluation Reference Group (MERG) provides guidance and support to UNAIDS and partners on monitoring of HIV/AIDS epidemic Membership of MERG: All 10 UN co-sponsors, bilateral and international agencies, implementing partners, government representatives, civil society, & people living with HIV. Current emphasis on coordination, harmonization, & information sharing; e.g. new indicators, coordination of data collection, publications, evaluations and M&E assessments. Bi-weekly multi-agency conference calls (MACC) among key agencies Interagency task teams (IATTs) & working groups on M&E, that respond to specific issues around each of the programme areas – e.g. young people, children affected by AIDS, & PMTCT and paediatric HIV 3

Global Indicator Harmonization  Indicator harmonization done through the UNAIDS HIV & AIDS MERG Indicator Technical Working Group (TWG)  Participating agencies endorsed indicator harmonization principles Agreement on indicators among donors and other agencies Guidance to countries on useful indicators to facilitate data comparability & reduce reporting burden on countries  TWG identified 40 core national indicators [25 UNGASS + 15 additional recommended]  Indicator Registry – a repository for all indicators, regularly updated and a global resource & dissemination mechanism for outputs from the indicator development process. 4

Goals To focus national monitoring efforts To reduce the data collection and reporting burden Objectives To provide guidance on prioritizing indicators for national monitoring of the AIDS epidemic & response To harmonize AIDS indicators among international agencies / donors and facilitate reporting to international levels and comparability of data Global Indicator Technical Working Group (TWG) 5

Objectives To develop a set of operational M&E guidelines for HIV prevention among: –Injecting drug use (IDU), –Men who have sex with men (MSM), –Sex work (SW) and; closed settings MERG Technical Working Group on HIV Prevention for Most-at-Risk Populations 6

National M&E indicator guidance  Guides to monitoring and evaluation that define core and additional indicators exist for the following:  United Nations General Assembly Special Session on AIDS (UNGASS) reporting guidance for 2010 country reporting  Addendum to the UNGASS guide - Additional national recommended indicators  Most-at-risk populations (MARPS)  Prevention of HIV infection among young people  Anti-retroviral therapy (ART)  Prevention of HIV infection in children and infants (PMTCT)  Orphans and vulnerable children (OVC)  Care and Support  All guides include core UNGASS indicators and additional indicators relevant for specific programme areas  Describe indicator definitions, calculation & data collection methods, interpretation and limitations of the indicators. 7

Core indicators revised for 2010 reporting 25 core indicators including 8 indicators for most-at-risk populations: - National commitment - National programme coverage indicators - National knowledge and behaviour - National impact - 15 additional recommended indicators No longer different indicators for generalized and concentrated/low prevalence epidemic types, so countries can apply any relevant to their situation Emphasis on disaggregated data: sex, age and various sub-populations UNGASS HIV indicator guidance for national programmes 8

M&E guidance for HIV prevention programmes for most-at-risk populations Describes M&E methods for most-at- risk populations, specific reference to most-at-risk adolescents 13 recommended core indicators Additional indicators for programme monitoring Data collection methods Examples of use of data for programme planning, monitoring & evaluation References for additional technical information 9

Recommended national HIV indicators for most-at-risk populations National programme (coverage) indicators Measurement method 1. Number & percentage of key intervention sites with HIV prevention interventions in place Key informant interviews and mapping 2. Number of key intervention areas covered with targeted condom outlets Condom outlet survey 3. Percentage of most-at-risk populations reached by HIV prevention programmes* Surveys of most-at-risk populations; Programme data and population size estimation 4. Percentage of most-at-risk populations that received an HIV test in the last 12 months and know their results* Surveys of most-at-risk populations; Programme data and population size estimation * UNGASS INDICATORS 10

Knowledge & Behaviour (Outcome) indicatorsMeasurement method 5. Percentage of most-at-risk populations who both correctly identify ways of preventing HIV transmission and who reject major misconceptions about HIV transmission* Surveys of most-at-risk populations 6. Percentage of female and male sex workers reporting the use of a condom with their most recent client* Surveys among sex workers 7. Percentage of female and male sex workers reporting consistent use of condoms Surveys among sex workers 8. Percentage of men reporting sex with a sex worker in the past 12 months General population surveys or surveys of higher-risk men 9. Percentage of men reporting condom use at last sex with a sex worker of those reporting sex with a sex worker in the past 12 months General population surveys or surveys of higher-risk men 10. Percentage of men reporting use of a condom the last time they had anal sex with a male partner* Surveys of men have sex with men 11. Percentage of injecting drug users reporting the use of a condom the last time they had sexual intercourse* Surveys of injecting drug users 12. Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they injected* Surveys of injecting drug users * UNGASS INDICATORS MARPS Core Indicators CONT’D… 11

Impact indicatorMeasurement method 13. Percentage of most- at-risk populations who are HIV infected* HIV prevalence surveillance * UNGASS INDICATORS MARPS HIV indicators cont’d… 12

13 UNAIDS- WHO- UNICEF- MACRO DHS - OTHER RESOURCES 13

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 Lack of supportive environment to foster free access and use of services for most-at-risk populations, hence collect & use data – legal, political will, commitment & leadership, social, institutional, etc  Poor coordination and management of M&E efforts, between governments and implementing partners & amongst partners themselves makes difficult to get a complete picture of the national response  Different epidemic types; not enough indicators to respond to all epidemic types  Limited or no specific allocation of resources for data collection, analysis and use Challenges & Opportunities for M&E of HIV Prevention among Most-at-Risk Populations Contextual & operational challenges: 15

Challenges & opportunities for M&E of MARPS: Methodological & ethical  Estimation of population size - ‘hard-to-reach’, hidden, marginalized, mobile or migrant populations  Lack of harmonization in indicator definitions and data collection & analysis methods negate data comparability & use – different age groups, different geographical study sites over time & sub-populations  Limited disaggregated data – sex, age, sub-populations at risk – limits effective use of data Many data sources – special surveys, programme statistics, estimates, research studies, etc. – requires national and international commitment and investment in collection of quality data from all sources Ethical issues in studying children <15 years 16

Summary and conclusions Increased data demands for evidence-based HIV programs for MARPS Guidance is available for improved monitoring and evaluation of HIV prevention among most-at-risk populations Increased need to monitor HIV program performance and process-level indicators Need to strengthen capacity of staff and funding for monitoring and evaluation work Strategic decisions about comprehensive data collection to ensure different types of data are collected for all HIV programme areas Need to strengthen collaboration and coordination between government and partners to continue to improve M&E methods and build national capacity A dedicated budget and government and partner commitment are important for successful implementation of national M&E systems for MARPS. 17

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