MONITORING AND EVALUATING HIVAIDS CARE AND SUPPORT

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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

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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. OReilly

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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

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Elements of Comprehensive Care and Support

• Human Rights and Legal Support
• e.g.
• PLHA participation
• Succession planning
• Stigma reduction

• Socioeconomic Support
• e.g.
• Material support
• Micro-credit
• Food support

PEOPLE, CHILDREN AND FAMILIES AFFECTED BY
HIV/AIDS

• 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

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The HIV Care Continuum
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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

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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

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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

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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

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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

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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

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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

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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

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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

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Health Facility Capacity Construction of
Indicator Through Scoring Box
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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

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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

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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

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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

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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/internation
  al guidelines
• Categories defined as absolute minimum
  tests basic tests desirable tests optional
  tests
• Source and Frequency Health facilities surveys
  every 2-4 years

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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

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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

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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

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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.

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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Care and Support Pilot Study Countries and sites

• Three Countries
• Kenya
• Ethiopia
• Uganda

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Care and Support Pilot Study Countries and sites

• Sites in Kenya
• Kakamega District
• Kakamega Provincial General Hospital
• St. Marys Mission Hospital, Mumias
• 2 Health centers
• 2 Dispensaries
• 1 VCT stand-alone
• St. Marys Mission Hospital, Diocese and SWAA
  Home Based Care Programs

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Care and Support Pilot Study Timeline

• Kenya
• Training August
• Pilot September
• Ethiopia
• Training Oktober
• Pilot October
• Uganda
• Training and Pilot - September