Order 187973: Public Health informatics informed approaches for monitoring or managing HIV in sex workers in Guyana (South America)

ITABLE OF CONTENTS

ACRONYMS ...................................................................................................................2 FOREWORD ..................................................................................................................4 CHAPTER 1. INTRODUCTION................................................................................6

1.1 HIV AND AIDS IN GUYANA.................................................................................... 6 1.2 THE PRESIDENTIAL COMMISSION ON HIV/AIDS ................................................. 10 1.3 RATIONALE FOR A NATIONAL M&E PLAN ............................................................ 11 1.4 GOALS AND OBJECTIVES OF THE NATIONAL M&E PLAN ...................................... 12 1.5 METHODOLOGY OF M&E PLAN DEVELOPMENT .................................................. 13

CHAPTER 2. MONITORING AND EVALUATION CONCEPTS AND PRINCIPLES................................................................................................................14

2.1 MONITORING AND EVALUATION DEFINITIONS .................................................... 14 2.2 LEVELS OF DATA IN HIV AND AIDS MONITORING AND EVALUATION ................ 14 2.3 PRINCIPLES OF A GOOD MONITORING AND EVALUATION SYSTEM ....................... 16

CHAPTER 3. NATIONAL LEVEL HIV AND AIDS INDICATORS ....................17 3.1 IMPACT .................................................................................................................. 17 3.2 STRENGTHEN NATIONAL CAPACITY...................................................................... 18 3.3 CLINICAL AND DIAGNOSTIC MANAGEMENT AND ACCESS TO CARE, TREATMENT, AND SUPPORT ............................................................................................................. 18 3.4 REDUCING RISK AND VULNERABILITY TO HIV INFECTION .................................. 20 3.5 SURVEILLANCE AND RESEARCH............................................................................. 21

CHAPTER 4. NATIONAL MONITORING AND EVALUATION IMPLEMENTATION STRATEGY ...........................................................................22

4.1 DATA COLLECTION STRATEGY OVERVIEW ........................................................... 22 4.2 DATA SOURCES ..................................................................................................... 22 4.3 INSTITUTIONAL ROLES AND RESPONSIBILITIES ..................................................... 25 4.4 REPORTING LEVELS AND INFORMATION FLOWS ................................................... 26 4.5 DATA DISSEMINATION PLAN................................................................................. 28 4.6 RESOURCE REQUIREMENTS ................................................................................... 28

CHAPTER 5. NATIONAL INDICATOR REFERENCE SHEETS ......................30 5.1 IMPACT INDICATORS .............................................................................................. 30 5.2 PRIORITY AREA 1: STRENGTHENING NATIONAL CAPACITY.................................... 34 5.3 PRIORITY AREA 2: CLINICAL AND DIAGNOSTIC MANAGEMENT AND ACCESS TO CARE, TREATMENT, AND SUPPORT ............................................................................. 40 5.4 PRIORITY AREA 3: REDUCING RISK AND VULNERABILITY TO HIV INFECTION ....... 54 5.5 PRIORITY AREA 4: SURVEILLANCE AND RESEARCH ............................................... 66

REFERENCES.............................................................................................................69 APPENDICES ..............................................................................................................71

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ACRONYMS AIDS Acquired Immunodeficiency Syndrome AIS AIDS Indicator Survey ANC Antenatal Clinic ART Anti-retroviral Therapy ARV Anti-retroviral BCC Behavior Change Communication BSS Behavioral Surveillance Study BBSS Bio-Behavioral Surveillance Study CAREC Caribbean Epidemiology Center CARICOM Caribbean Community CBO Community-based Organization CDC US Centers for Disease Control and Prevention CD4 Cluster Designation 4 (T-helper cell antigen) CHRC Caribbean Health Research Council CIDA Canadian International Development Agency CRIS Country Response Information System CSO Civil Society Organization DHS Demographic and Health Survey EU European Union FBO Faith-based Organization GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GoG Government of Guyana GPC Guyana Pharmaceutical Corporation GUM Genito-Urinary Medicine Clinic HBS Household Budget Survey HDI Human Development Index HMIS Health Management Information System HPC Home and Palliative Care HIV Human Immunodeficiency Virus HSDU Health Sector Development Unit IDB Inter-American Development Bank IEC Information, Education, Communication ILO International Labor Organization JICA Japanese International Cooperation Agency MARP Most At-Risk Population M&E Monitoring and Evaluation MERG Monitoring and Evaluation Research Group MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MOH Ministry of Health MSM Men Who Have Sex with Men NAC National AIDS Committee NAP National AIDS Program NAPS National AIDS Program Secretariat NBTS National Blood Transfusion Service NGO Non-Governmental Organization NSP National Strategic Plan OI Opportunistic Infection

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OPEC Organization of Petroleum Exporting Countries OVC Orphans and Vulnerable Children PAHO Pan-American Health Organization PCHA Presidential Commission on HIV/AIDS PEPFAR US President’s Emergency Plan for AIDS Relief PLHIV Persons Living With HIV PMTCT Prevention of Mother-to-Child Transmission (of HIV) PMU Program Management Unit PRSP Poverty Reduction Strategy Paper RAC Regional AIDS Committee RHA Regional Health Authority SMART Specific, Measurable, Attainable, Realistic, and Time-Bound SPA Service Provision Assessment STD Sexually Transmitted Disease STI Sexually Transmitted Infection SW Sex Worker (or Sex Work) TB Tuberculosis UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Program UNGASS United Nations General Assembly Special Session UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund UNTG United Nation Theme Group USAID United States Agency for International Development VCT Voluntary Counseling and Testing WB World Bank WHO World Health Organization

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FOREWORD

The Republic of Guyana is severely affected by the HIV epidemic. HIV affects all levels and sectors of society and is currently the leading cause of mortality in young adults in Guyana. Following the first reported case of AIDS case in Guyana in 1987, a national institutional infrastructure was established to coordinate the response to AIDS and provide strategic leadership to address the challenges of HIV and AIDS at the national, regional, and sub-regional levels. A national policy on HIV and AIDS was passed by parliament in 1999 and in 2005, the Government of Guyana (GoG) established the Presidential Commission on HIV/AIDS (PCHA) to provide the leadership to and oversight of inter-sectoral coordination of the national response. The National AIDS Programme Secretariat (NAPS) was established to coordinate the overall national AIDS response. To fully realize the strategic leadership of the PCHA and the coordination role of the NAPS, a national monitoring and evaluation plan has been developed that will harmonise monitoring and evaluation (M&E) efforts and ensure that the impact of the HIV epidemic and the effectiveness of the national response are adequately monitored.

The general purpose of this monitoring and evaluation plan is to:

Provide a framework that will be used to monitor and evaluate the coordinated national AIDS response;

Ensure consistent use of all indicators and appropriate linkages between all initiatives supported by the GoG, partners, and key stakeholders;

Ensure appropriate and sustainable linkages between data collection efforts by different stakeholders.

The M&E Plan for the national response to the HIVepidemic in Guyana has been designed with the recognition that there are a number of global commitments, goals, and internationally harmonized indicators that require due attention. International and national commitments that inform this M&E Plan include the Millennium Development Goals (MDGs); the United Nation’s General Assembly Special Session on HIV/AIDS ‘Declaration of Commitment;’ (UNGASS 2001) the movement towards universal access to HIV prevention, treatment, care and support, and the key funding mechanisms: the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). Monitoring and evaluation of the Guyana National Strategy for HIV/AIDS (2007 - 2011) is based on the inputs-processes-outputs-outcomes-impact framework. A set of core national indicators that cut across all sectors and program areas has been established and will form the basis of monitoring the national response and routine reporting. Annual and quarterly national reports with data produced by regional and local bodies will be presented by the GoG. The PCHA and NAPS will play an

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integral role in establishing and maintaining the flow of data from the regions, line ministries, and international and local agencies. The Regional Health Authorities (RHA) or Regional Health Department will coordinate all actors working in HIV/AIDS at the regional and sub-regional levels. Resources will be provided to collect all the data that is required through the mechanisms that have been identified in this document. The main challenges will be to improve the validity, reliability and national representativeness of the data collected and enforcing reporting requirements. For each core indicator in the monitoring and evaluation framework, the quality of data collected through the indicators will be assessed periodically and appropriate action will be taken to make the necessary improvements.

The core indicators are reported by program area in a matrix. The criterion for indicator selection was based on the 2007 - 2011 Guyana National Strategic Plan (NSP) for HIV/AIDS, technical and financial feasibility of collection, comprehensiveness, and simplicity. The indicators have been grouped into four key priority areas: Strengthen National Capacity; Clinical and Diagnostic Management and Access to Care, Treatment, and Support; Reducing Risk and Vulnerability to HIV Infection; and Surveillance and Research. For each core indicator, details have been included in tabular form to show indicator characteristics, such as data collection tool, frequency of data collection, and responsible agency. The main report and appendices provide details for each indicator and program area.

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Chapter 1. Introduction 1.1 HIV and AIDS in Guyana Guyana has a population of about 750,000 inhabitants (Bureau of Statistics 2002) with a landmass of 215,000 km2 extending along the northeastern shore of South America. It is the only English-speaking country in South America and it is a member of the Caribbean Community (CARICOM). Most of the population (86 percent) is concentrated in the coastal areas and approximately 70 percent of the population lives in rural communities. Per capita GDP is estimated to be about $597 (2000), among the lowest in the Americas, and its 107 rank in the Human Development Index (HDI) Report is the lowest of the English-speaking Caribbean (UNDP 2005). Administratively, Guyana is divided into 10 regions, with three coastal regions (3, 4, and 6) collectively accounting for 72 percent of the household population. The first AIDS case in Guyana was reported in 1987. From 1987 to 2002, a cumulative total of 3163 cases have been reported to the National Surveillance Unit (CAREC 2004). The most recent UNAIDS estimates suggest that Guyana currently has one of the highest prevalences of HIV infection in the Latin American and Caribbean region, second only to Haiti. Adult prevalence is estimated to be about 2.5 percent and, consistent with trends in other Caribbean countries, the epidemic is generalized because more than 1 percent of ante natal women are infected. From 1997 to 2002, there has been a 3.2 fold increase in the number of reported HIV cases, with the sharpest overall increase from 2001 to 2002 (due in part to increased case detection). Since 1989, males have experienced a six-fold increase in HIV cases, and females have experienced a five-fold increase in HIV cases (CAREC 2004). AIDS is currently the leading cause of death for young adults aged 25-49 years (MOH 2002a). This age group accounted for 70 percent of the reported AIDS cases in 2002. While the latest data from 2002 suggests that there are more male HIV infections, the number of female infections continues to grow. The current sex ratio is 1.1, down from 2.8 in 1989 (CAREC 2004). Since the first reported case, there has been a progressive increase in the prevalence of HIV in Guyana; however, the true rate of infection and absolute number of infected individuals is largely unknown because under-reporting is estimated to be as high as 60 percent and AIDS data are incomplete (CAREC 2004; CHRC 2004). UNAIDS estimates for Guyana suggest that at the end of 2003, there were about 11,000 people living with HIV and about 1,100 AIDS-attributable deaths annually (UNAIDS 2004). HIV continues to affect all segments of the population and all regions of Guyana. The highest HIV prevalence has been documented in female sex workers (SW) in the capital of Georgetown (46 percent; Persaud, et al. 1999) and gold miners working in the interior regions (6.5 percent; Palmer, et al. 2002). Data for HIV and AIDS have been reported from all regions of Guyana, with regions 4 and 10 reporting the highest incidence rates. Region 4, which includes the capital of Georgetown, is the most populous and region 10 includes the major mining town of

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Linden. While the overall prevalence is believed to be low in the indigenous Amerindian community, this group is potentially at risk of increased exposure to HIV as the interior regions become more developed and formal links to commercial interests become tighter. Since the first reported case of AIDS in 1987, the GoG has been cognizant of the devastating effects that HIV can have on national development and poverty reduction efforts. Toward this end, the GoG has demonstrated strong political will in combating the HIV epidemic and responded by establishing the National AIDS Program (NAP) under the Ministry of Health (MOH) in 1989. This subsequently led to the establishment of the National AIDS Committee (NAC), the Genito- Urinary Medicine (GUM) Clinic, the National Laboratory for Infectious Diseases (NLID), and the National Blood Transfusion Service (NBTS). In 1992, the National AIDS Program Secretariat (NAPS) was established and charged with the role of coordinating the overall national response to the HIV epidemic. NAPS worked with the NAC, a voluntary body composed of representatives from many sectors and organizations, to plan and implement the NSP. NAC’s primary role was to advise the MOH on HIV/AIDS policy and advocacy issues. Regional AIDS Committees (RAC) were also established to coordinate and implement HIV activities at the regional level. Following the success of the 1999-2001 National Strategic Plan for HIV/AIDS and the successful parliamentary passage of the national HIV/AIDS policy paper in 1999, the successive 2002-06 Plan was written. The 2002-06 National Plan was guided by the following principles: the use of a multi-sectoral and inter-disciplinary response to HIV; greater involvement of persons living with HIV (PLHIV) in the planning and implementation of the response; information, education, and communication (IEC) strategies to empower persons to prevent further HIV transmission; guarantee confidential voluntary counseling and testing (VCT); care and support for persons living with HIV in health and social service delivery systems; and minimizing and eliminating inequalities in HIV and AIDS services across the regions. The national HIV/AIDS policy document was revised in 2003 to reflect proposed changes in the coordinating mechanisms within the NAP and to provide a policy framework for providing access to free care and treatment for all persons living with HIV.. The 2001 Guyana Poverty Reduction Strategy Paper (PRSP) identified HIV as an important focal area and proposed a number of multi-sectoral actions to respond to HIV. A pilot of prevention of mother-to-child-transmission (PMTCT) services was conducted at eight sites in November 2001 and the GoG committed to an expansion of PMTCT services to 65 sites by December 2005. A treatment program with ARVs has been available at the Genito-Urinary Medicine (GUM) Clinic since April 2002 and the MOH has committed to a plan to scale up antiretroviral treatment (ART), with a targeted enrollment of about 6400 people by the end of 2008. The 2002-06 National Strategic Plan (NSP) identified several components of a comprehensive national HIV/AIDS prevention program, which include the following:

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IEC/Behavior Change Communication (BCC) Condom Distribution VCT Prevention and Control of STI Prevention of Mother-to-Child-Transmission (PMTCT) Laboratory Control and Blood Safety

The 2002-06 NSP was conceived with the anticipated financing of donors rather than what was actually required (estimated at US$20,577,903 over five years) (GFATM 2005). Since its implementation, the resource requirements to expand services throughout the country have become clearer and external financing for HIV has greatly increased (see Table 1). Since 2000, it is estimated that external financing for HIV has surpassed domestic sources of funding by 50 percent (USAID 2004). A new NSP (2007-11) has been developed with the following objectives:

• Empower citizens by providing a universal HIV and AIDS care, support, education and awareness program;

• Promote behaviour changes that reduce risks among all people; • Enable citizen to know his or her HIV status by providing easy accessible

counselling and testing; • Provide easily accessible PMTCT services to all pregnant women and their

families; • Ensure blood safety supply; • Provide treatment, care and support for OVC; • Provide treatment, care and support for all persons living with HIV; • Create space for the involvement of all citizens and group in the multi-

sector response to HIV, including space for the involvement of persons living with HIV

• Reduce stigma and discrimination; • Build capacity to the overall response; • Improve the information system and strengthen the surveillance program; • Strengthen the overall coordination of the HIV response program.

The overall strategic goal of the 2007-11 NSP is to reduce the social and economic impact of HIV and AIDS on individuals and communities, and ultimately the development of the county.

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Table 1. Donor Matrix

Donor/Partner Major Area of Assistance Estimated Funding

UNAIDS Secretariat

Coordinate HIV activities of the UN System; Strengthen capacity for UNGASS reporting; Facilitate donor coordination; Broker technical support and capacity investment needs to reach the targets for universal access (2018 and 2010)

Ongoing

UNDP Limited HIV-related activities; Mainly related to poverty reduction and policy development

Ongoing

UNICEF

Strengthen coordination and M&E of PMTCT services; support knowledge of women, children, and health care workers; support care and treatment and support for HIV positive children; youth-friendly health services

$1.5 mil (est) (2006-10)

PAHO/WHO

Technical assistance for HIV prevention, TB, and malaria control; small grants scheme management; surveillance and laboratory support . Chair UN Theme Group on HIV

Ongoing

ILO Joint ILO, Ministry of Labour and US Department of Labour Project for HIV in the workplace

Ongoing

CIDA

HIV prevention; communicable disease control; public health management system; stigma and discrimination; TB prevention and malaria

CN$5mil (2003-07)

EU Strengthen national capacity to respond to HIV Limited

World Bank

Grant for HIV program; support institutional capacity strengthening; monitoring, evaluation, and research and mainstreaming of HIV in key line ministries

US$10 mil (2004-08)

UNFPA-OPEC Fund Caribbean-Central America project for HIV prevention among youth as part of adolescent health program

US$450,000 (2004-08)

GFATM

Multifaceted support for HIV prevention, treatment, care and support; training; HMIS; upgrade laboratory capacity; strengthen surveillance system;

US$27.2 mil (2004-08)

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quality care for persons living with HIV; expand care and treatment; reduce stigma and discrimination; condom social marketing

IDB Regional support for HIV US$6.7mil (2004-08) JICA Small grant for HIV Limited

GATC HIV project targeting sex work, including condom social marketing campaign

Limited

The President Emergency Plan for AIDS Relief (US)

Coordinated, comprehensive HIVsupport for care and treatment, prevention, and laboratory support. Main partners are CDC and USAID

US$34mil (2004-08)

1.2 The Presidential Commission on HIV/AIDS In order to strengthen the implementation and oversee coordination of the various components of the NAP, the GoG established the Presidential Commission on HIV/AIDS (PCHA) in 2005 under the aegis of the Office of the President. The Commission is chaired by the President of Guyana. The GoG response to HIV is augmented by the independent activities of numerous NGOs, CBOs, faith-based organizations (FBOs), the private sector, and civic organizations. The primary responsibility of the PCHA is to oversee, and support the national response to HIV. The members include key Ministers, the Attorney General, chair of the NAC, the chair of the United Nations Theme Group (UNTG) on HIV, USG, the UNAIDS Country Coordinator, donor and multilateral partners, and the Head of the Presidential Secretariat. Key functions of the PCHA include the following:

Supporting the implementation of the National Strategic Plan; Mobilizing multi-sector support for the national response; Coordinating, preparing and assisting in the implementation of the line

ministries’ work program; Advising the Cabinet on HIV policies and strategies; Mobilizing resources (national and international) for HIV programming; Presenting annual and quarterly reports on the progress of the national

response. Sessions are held quarterly, wherein each Ministry presents on key HIV-related activities. A report to the public will be presented once a year to the National Assembly.

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Figure 1. Guyana multi-sectoral response mechanism for HIV

1.3 Rationale for a National M&E Plan Consistent with the goals of the 2007-11 National Plan for HIV/AIDS, and the Three Ones” principles, there are a number of reasons for the development of a National Monitoring and Evaluation Plan for HIV:

To strengthen the national, multi-sectoral response to HIV, by guiding the systematic collection, processing, and analysis of data at all levels;

To inform national HIV policies and procedures to better serve those affected by HIV;

To track progress and evaluate the response of the national plan; To facilitate the standardization of M&E methodologies so as to allow

meaningful comparisons over time at all program levels and across all actors; To serve as a platform for partnership, collaboration, and networking for all

stakeholders involved in the national prevention and controls program; To meet the reporting requirements of the international donor community in

order to secure consistent funding for the HIV response.

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Box 1. The Three Ones

On 25 April 2004, the representatives of major donor organizations and of many developed countries met to agree on a common framework to better coordinate the scale-up of national AIDS programs and related activities. All meeting participants agreed to the following “Three Ones Principles”: • One AIDS action framework that provides the basis for

coordinating the work of all partners and stakeholders • One national AIDS coordinating authority, with a broad-based

multi-sectoral mandate

• One national monitoring and evaluation (M&E) system A strong M&E system will ensure that: 1) relevant, timely, and accurate data are made available to program leaders and managers; 2) select quality data can be reported to national program leaders; and 3) the national program is able to meet donor and international reporting requirements under a unified global effort to combat the HIV pandemics. (Source: Global Fund Monitoring and Evaluation Toolkit 2004)

1.4 Goals and Objectives of the National M&E Plan There is a broad need to provide strategic information that will enable tracking of progress, with the specific aim of enhancing decision-making at all program levels in the implementation and coordination of the 2007-11 National Strategic Plan for HIV/AIDS in Guyana. The specific purpose of the National M&E Plan include the following:

To promote the importance of routine monitoring and systematic data

collection to better inform decision making in the further planning of HIV- related activities;

To better understand program trends and impacts as they relate to the NSP; To secure future funding for HIV interventions by successfully meeting

reporting requirements of partners.

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1.5 Methodology of M&E Plan Development The M&E Plan was developed through a collaborative venture between the MOH and its in-country partners working in the area of HIV. Support was also provided by technical experts in the M&E field. Meetings were conducted with various stakeholders, and consultations were performed with outside technical experts. The methods used include the following:

Review of GoG national strategic objectives and targets and the creation of a logic model for achievement of results (Appendix 1);

Creation and support of the Monitoring and Evaluation Reference Group (MERG) in November 2004;

A review of national and international documents regarding priority program areas, suggested indicators, and regional and global standards and goals;

Consultative discussions with key stakeholders and development partners to assess current capacity and needs for M&E for HIV and AIDS;

Assessment of key national-level surveys and reports with population-based indicators relevant to the monitoring and evaluation of the national HIV response;

National consultative workshop to compliment activities.

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Chapter 2. Monitoring and Evaluation Concepts and Principles 2.1 Monitoring and Evaluation Definitions Monitoring and evaluation (M&E) efforts are aimed at the collection of information at all program levels in order to determine the progress of a program towards it goals. M&E is an integral part of good program management and provides information on the scope, quality, scale/coverage, and success of programs. Monitoring generally refers to the routine collection of information across time and sites in order to track a program’s ongoing activities. Monitoring permits program managers to use this data to inform program modifications and answer the question: What is being done? Policy makers use monitoring to track key health-related indicators, often without attributing change to any particular program or set of programs. Evaluation involves the assessment of program implementation in order to determine the worth or value of a program in terms of its success in achieving predetermined outcomes/goals. Evaluation is usually achieved through a detailed analysis of the program’s process and outcomes or impacts. Evaluation lends itself to the linkage of outcomes to the program process, as well as rule-out non-program effects on outcomes. Indicators are qualitative or quantitative units of information that provide information on change in a specific condition over time. A good indicator should be SMART.

Specific – An indicator must be related to the conditions that the program wishes to change

Measurable – An indicator must be quantifiable and allow for statistical analysis of the data. Certain development process indicators are difficult to quantify so qualitative indicators can and should be used

Attainable – An indicator must be attainable at a reasonable cost using appropriate collection methods

Relevant – An indicator must be necessary to measure and have relevance to the management information needs of the persons who will use it

Time-bound – An indicators must have a time period for collection clearly stated

2.2 Levels of Data in HIV and AIDS Monitoring and Evaluation There are several different levels of data in M&E. Program-based data typically provides process M&E (program inputs, program activities, program outputs). Outcome and impact M&E is usually derived from population-based behavioral,

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biological, and social data. The M&E framework typically has the following levels of data: Inputs are the financial, human, and material resources that are necessary to produce the intended output of a particular program; Activities/ Process refer to the steps in the implementation of the program. The data suggest that an activity is or is not being conducted; Outputs are the immediate results of the program activities. Outputs are expressed separately and directly in terms to the activity with which it is associated; Outcomes are the medium-term or intermediate results of the program activities. Outcomes are often expressed in terms of a set of activities, as opposed to single activities. These indicators often require separate surveys to measure; Impact refers to the long-term results expected of a program. These indicators are often the overall goals of a program. Figure 2. Levels of Monitoring and Evaluation

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2.3 Principles of a Good Monitoring and Evaluation System For this M&E plan, the following principles will be employed:

Presence of an M&E Unit – Establishment of an M&E unit with adequate budget and trained and qualified staff. The Unit needs to be linked to all the key stakeholders, including NGOs, FBOs, sector and line ministries, and national and regional staff;

Clear goals and objectives – Well-defined national program goals, targets, and

objectives where regular reviews and evaluations of the implementation are conducted. Guidance and guidelines also need to be in place at the regional level and across all sectors;

Core set of indicators and targets – A set of national core/priority indictors

needs to be selected that cover all of the program inputs, processes, outputs, outcomes, and impact. Indicator selection should be made through full participation of all stakeholders and with an aim of maintaining relevance and comparability. The process also needs to incorporate past and future data collection efforts in order to properly assess national trends;

A plan for data collection and analysis – An overall data collection plan should

be implemented at all levels of the program;

A clear plan for data use and dissemination – A clear plan for scheduled reports of the M&E Unit and annual meetings with policy-makers and planners should be in place;

M&E should be proportional to program resources (ideally about 7-10 percent

of program budget);

To minimize data collection burden and maximize limited resources, M&E activities need to be well-coordinated and utilize ongoing data collection and analysis, where appropriate, in preference to designing new instruments or stand-alone systems.

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Chapter 3. National Level HIV and AIDS Indicators The National HIV M&E framework relies on data collected from surveys and routine data collection methods. All data obtained through routine reports will be standardized through the development of uniform forms distributed to all partners and stakeholders. The national indicators were selected based on the goals and objectives of the NSP and grouped according to priority intervention areas identified by the NSP. Four principles guided the selection of the national indicators for monitoring and evaluating the national HIV response. First, the indicators must be consistent with the objectives of the NSP. Second, the indicators should allow for international and regional comparisons. Third, the indicator can be feasibly collected from an existing or potential source and are SMART. Fourth, the indicators have a baseline measure (where feasible). A number of key indicators have been selected for which ambitious targets have been set towards universal access to HIV prevention, treatment, care and support, by 2010. (National Level indicators below marked with an asterisk*) 3.1 Impact The overall strategic goal of the NSP is to reduce the social and economic impact of HIV and AIDS on individuals and communities, and ultimately the development of the country. Key Objective(s)

Reduce the spread of HIV in Guyana and increase the quality of life for persons living with HIV

Indicators Imp1 Proportion of all deaths attributable to AIDS Imp2* Percentage of adults and children with HIV still alive 12 months after

initiation of antiretroviral therapy Imp3 HIV prevalence among women aged 15-24 Imp4 HIV prevalence among most-at-risk populations Imp5 Percentage of infants born to HIV-infected mothers who are infected Imp6 Ratio of current school attendance among orphans to that among non-

orphans age 10-14

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3.2 Strengthen National Capacity

3.2.1 Policy Formation Indicators Nc1* Amount of national funds allocated by Government for HIV prevention

and care. Nc2* Implementation of the “Three Ones” principles Nc3 National Composite Policy Index Nc4 Percentage of schools with teachers who have been trained in life-skills

based HIVeducation and who taught it during the last academic year 3.2.2 Partnerships / Multi-sectoral Response Indicator Nc5 Number of line ministries with HIV work plans and budgets 3.3 Clinical and Diagnostic Management and Access to Care, Treatment, and Support 3.3.1 Access to ART Indicators Cts1* Percentage of women, men, children with HIV infection receiving ART,

who are eligible according to national guidelines Cts2 Number and percentage of regions with at least one service outlet providing

ART services following national standards Cts3 Number of health workers trained on ART delivery according to national

guidelines 3.3.2 VCT Indicators Cts4* Percentage of the general population aged 15-49 receiving HIV test results

in the past 12 months Cts5* Number of individuals trained in the provision of VCT according to national guidelines

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3.3.3 Home and Palliative Care

Indicators Cts6 Number of regions with service outlets that provide HPC Cts7 Number of service outlets that provide HPC Cts8 Number of persons trained to provide HPC according to national guidelines Cts9 Number of persons who receive HPC following national standards 3.3.4 OI and STI Indicators Cts10 Percentage of men and women with STI at health care facilities who are

appropriately diagnosed, treated, and counseled Cts11 Number of persons trained in the management of STI according to national

guidelines 3.3.5 Tuberculosis Indicators Cts12 Percentage of HIV-positive registered TB patients given ART during TB

treatment Cts13 Percentage of registered TB patients tested for HIV 3.3.6 Lab Support Indicators Cts14 Percentage of patients on ARVs who receive regular CD4 monitoring

following ARV national treatment guidelines Cts15 Number of regional labs with capacity to perform CD4 tests following

national standards Cts16 Number of persons trained to conduct CD4 testing according to national

guidelines

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3.4 Reducing Risk and Vulnerability to HIV Infection 3.4.1 IEC/BCC Indicators Pv1* Percentage of young men and women aged 15-24 who have had sex before age 15 Pv2 Percentage of youth aged 15-24 reporting use of a condom during last

sexual intercourse with a non-regular partner Pv3 Percentage of people aged 15-49 expressing accepting attitudes towards

people living with HIV Pv4* Percentage of people, aged 15-49, who correctly identify ways of preventing

sexual transmission of HIV and who reject major misconceptions about HIV transmission (male/female)

Pv5* Number of condoms (male and female) distributed in the past 12 months Pv6* Number of targeted prevention programmes for vulnerable groups Pv7* Percentage of members of most-at-risk populations who report condom use

at last sexual encounter with regular or non-regular partner – a) Men who have sex with men; b) sex workers; and c) mobile and hard-to-reach populations

3.4.2 PMTCT Indicators Pv8* Number of service outlets that offer PMTCT services Pv9* Number of pregnant women who receive HIV counseling and testing for

PMTCT and receive their test results Pv10 Percentage of HIV-infected pregnant women who receive a complete

course of ARV prophylaxis as part of PMTCT Pv11 Number of health workers trained in the provision of PMTCT according to

national guidelines Pv12 Percentage of babies born to HIV-positive women who are tested before

age 18 months 3.4.3 OVC Indicators Pv13* Percentage of OVC whose households received free, basic external support

in caring for the child Pv14 Number of providers/caretakers trained in the provision of care for OVC

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3.4.4 Blood Safety Indicators Pv15 Percentage of transfused blood units in the public and private sector

screened for HIV 3.5 Surveillance and Research Indicators Sr1 Percentage of service outlets with record-keeping systems to monitor HIV

and AIDS care and treatment Sr2 Number of persons trained in strategic information (monitoring and

evaluation and/or surveillance and/or HMIS)

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Chapter 4. National Monitoring and Evaluation Implementation Strategy 4.1 Data Collection Strategy Overview A comprehensive monitoring and evaluation plan ensures that indicators and sampling methodologies are standardized and comparable over time, minimizes duplication of effort, and ultimately leads to more efficient use of data and resources. It is important to note that M&E activities have been conducted in Guyana, and pre-date the development of this Plan. Therefore, the aim of this plan is not to invent new systems, but to employ systems that are already in place while recognizing that there may be certain weaknesses and gaps that will need to be addressed in order to create a more comprehensive M&E system that will ensure high quality data in the long term. Monitoring and evaluation of the national response to HIV will be facilitated under the leadership of the Presidential Commission on HIV/AIDS and a national HIV M&E Unit within the Ministry of Health (NAPS). The national indicators for each HIV and AIDS intervention area, the data source, the frequency of data collection, measurement tool, and the method of measurement are clearly defined in the national M&E plan so as to assist the ease of data collection by the various actors. Care has been taken to be consistent with the principles of a good M&E system outlined in Chapter 2. The NAPS will work with all stakeholders and partners to collect data for the completion of reports on the national response. National indicators have been selected, where appropriate, from existing routine data collection systems in preference to new surveys or stand-alone systems. The MOH is working with donors and partners to strengthen program monitoring and evaluation through the foreseen implementation of a Country Response Information System (CRIS) and the strengthening of paper-based facility / service level reporting (World Bank 2004). 4.2 Data Sources Because anticipated resources are limited, data generated by the national M&E plan should serve the needs of multiple stakeholders. These include Ministries, donors at the national and international level, the Regional Health Authorities and Departments at the regional level, and program managers and facility heads at the service delivery point level, and all government and non-government implementers to provide evidence-informed strategic information to guide action. Data sources for Guyana’s M&E plan are from the following: HIV and AIDS surveillance; population-based surveys, special studies, and operations research; the health management information system (HMIS); and program monitoring and reporting. It is anticipated that data will be available through the following sources:

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HIV and AIDS Surveillance

Bio-Behavioral Surveillance Survey (BBSS) targeting MSM and FSW (biological markers for HIV and other STI were included)

Behavioral Surveillance Survey (BSS) targeting school-aged children, out-of- school youth, the police, the military, and sugar workers

Sentinel surveillance at ANC sites Routine AIDS case reporting Routine STI and OI reporting Routine NBTS reports Mortality data for AIDS-related deaths

Population-based surveys, special studies, and operations research

AIDS Indicator Survey (AIS) portion of the DHS Multiple Indicator Cluster Survey (MICS) of households (for OVC-related

data) Qualitative assessment of successful and unsuccessful PMTCT program

completion among pregnant women Study of the prevalence and risk factors for HIV and syphilis among Guyana’s

gold miners Service provision assessment (SPA), a facility-based survey to assess the

capacity of health facilities to provide needed services Epidemiological report synthesizing national reports and population-based

surveys on HIV and AIDS HMIS (facility-based reporting)

HMIS assessment report Routine facility reports

Program monitoring and reporting

Routine program reports 4.2.1 HIV and AIDS Surveillance Surveillance describes an epidemic and its spread over time. Surveillance also contributes to predicting future trends and identifies potential high-risk groups, which can inform the design of prevention programs. There are five main types of HIV and AIDS surveillance:

Biological surveillance - specimens such as blood are collected and tested for HIV. This may include repeated population surveys with biomarkers for HIV such at the AIS or BSS, screening of blood donors, and testing of

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pregnant women or STI clinic patients. Biological surveillance, by tracking HIV prevalence, measures impact;

AIDS case surveillance - counts the number of new AIDS cases (HIV- infected persons that became ill with AIDS according to national or international standards);

Behavioral surveillance - collects information about individual’s behavior that may or may not put them at risk for acquiring HIV infection. Behavioral surveillance, by tracking HIV-related behaviors, measures outcomes;

Surveillance of HIV-related infections - for example STI or OI such as TB; Surveillance of HIV and AIDS -related mortality – HIV andAIDS-

attributable deaths in the general population. In Guyana, HIV and AIDS surveillance activities have been conducted in all the above areas; however the quality of data from each source should be continuously monitored to ensure that high-quality data are employed for monitoring and evaluating the national response to HIV. For example, CAREC requires public and private facilities in all CAREC countries to report AIDS cases using a standardize CAREC format. Facilities compile monthly reports, which get sent to the Director of Disease Control within the MOH. One weakness of this system is the lack of enforcement mechanisms if facilities fail to report. This is a key issue in the private sector. Since there is not a unique patient tracking system, another key issue is double counting of HIV cases. Despite some clear limitations, these systems should be employed, but efforts should be made to achieve improvements over time. For a generalized epidemic, a surveillance system should monitor the HIV epidemic in the sexually active population. Surveys of the population have been conducted in 2004 (BSS and AIS), but most are too difficult and expensive to perform on a routine basis. Instead it is easier to put under surveillance a sub-group of population that is more or less representative of the sexually active population, such as pregnant women. These sub-groups are called sentinel populations. HIV surveillance employing a sentinel population is called HIV sentinel surveillance. The objective of HIV sentinel surveillance is to follow the trend of HIV infection in the selected sentinel population by the use of sentinel sites. These sites are chosen because they offer easy access to the sentinel population such as pregnant women (sentinel site: antenatal clinics in most countries but regional laboratories in Guyana), STI patients (sentinel site: STI clinics), or blood donors (at blood banks). 4.2.2 Population-based surveys, special studies, and operations research Population-based surveys are usually performed every 3-5 years, and are designed to provide national estimates of behaviors, risk factors, and demographic trends related to HIV/AIDS. The most common population-based surveys for HIV andAIDS include the DHS, AIS, and MICS. Bio-behavioral data are particularly important in countries with concentrated or low-level epidemics. In general, large population- based surveys are expensive to conduct and may not be feasible in certain settings; therefore, they are useful when employed to establish baseline, and should be

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repeated as resources allow. Special studies and operations research applies systematic research techniques to address particular research or evaluation questions or improve service delivery. Operations research is designed to assess the accessibility, availability, quality, and sustainability of program. Both aim to improve programs and inform decisions about future resource allocations. 4.2.3 HMIS (facility-based reporting) The ability to manage and monitor health services at the central level depends on the availability, completeness, and validity of data generated at the service level. Health management information systems (HMIS) are designed to collect, analyze, and use routine patient or facility data. They are also designed to identify the major health information and data subsystems that are required to support the programs of the national health system and to enhance the accountability of the health service to carry out essential public health functions. Data collected through this system will be employed to engage in service performance assessment, planning, and monitoring national trends. 4.2.4 Program monitoring and reporting Routine program reporting includes systems to collect, analyze, and use data that is not facilities-based, e.g., OVC, community-based care, or BCC interventions. In general, program managers should collect and collate data, and systems should be designed to ensure that programs are routinely reporting on their HIV/AIDS-related activities in coordination with other relevant actors. 4.3 Institutional Roles and Responsibilities This M&E Plan will be implemented through and institutional structure that will permit the wide participation of all public and private sector actors, civil society, and the international donor community. The roles and responsibilities of the institutions that are part of the GoG governance structure for the National M&E Plan are presented in this section. Presidential Commission on HIV/AIDS (PCHA) – The PCHA is the GoG body responsible for supporting, coordinating, and providing oversight of the national HIV response under the aegis of the Office of the President. The overall responsibilities of the PCHA have been outlined in Chapter 1. Health Sector Development Unit (HSDU) programmatic responsibilities include (World Bank 2004):

Advising the PCHA through the Minister of Health on new policies or changes in existing policies;

Provide guidelines for preparing annual work plans and sub-projects;

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Receiving evaluated sub-projects recommended by the Ad Hoc Committee for Reviewing Civil Society Proposals;

Consolidating work plans and sub-projects and forwarding them to the PCHA for ratification;

Ensuring that all technical needs and resources for implementing agencies are met;

Ensuring transparency and adequate national coverage of interventions; Coordinating research, behavioral surveys, and revising and preparing relevant

legal documents; Monitoring input and process indicators on a monthly basis and evaluating

project outcomes and impact on a periodic basis; Liaise with the World Bank and GFATM for overall project management

including fiscal monitoring and procurement. The National AIDS Program Secretariat (NAPS), is the technical body of the Ministry of Health responsible for the Ministry of Health’s response and for the coordination and technical oversight for the Line Ministry and Civil Society component overall response. MOH will through the National AIDS Programme Secretariat provide technical assistance and guidance to other implementing agencies. Line department, units at the central level, and regional health authorities will have the responsibility of implementing MOH HIV programs and activities. Assigning implementation to the line units will increase the capacity of the MOH line departments UN Theme Group on HIV will provide advice to the PCHA and NAPS on HIV policies and operations. The Theme Group represents the multilateral community and, through the UNAIDS Secretariat will continue its role of serving as coordinating donor support, ensuring that the national policies are promoted and applied by all implementing partners, mobilizing resources and strengthening institutions, encouraging research and including its results in programs, and evaluating the results of interventions and provide solutions as appropriate.. An important role of the UN System in Guyana is to facilitate the identification of technical resource and capacity investmement needs to reach the targets that have been set towards universal access The National AIDS Committee (NAC) is an independent advocacy body for civil society and the private sector. The body will provide the Minister of Health recommendations and advise on HIV/AIDS policies; on educational, training and public information activities; and on measures to improve programs and the effectiveness of national response. 4.4 Reporting Levels and Information Flows All partners and stakeholders will be required to report monthly or quarterly to the national HIV M&E Unit on program indicators for activities that they are

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conducting in this sector. Data collection formats and requirements will be developed and disseminated in the M&E operations manual. Strategic information flows from the regional level to the national level are summarized in Figure 3. Most health related indictors will originate from health facilities (health posts and health centers) and private health institutions will be expected to report to the RAC or directly to the MOH. Figure 3. Strategic Information Map

4.4.1 Coordination Functions - Mechanisms and Roles An important role of the NAPS is to coordinate data from multiple levels and sources; track the progress of the national response for national and international reporting; and provide regular feedback to actors at the sub-national levels. National Coordination of the multi-sectoral national response to HIV is the core function of the NAPS. The PCHA is charged to facilitate this task by bringing together all key implementers of HIVprograms to disseminate reporting requirements of the National M&E plan and generate support for its implementation. Efficient implementation of the national strategic plan requires well-coordinated mechanisms at all levels of monitoring and evaluation. Regional The indicators included in the National M&E framework were selected to measure and evaluate the National HIV/AIDS Plan. Program indicators should be

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aggregated at the regional level where they are collated and sent to the National M&E Unit. It is anticipated that additional program indictors will be required at the regional level in order to track the progress of programs at this level. Therefore, harmonization of indicators collected to track progress at the national and regional levels should be coordinated by the Regional Health Authorities or Regional Health Departments. Donor Support Donor and partner support will be very important to ensure effective and efficient implementation of the National M&E framework. Notably, most donors require more information than is required for monitoring the national HIV/AIDS Plan. The national M&E Unit, working in collaboration with the donor coordination the UNAIDS Secretariat, will ensure the integration of donor reporting requirements into the national plan. 4.5 Data Dissemination Plan The NAPS is responsible for the dissemination of monitoring and evaluation data in quarterly and annual national surveillance reports, HIV and AIDS fact sheets, brochures, and periodic stakeholder workshops. To facilitate information sharing, the GoG has implemented a national HIV website and electronic resource center, which will serve as a donor coordination mechanism and clearinghouse for official HIV and AIDS-related reports and documents from the GoG. Dissemination of M&E results will serve to inform planning of HIV interventions, provide feedback on the resource requirements for HIV and AIDS, and increase public commitment to reducing HIV and AIDS. 4.6 Resource Requirements There is a need to strengthen national capacity for monitoring and evaluation at all levels in terms of both personnel and resource requirements. This is partly the result of HIV being relatively new to the development sector, hence nationally agreed upon indicators for monitoring and evaluating HIV interventions have not been available. Furthermore, there have been few people involved in implementing M&E activities. At the national level there is little institutional knowledge of M&E systems and this highlights the need to build capacity for M&E activities at all levels. The NAPS will address the issues related to capacity building and develop training strategies and will attempt to make sure all regions have M&E staff for HIV-related activities. The NAPS also will work with all partners to strengthen the HIV and AIDS M&E system in the country. Implementation of the national M&E framework will require a great deal of resources to support M&E capacity building, finance for data collection, analysis and dissemination, and technical support for population-based and facility-based surveys.

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This requires due emphasis at all levels for strong management support and allocation of enough budget for M&E. International standards suggest about 7-10 percent of total program costs should be allocated to M&E activities. Details on the amount of resource requirements will be included in the M&E Operations Manual. The remaining items are required to implement the M&E system:

Development of an M&E Operations Manual. The manual will include specific details of the measurement tools of indicators included in the M&E framework;

A M&E training should be organized and a training manual based on the M&E plan should be developed.

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Chapter 5. National Indicator Reference Sheets 5.1 Impact indicators Imp1: Proportion of all deaths attributable to AIDS Definition The number of deaths that are attributable to AIDS

(disaggregated by gender, age, region, and urban/rural), expressed as a proportion of all deaths annually

Calculation Numerator: AIDS-related deaths in the resident population aged 18-59 in the past 12 months Denominator: All-cause mortality in the resident population aged 18-59 in the past 12 months

Rationale and what is measured

To assess progress in reducing AIDS-related mortality

Measurement tool Vital registration system and program reports Method of measurement National mortality statistics. The vital statistics

department should routinely report data and AIDS deaths should be medically-certified, where possible

Data collection frequency Baseline, then annually Frequency of reporting Annually Responsible body MoH Remarks/notes This indicator is calculated using data from vital

registration systems Indicators recommended by MOH Imp2: Percentage of adult and children with HIV still alive 12 months after initiation of antiretroviral therapy Definition This is the number of HIV positive adults and

children receiving ART and still alive 12 months after HIV positive diagnosis (disaggregated by gender, age, region, and urban/rural), expressed as a proportion of all HIV adult and children who test HIV positive in the last 12 months

Calculation Numerator: Number of adults and children continuously on ART at 12 months after initiation of treatment Denominator:

(a) Minimum survival: Total number of adults and children who initiated ART in the ART start-up group 12 months earlier, including those who have stopped ART, those who

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have transferred out, and people lost to follow-up

(b) Maximum survival: Total number of adults and children who initiated ART in the ART start-up group 12 months earlier, excluding those who have stopped ART, those who have transferred out, and people lost to follow-up

Rationale and what is measured

To assess progress in increasing survival among infected adults and children by maintaining them on antiretroviral therapy

Measurement tool Vital registration system and program reports Method of measurement This indicator is obtained from the patient registrars

(HMIS) by tallying several monthly cohorts, each tabulated after they have received a positive HIV test result and post-test counseling. Data should be collected continuously and aggregated

Data collection frequency Monthly Frequency of reporting Annual Responsible body Ministry of Health/NAPS Remarks/notes This indicator is calculated using data from vital

registration systems Indicator recommended by UNGASS Imp3: HIV prevalence among women aged 15-24 Definition Number of women aged 15-24 infected with HIV

(disaggregated by 5 year age groups and region), expressed as a proportion of all women aged 15-24

Calculation Numerator: Number of ANC attendees (aged 15-24) tested whose test results are positive Denominator: Number of ANC attendees (15-24) tested for their HIV infection status

Rationale and what is measured

To assess progress toward reducing HIV infection. At younger ages, trends in HIV prevalence are a better indication of recent trends in HIV incidence and risk behavior than prevalence in older ages

Measurement Tool Sentinel surveillance at ANC sites Method of measurement This indicator is calculated using data from pregnant

women attending ANCs Data collection frequency Biennial Frequency of reporting Annual Responsible body Ministry of Health

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Remarks/notes Parallel behavioral surveillance (BSS) data should be used to aid interpretation of trends in HIV prevalence

Indicator recommended by UNGASS; MDG Imp4: HIV prevalence among most-at-risk populations Definition Prevalence of HIV infection among most-at-risk

populations (MSM, CSW, mobile and hard-to-reach populations, STI patients, TB patients)

Calculation Numerator: Number of people in most-at-risk populations tested whose test results are positive Denominator: Number of people in most-at-risk populations tested for their HIV infection status

Rationale and what is measured

To measure prevalence of HIV infection among most-at-risk populations (MSM, SW, STI patients, TB patients). Countries with generalized epidemics can have concentrated sub-epidemics among one or more most-at-risk populations

Measurement tool BBSS and AIS with HIV testing and sentinel surveillance at STI and TB clinics

Method of measurement This indicator is calculated using data from population-based surveys and routine sentinel surveillance at STI and TB clinics

Data collection frequency Every 2-3 years Frequency of reporting Every 2-3 years Responsible body Ministry of Health Remarks/notes Indicator recommended by MOH Imp5: Percentage of infants born to HIV infected mothers who are infected Definition Number of HIV positive infants born to HIV

infected mothers expressed as a proportion of all infants born to HIV infected mother

Calculation The indicator can be calculated by taking the weighted average of the probabilities of MTCT for pregnant women receiving and not receiving antiretroviral; the weights being the proportions of women receiving and not receiving ARV, respectively. Expressed as a simple mathematical formula: Indicator score = { T*(1-e) + (1-T) } * v where:

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T = proportion of HIV-positive pregnant women provided with antiretroviral treatment v = MTCT rate in the absence of any treatment e = efficacy of treatment provided T is simply a national indicator {Pv8}. Default values of 25% and 50%, respectively, can be used for v and e. However, where scientific estimates of the efficacy of the specific forms of antiretroviral treatment (e.g., nevirapine) used in the country are available, these can be used in applying the formula. When this is done, the values of these estimates should be recorded. The most common forms of treatment provided during the last 12 months should be noted

Rationale and what is measured

To assess progress towards eliminating mother-to- child transmission

Measurement tool Program records and facility surveys Method of measurement Data collection frequency Every 2 years Frequency of reporting Every 2 years Responsible body Ministry of Health Remarks/notes This indicator ignores the effect of breastfeeding on

MTCT of HIV and may yield poor estimates for T when usage of ANC services are low

Indicator recommended by UNGASS Imp6: Ratio of current school attendance among orphans to that among non- orphans aged 10-14 Definition Ratio of the current school attendance rate of

children aged 10-14 both of whose biological parents have died to the current school attendance rate of children aged 10-14 both of whose parents are still alive and who currently live with at least one biological parent

Calculation Orphan school attendance: Numerator: Number of children who have lost parents and are still in school Denominator: Number of children who have lost both parents

Non-orphan school attendance:

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Numerator: Number of children, both of whose parents are still alive with at least one parent and who are still in school Denominator: Number of children both of whose parents are still alive and who live with at least one parent

Calculate the ratio of orphans to non-orphans

Rationale and what is measured

Assesses the progress towards preventing relative disadvantage in school attendance among orphans versus non-orphans

Measurement tool AIS Method of measurement

Data collection frequency Every 4-5 years Frequency of reporting Every 4-5 years Responsible body Ministry of Labour, Human Services and Social

Security/Ministry of Health Remarks/notes This indicator score is required for all children aged

10-14 years and for boys and girls, separately. Where possible, the indicator should be calculated by single year of age

Indicator recommended by UNGASS; MDG 5.2 Priority Area 1: Strengthening national capacity 5.2.1 Policy formation Nc1: Amount of national funds allocated by government for HIV prevention and care Definition The amount of money allocated in national accounts

for spending on HIV prevention and care programs per adult aged 15-49

Calculation Numerator: The total amount of funding allocated in national accounts for spending on HIV prevention and care programs Denominator: Total number of adults aged 15-49 in the resident population

Rationale and what is measured

Measures of expenditure provide an indication of the government’s willingness to back up policy with resources that enable policies to be implemented. This indicator measures resources made available by a government in its budget and national accounts for the response to the HIV epidemic. It also develops a

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common framework for tracking HIV-targeted allocations and expenditure in the national budget and indicates prioritization of interventions. Note: This indicator is restricted to spending and budgetary allocations from national accounts. It includes money loaned by international institutions, which may in effect amount to money borrowed at 30 percent or less of current money market rates. This may be influenced by the priorities of lending institutions as well as borrowers, but since the money must eventually be paid back by national taxpayers, it is included for the purposes of this indicator. Spending by bilateral donors, non-governmental organisations and the private sector are not included. It is recognised that in many countries, spending from these sources far outweighs spending from national accounts. It is important to bear in mind, however, that this indicator is not intended as a measure of resource availability, but as an indicator of political commitment to responding to HIV on the part of national governments. All governments reflect their political priorities in their spending and allocation of internal resources. Changes in funding allocated to HIV prevention and care is therefore a good indicator of the political importance that responding to the epidemic is accorded, compared with other priorities such as defence, education or infrastructure development.

Measurement Tool National AIDS Spending Assessment (NASA) Method of measurement The National AIDS Spending Assessment

examines primary and secondary data sources from relevant government ministries and agencies. Allocations are disaggregated according to the type of services provided, highlighting priorities in the government’s response to the epidemic.

Data collection frequency Annual Frequency of reporting Annual Responsible body Ministry of Finance/Ministry of Health Remarks/notes Indicator recommended by UNAIDS Nc2: National commitment - The “Three Ones” Principles Indicator Definition This is a composite indicator that includes the

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following elements: 1. One agreed HIV action framework that provides the basis for coordinating the work of all partners 2. One national HIV Coordinating Authority, with a broad-based multi-sectoral mandate 3. One agreed country-level monitoring and evaluation system

Calculation Rationale and what is measured

The first component seeks to assess whether one Action Framework exists that would provide the legal basis for coordination among all partners and a ‘costed’ plan of Action; The second component relates to the legal mandate of an overarching national authority to coordinate a broad-based multi-sectoral response; The third component seeks to assess whether key elements of a country-level M&E system are in place, including the following:

• Presence of an M&E Unit • Clear program goals, targets, and objectives • A set of national core/priority indicators • Allocation of financial resources (7-10%) of

the HIV budget for M&E • A plan for data collection and analysis • A clear plan for data use and dissemination • M&E activities are well-coordinated and

utilize ongoing data collection and analysis, where appropriate, in preference to designing new instruments or stand-alone systems

Measurement Tool Questionnaire Method of measurement Score of respondents Data collection frequency Annual Frequency of reporting Annual Responsible body Ministry of Health Remarks/notes Indicator recommended by UNAIDS Nc3: National composite policy index Definition The National Composite Policy Index is a

UNGASS national commitment and action indicator designed to assess progress in the development and implementation of national level

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HIV/AIDS policies and strategies Calculation Rationale and what is measured

To assess progress in the development and implementation of national-level HIV/AIDS policies and strategies. It also aims to estimate the amount of effort put into national HIV/AIDS programs by national level government, NGOs, and international organizations

Measurement tool National Composite Policy Index country assessment questionnaire

Method of measurement The composite index covers the following broad areas of policy: strategic plan, political support, prevention, care and support, monitoring and evaluation, human rights, and civil society involvement. A number of specific policy indicators have been identified for each of these areas

Data collection frequency Biennial Frequency of reporting Biennial Responsible body Ministry of Health Remarks/notes The National Composite Policy Index attempts to

assess both policy development and progress made in policy implementation and, to the extent possible, integrated many elements from the AIDS Program Index effort

Indicator recommended by UNGASS Nc4: Percentage of schools with teachers who have been trained in life-skills based HIV/AIDS education and who taught it during the last academic year Definition Percent of schools with teachers who have been trained in

life-skills based HIV education and who taught it during the last academic year. Training refers to new training or refresher training of individuals. This indicator assumes that training is conducted to national or international standards, when available. The training must have specific objectives, a course outline or curriculum, and expected knowledge, skills and / or competencies to be gained by participants. A life- skills based approach to HIV/AIDS education helps young people assess the individual, social, and environmental factors that raise and lower the risk of HIV transmission

Calculation Numerator: Number of schools with staff trained in and regularly teaching life-skills-based HIV education Denominator: Total number of schools surveyed

Rationale and what is measured

This indicator assesses progress towards implementation of life-skills based HIV education in all schools

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Measurement tool School survey Method of measurement

Principles/heads of a nationally representative sample of schools (both public and private) are briefed on the meaning of life-skills based HIV education and then are asked the following questions:

1. Does your school have at least one qualified teacher who has received training in participatory life-skills based HIV education in the last 5 years?

2. If the answer to question 1 is “yes”: Did this person

teach life-skills based HIV education on a regular basis to each grade in your school throughout the last academic year?

The teacher training must have included time dedicated to mastering facilitation of participatory learning experiences that aim to develop knowledge, positive attitudes, and skills (e.g. interpersonal communication, negotiation, decision- making, critical thinking and coping strategies) that assist young people in maintaining safe lifestyles. Whenever possible, the teacher training should have been performed in accordance with the latest UNICEF guidelines, which can be found at http://www.unicef.org/lifeskills/index_documents.html. For the purposes of calculating this indicator, at least 30 hour of tuition per year per grade of pupil is recommended if life-skills-based HIV education is to qualify as standard tuition.

Data collection frequency

Biennial

Frequency of reporting

Biennial

Responsible body Ministry of Education/Ministry of Health

Remarks/notes The indicator is a measure of coverage and not necessarily a measure of the quality of education provided. Indicator scores are required for all schools combined and for primary and secondary schools separately each by private/public status and by urban/rural setting. Church schools should be treated as private schools for this purpose. If school provides both primary and secondary education, information should be collected and reported separately for

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both levels of education Indicator Recommended by

UNGASS

5.2.2 Partnerships / multi-sectoral response Nc5: Number of line ministries with HIV work plans and budgets Definition The number of Line Ministries that have a complete

annual HIV work plan and budget that describes the activities to be undertaken in a specific year, the budget for these activities, and the sources of funding for these activities

Calculation Number of Line Ministries with a HIV/AIDS work plan and budget allocated for the work plan

Rationale and what is measured

This indicator assesses the commitment across sectors to be actively involved in the national response to HIV

Measurement tool Special survey of Line Ministries Method of measurement A survey of Line Ministries is conducted to assess

the number of Line Ministries that have a HIV work plan and budget, which is consistent with national policy, and includes, at the minimum, the following components: Key components: annual work plan Detailed list of activities for each defined objective Timeframe for each activity Definition of the person(s) or agency responsible for

implementation of each activity Definition of the indicators to be used to assess

whether or not activities were successfully implemented

Definition of the budget required for each activity, whether or not activities were successfully implemented

Description of the source of funding for each activity

Key components: annual budget There should be a table summarizing the budget required for the annual plan of activities. This should include the total budget requirements and a

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breakdown of the budget by line item

Data collection frequency Annual Frequency of reporting Annual Responsible body Line Ministries/Ministry of Health Remarks/notes Assessment of the annual work plan and budget

alone cannot measure successful implementation or whether the planned activities and budget will be sufficient to achieve objectives

Indicator recommended by World Bank 5.3 Priority Area 2: Clinical and Diagnostic Management and Access to Care, Treatment, and Support 5.3.1 Access to ART Cts1: Percentage of women, men, and children with HIV infection receiving ART who are eligible according to national guidelines Definition Number of persons with HIV infection receiving

antiretroviral combination therapy, expressed as a proportion of all persons with HIV infection who are eligible for ART according to national guidelines

Calculation Numerator: All people with HIV infection receiving ART at the start of the year, plus the number of people who have commenced ART treatment in the preceding 12 months minus the number of people for whom treatment was terminated in the preceding 12 months (including those who died or were lost to follow-up) Denominator: Number of people with known HIV infection who are eligible for ART according to national guidelines The number of adults in need of ART is calculated by adding the number of adults newly in need of ART to the number who were on treatment in the previous year and survived to the current year

Rationale and what is measured

This indicator assesses progress towards providing antiretroviral combination therapy to all eligible people with HIV infection

Measurement tool Program reports and facility surveys Method of measurement The denominator is generated by estimating the

number of people with HIV infection requiring ART, most frequently on the basis of the latest

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sentinel surveillance data Data collection frequency Monthly Frequency of reporting Annual Responsible body NAPS/Ministry of Health Remarks/notes The start and end dates of the period for which

ART is given should be stated. Overlaps between reporting periods should be avoided as much as possible. The provision of ART in the private sector should be included in the calculation of the indicator whenever possible

Indicator recommended by UNGASS; GFATM Cts2: Number and percent of regions with at least one service outlet providing ART services following national standards Definition Number and percent of regions with at least one

service outlet providing ART following national standards. A service outlet refers to the lowest level of service for which data exists, e.g., hospital, clinic, or mobile unit

Calculation Numerator: Number of regions with at least one service outlet providing ART following national standards Denominator: Total number of regions or regional clusters

Rationale and what is measured

Provides an estimate of the geographic coverage and availability of ART services

Measurement tool Program reports and facility surveys Method of measurement This indicator may include regions with NGOs

providing ART services. In order to measure this indicator, reviews of records of regional health authorities or departments, which may have a list of service outlets, is recommended. Surveys of health facilities are also recommended

Data collection frequency Annual Frequency of reporting Annual Responsible body NAPS/Ministry of Health

Remarks/notes This indicator is useful for tracking changes over time as service provision is scaled up; however, once coverage has reached a certain level, it is unlikely to fall and this indicator will become redundant. This indicator does not describe the geographic location

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or distribution of service outlets Indicator recommended by UNAIDS; WHO Cts3: Number of health workers trained on ART delivery according to national guidelines Definition Number of health workers newly trained or retrained

on ART delivery during the preceding 12 months. Training refers to new training or refresher training of individuals. This indicator assumes that training is conducted to national or international standards, when available. The training must have specific objectives, a course outline or curriculum, and expected knowledge, skills and / or competencies to be gained by participants. This covers health workers and others who have been trained to a level enabling them to take up a direct function in support of the scaling up of clinical or community-based ART services. The training should include the provision on clinical ART services, program management, prevention services or monitoring. It is assumed that such trainings occur through specialized programs that health workers attend after their regular education (in-service training). Only health workers who have undergone such training should be included. Health workers include the following:

Physicians and health workers with physician skills (e.g., medics)

Nurses and other health workers with nursing skills (e.g., midwives, clinical officers)

Other health care workers and lays staff in clinic settings

Laboratory technicians and staff Pharmacy/dispensing staff Community treatment supporters (e.g., peer

educators, outreach workers, volunteers, informal caregivers)

Calculation Persons who have completed one or more trainings

with content related to the delivery of ART

Rationale and what is measured

This indicator measures the availability of a trained workforce for achieving national scale-up targets. It

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includes both clinical and non-clinical health workers who contribute to the development and implementation of ART services and provide critical support services

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide training (public, private, and NGOs) is recommended. Surveys of health facilities providing ART are also recommended

Data collection frequency Annual Frequency of reporting Annual Responsible body NAPS/Ministry of Health Remarks/notes This indicator is most useful in the initial phases of a

countrywide response to HIV/AIDS, when the cumulative number of trained health professionals is expected to be continuously increasing until it reaches a desired ceiling. At this point the quantitative focus of the indicator on the number of health workers trained may become redundant, and measurement may shift so as to capture the quality of training, refresher training and the testing/supervision of health care practices

Indicator recommended by MOH 5.3.2 VCT Cts4: Percentage of the general population aged 15-49 receiving HIV test results in the past 12 months Definition Number of persons aged 15-49 that were tested for

HIV in the past 12 months and received their test results, expressed as a proportion of the total population aged 15-49

Calculation Numerator: Number of people 15-49 years who reported received their HIV test result in the past 12 months Denominator: Total population 15-49 years surveyed

Rationale and what is measured

This indicator gives an estimate of the coverage of counseling and testing services and the percentage of people who know their HIV status. Estimates of coverage of counseling and testing services help to determine whether those services are achieving their threefold aims of providing an entry point for care

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and support, promoting safe behavior, and breaking the cycle of silence and stigma

Measurement tool AIS Method of measurement Respondents are asked whether they were tested in

the past 12 months, and if so, whether they received their test results. This question is prefaced by the statement saying, “I do not want to know the results of the test,” so as to minimize stigma-based fear of answering the question truthfully

Data collection frequency Baseline, then every 2-3 years Frequency of reporting Every 2-3 years Responsible body Regional Health Authority & Department/Ministry

of Health Remarks/notes This indicator should be stratified by age, gender,

vulnerable group, and how the counseling and testing services were provided. In general, three service delivery methods should be considered: stand-alone or free-standing VCT sites (includes mobile testing); counseling and testing sites within health facilities to which people are referred; or fully integrated counseling and testing services in which a provider can refer the person to a laboratory for a test, but the provider carries out the counseling

Indicator recommended by MOH Cts5: Number of individuals trained in the provision of VCT according to national guidelines Definition Number of individuals (by type) trained in the

provision of VCT services in accordance with national guidelines during the last 12 months. Training refers to new training or refresher training of individuals. This indicator assumes that training is conducted to national or international standards, when available. The training must have specific objectives, a course outline or curriculum, and expected knowledge, skills and / or competencies to be gained by participants

Calculation Persons who have completed at least one or more trainings with content related to the provision of VCT services

Rationale and what is measured

This indicator provides an estimate of the availability of VCT services

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide

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training (public, private, and NGOs) is recommended. Surveys of health facilities providing HPC are also recommended. If a training course is conducted in several sessions or covers more than one counseling and testing topic, for example “specimen collection” and “post test counseling”, individuals should only be counted once for that training course

Data collection frequency Annual Frequency of reporting Annual Responsible body NAPS/Ministry of Health Remarks/notes This indicator does not measure the quality of the

training, nor does it measure the outcomes of the training in terms of the competencies of individuals trained, nor their job performance.

Indicator recommended by MOH 5.3.3 Home and palliative care (HPC) Cts6: Number of regions with service outlets that provide HPC Definition Number of regions that have outlets that provide

HPC. A service outlet refers to the lowest level of service for which data exists, e.g., hospital, clinic, mobile unit, or CBO/FBO/NGO. HPC is the provision of care, support, and symptom alleviation to a person chronically or intermittently ill in the home or in a clinical setting, when the interventions provided by family members are complementary to those of a client’s medical team

Calculation Regions or regional clusters with at least one or more serviced outlets that provide HPC

Rationale and what is measured

Provides an estimate of the geographic spread or coverage of HPC services

Measurement tool Program reports and facility surveys Method of measurement This indicator may include regions with service

outlets that are CBOs/FBOs/NGOs providing HPC. In order to measure this indicator, reviews of records of regional health authorities or departments, which may have a list of service outlets, is recommended. Surveys of health facilities are also recommended

Data collection frequency Annual Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health

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Remarks/notes This indicator is useful for tracking changes over time service provision scales up; however, once geographic coverage is universal (based on the total number of regions or blocks of regions) then this indicator become redundant. This indicator does provide an estimate of the distribution of service outlets

Indicator recommended by Ct7: Number of service outlets that provide HPC Definition Number of service outlets that provide HPC. A

service outlet refers to the lowest level of service for which data exists, e.g., hospital, clinic, mobile unit, or CBO/FBO/NGO. HPC is the provision of care, support, and symptom alleviation to a person chronically or intermittently ill in the home or in a clinical setting, when the interventions provided by family members are complementary to those of a client’s medical team.

Calculation Service outlets that provide HPC Rationale and what is measured

Provides an estimate of the national availability of HPC services

Measurement tool Program reports and facility surveys Method of measurement This indicator may include CBOs/FBOs/NGOs

providing HPC. In order to measure this indicator, reviews of records of regional health authorities or departments, which may have a list of service outlets, is recommended. Surveys of health facilities are also recommended

Data collection frequency Annual Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes This indicator is useful for tracking changes over time

as service provision is scaled up; however, once coverage has reached a certain level, it is unlikely to fall and this indicator will become redundant. This indicator does not describe the geographic location or distribution of service outlets

Indicator recommended by Cts8: Number of persons trained to provide HPC according to national guidelines Definition Number of persons that are trained to provide HPC

during the preceding 12 months. Training refers to

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new training or refresher training of individuals. This indicator assumes that training is conducted to national or international standards, when available. The training must have specific objectives, a course outline or curriculum, and expected knowledge, skills and / or competencies to be gained by participants. HPC is the provision of care, support, and symptom alleviation to a person chronically or intermittently ill in the home or in a clinical setting, when the interventions provided by family members are complementary to those of a client’s medical team

Calculation Persons who have completed at least one or more trainings with content related to the delivery of HPC

Rationale and what is measured

Provides an estimate of the availability of HPC services

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide training (public, private, and NGOs) is recommended. Surveys of health facilities providing HPC are also recommended

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes This indicator does not measure training quality or

outcome measures related to job performance Indicator recommended by Cts9: Number of persons who receive HPC following national standards Definition Number of persons who receive HPC following

national standards. HPC is the provision of care, support, and symptom alleviation to a person chronically or intermittently ill in the home or in a clinical setting, when the interventions provided by family members are complementary to those of a client’s medical team

Calculation This indicator consists of the number of people receiving HPC at the start of the year plus the number of people who have commenced HPC in the past 12 months minus the number of people for whom HPC was terminated in the past 12 months (including those who died)

Rationale and what is measured

Provides an estimate of the availability of HPC services

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Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide HPC (public, private, and NGOs) is recommended. Surveys of HPC facilities are also recommended

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes Indicator recommended by MOH 5.3.4 OI and STI Cts10: Percentage of men and women with STI at health care facilities who are appropriately diagnosed, treated, and counseled Definition Percent of persons with STI who are provided

appropriate diagnosis, treatment, and counseling Calculation Numerator: Number of STI patients for whom the

correct procedures were followed: a) history taking; b) examination; c) diagnosis and treatment; and d) effective counseling on partner notification, condom use and HIV testing. This indicator assumes that diagnosis, treatment and counseling are conducted to national or international standards, when available Denominator: Number of STI patients for whom provider-client interactions were observed

Rationale and what is measured

The availability and utilization of services to treat and contain the spread of STI can reduce the rate of HIV transmission within a population. One of the cornerstones of STI control is comprehensive case management of patients with symptomatic STI. This composite indicator reflects the competence of health service providers to appropriately provide these services, and the quality of services provided

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide HPC (public, private, and NGOs) is recommended. Surveys of HPC facilities are also recommended

Data collection frequency Biennial Frequency of reporting Annual Responsible body Regional Health Authority &

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Department/NAPS/Ministry of Health Remarks/notes Desegregation by gender and for patients under and

over 25 is recommended. Indicator recommended by UNGASS Cts11: Number of persons trained in the management of STI according to national guidelines Definition Number of persons that are trained to provide STI

management. Training refers to new training or refresher training of individuals. This indicator assumes that training is conducted to national or international standards, when available. The training must have specific objectives, a course outline or curriculum, and expected knowledge, skills and / or competencies to be gained by participants. Management of STI includes history taking, examination, diagnosis and treatment, and effective counseling on partner notification, condom use and HIV testing

Calculation Persons who have completed at least one or more trainings with content related to the management of STI

Rationale and what is measured

Provides an estimate of the availability of STI services

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide STI services (public, private, and NGOs) is recommended. Surveys of facilities that provide STI services are also recommended

Data collection frequency Biennial Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes This indicator does not measure training quality or

outcome measures related to job performance Indicator recommended by MOH 5.3.5 Tuberculosis Cts12: Percentage of HIV positive registered TB patients given ART during TB treatment Definition Number of HIV-positive registered TB patients who

are started on ART or continue previously initiated ART, during or at the end of TB treatment, expressed

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as a proportion of all HIV-positive registered TB patients

Calculation Numerator: All HIV-positive TB patients receiving ART at the start of the year plus the number of people who have commenced ART in the past 12 months minus the number of people for whom ART was terminated in the past 12 months (including those who died) Denominator: All HIV-positive TB patients registered over the same given time period

Rationale and what is measured

Provides a measure to commitment and capacity of TB service to ensure that HIV-positive TB patients are able to access ART

Measurement tool Program reports and facility surveys Method of measurement Data collection methods depend on who provides

ART for TB patients. If a TB patient is referred to HIV or other care services, then a system must be established to ensure that the TB program is informed of the outcome of the referral and this information is captured in a modified TB register or TB/HIV register. TB patients may be started on ART at any time during their TB treatment; therefore, the data collection method should be able to capture ART initiation at any time during TB treatment

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes This indicator does not measure whether patients are

treated with an appropriate ART regimen, at what point during TB treatment patients are started on ART, whether they adhere to therapy, or the quality of patient monitoring or follow-up

Indicator recommended by WHO Cts13: Percentage of registered TB patients tested for HIV Definition Number of registered TB patients who are tested for

HIV (after giving consent) expressed as a proportion of the total number of registered TB cases

Calculation Numerator: All TB patients receiving TB treatment at the start of the year plus the number of people who have commenced TB treatment in the past 12 months minus the number of people for whom TB treatment

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was terminated in the past 12 months (including those who died) Denominator: All TB patients registered over the same time period

Rationale and what is measured

Provides an assessment of the uptake of HIV testing by TB patients

Measurement tool Program reports and facility surveys Method of measurement National treatment protocols should suggest that all

TB patients should be offered an HIV test and all HIV-positive patients should be screened for TB

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes This indicator does not measure whether patients are

treated with an appropriate ART regimen, at what point during TB treatment patients are started on ART, whether they adhere to therapy, or the quality of patient monitoring or follow-up

Indicator recommended by WHO 5.3.6 Lab support Cts 14: Percentage of patients on ARVs who receive regular CD4 monitoring following national ARV treatment guidelines Definition Number of HIV-positive patients who are started on

ARVs or continue previously initiated ARVs and who receive regular CD4 monitoring, expressed as a proportion of all HIV-positive patients who have initiated ARVs

Calculation Numerator: All HIV-patients receiving both ARVs and regular CD4 monitoring at the start of the year plus the number of people who have commenced ARVs and CD4 monitoring in the past 12 months minus the number of people for whom ARV treatment was terminated in the past 12 months (including those who died). This indicator assumes that diagnosis, treatment and counseling are conducted to national or international standards, when available Denominator: All HIV-positive patients receiving ARVs over the same time period

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Rationale and what is measured

Provides an assessment of the number of HIV- positive patients managed under comprehensive national or international standards for ARVs and a broad measure of the scale-up of ARV use according to levels of testing priorities. WHO currently defines four levels of testing priorities:

1) Absolute minimum tests before starting antiretroviral combination therapy: HIV antibody test and hemoglobin or hematocrit level;

2) Basic tests: white blood cell count and differential, serum alanine or aspartate aminotranferase level, serum creatinine, blood urea nitrogen, serum glucose and pregnancy test;

3) Desirable tests: bilirubin, amylase, serum lipids and CD4 count; and

4) Optional tests: viral load Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide CD4 services (public and private) is recommended. Surveys of facilities providing CD4 services are also recommended

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes This indicator does not measure whether patients are

treated with an appropriate ART regimen, whether they adhere to therapy, or the quality of patient monitoring or follow-up

Indicator recommended by MOH Cts 15: Number of regional labs with capacity to perform CD4 tests following national standards Definition Number of laboratories with the capacity to perform

CD4 tests according to national or international testing guidelines, if available

Calculation Public or private laboratory with the capacity to perform CD4 testing (level 3 laboratory)

Rationale and what is measured

Provides a broad measure of the scale-up of ARV use and monitoring according to levels of testing priorities. WHO currently defines four levels of testing priorities:

1) Absolute minimum tests before starting

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antiretroviral combination therapy: HIV antibody test and hemoglobin or hematocrit level;

2) Basic tests: white blood cell count and differential, serum alanine or aspartate aminotranferase level, serum creatinine, blood urea nitrogen, serum glucose and pregnancy test;

3) Desirable tests: bilirubin, amylase, serum lipids and CD4 count; and

4) Optional tests: viral load. Laboratories are classified into three levels as follows:

Level 1: they meet the minimum testing requirements for testing categories 1 and 2 (above);

Level 2: they meet the minimum testing requirements for testing categories 1, 2, and 3; and;

Level 3: they meet the minimum requirements of all four testing categories.

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide CD4 services (public and private) is recommended. Surveys of laboratories providing CD4 services are also recommended

Data collection frequency Annual Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes Indicator recommended by MOH Cts 16: Number of persons trained to conduct CD4 testing according to national guidelines Definition Number of persons that are trained to conduct CD4

testing in a laboratory setting. Training refers to new training or refresher training of individuals. This indicator assumes that training is conducted to national or international standards, when available. The training must have specific objectives, a course outline or curriculum, and expected knowledge, skills and / or competencies to be gained by participants.

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Calculation Persons who have completed at least one or more trainings to conduct CD4 testing in a laboratory setting

Rationale and what is measured

Provides an estimate of the capacity to provide CD4 services

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide training (public, private, and NGOs) is recommended. Surveys of laboratories providing CD4 services are also recommended

Data collection frequency Biennial Frequency of reporting Annual Responsible body Regional Health Authority &

Department/NAPS/Ministry of Health Remarks/notes Indicator recommended by MOH 5.4 Priority Area 3: Reducing risk and vulnerability to HIV infection 5.4.1 IEC/BCC Pv1: Percentage of young men and women aged 15-24 who have had sex before the age of 15 Definition The number of young men and women aged 15-24

who reported having penetrative sex before the age of 15, expressed as a proportion of all youth surveyed

Calculation Numerator: Number of young men and women aged 15-24 who have had penetrative sex before the age of 15 Denominator: Total number of men and women aged 15-24 surveyed

Rationale and what is measured

This indicator provides information on the prevalence of early sexual initiation among young people. Sex at young ages is thought to be more risky than sex later in life. The female genital tract is more susceptible to infection with HIV before it has fully matured. Typically, young people have partnerships that are more often of short duration and perhaps less formal than those of older people. Moreover, they are less likely to live with their sexual partners, and this can often result in one of

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the partners having additional concurrent partners, increasing the risk of infection. People who begin having sex at young ages may spend a longer time in such less stable sexual relationships than people who delay their first sexual intercourse. Moreover, they may be more likely than older people to be bullied or exploited in sexual relationships.

Measurement tool BSS Method of measurement This measure is constructed from BSS data on recall

and current status reported by young people. Young people are asked whether or not they have had penetrative sex, either vaginal or anal, and at what age

Data collection frequency Every 4-5 years Frequency of reporting Every 4-5 years Responsible body Ministry of Health Remarks/notes The advantage of using the reported age at sexual

initiation is that it makes the most use of data that are already collected. Previously, sexual initiation has been measured by calculating the median age at first sex. Three different methods of calculating this value were proposed, each of which had unique limitations and produced different results. The above calculation is simple and allows easy comparison between times. The denominator is easily defined because all members of the survey sample contribute to this measure. For most people, first sex is a significant event that they probably remember with little difficulty. People may, however, be unsure of their exact age. The responses of young people of both sexes may be influenced by views on young people’s sexuality in the society in which they live. An analysis of the reporting of age at first sex, however, has shown that the occurrence, extent and direction of reporting or recall bias are not predictable.

Indicator recommended by UNGASS Pv2: Percentage of youths aged 15-24 reporting use of a condom during last sexual intercourse with a non-regular partner Definition Number of youths aged 15-24 years reporting

condom use with their last sexual encounter with a non-regular partner (commercial or non- commercial), expressed as a proportion of all youth reporting sexual activity with a non-regular partner (commercial or noncommercial) in the past 12

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months

Calculation Numerator: Number of youth who have reported using a condom during their last sexual encounter with a non-regular partner (commercial or noncommercial) in the past 12 months Denominator: Total number of youths who have had sexual intercourse with non-regular partners in the past 12 months

Rationale and what is measured

Provides assessment of the progress towards preventing early-age exposure to HIV through unprotected sex with non-regular partners. This is particularly important for youth because they have low prior exposure to infection and (typically) they have relatively high numbers of non-regular sexual partners

Measurement tool BSS & AIS & MICS Method of measurement This measure is constructed from BSS data on

current status reported by young people. Survey respondents are asked whether they have commenced sexual activity in the past 12 months. Those who report sexual activity are then asked if they have had sexual intercourse with a non-regular partner (commercial and/or non-commercial) in the past 12 months. If the answer is yes, then they are asked if they had consistent (100%) condom use with their non-regular partner over the past 12 months

Data collection frequency Every 4-5 years Frequency of reporting Every 4-5 years Responsible body Ministry of Health Remarks/notes Indicator scores are required for all respondents

aged 15-24 years and for males and females, separately, each by urban/rural residence. Percent of young people who said they had started sex and the percent of these who had had a non-regular partner in the last 12 months should be stated

Indicator recommended by UNGASS; MDG Pv3: Percentage of people aged 15-49 expressing accepting attitudes towards persons living with HIV Definition Number of people aged 15-49 years expressing

accepting attitudes toward persons living with HIV,

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expressed as a proportion of all people who have ever heard of HIV

Calculation Numerator: Number of people who are able to respond to six questions, which jointly measure stigma and discrimination against people living with HIV Denominator: Total number of individuals who have ever heard of HIV

Rationale and what is measured

Provides assessment of the progress in decreasing stigma and discrimination against people living with HIV

Measurement tool BSS & AIS & MICS Method of measurement This measure is constructed from BSS and AIS data.

In the BSS, the indictor is constructed by the percentage of respondents able to provide the following six answers, which jointly measure the absence of stigmatizing and discriminating attitudes against people living with HIV

1) Should people infected with HIV be quarantined? (No);

2) Willingness to share a meal with an HIV positive person (Yes);

3) Willingness to care for a male relative infected with HIV (Yes);

4) Willingness to care for a female relative infected with HIV (Yes);

5) Should an HIV infected colleague be allowed to continue working? (Yes);

6) Willingness to buy food from a shopkeeper or food seller whom one knew was HIV positive (Yes); and

7) If a member of the family became ill with HIV, would the respondent want it to remain a secret? (No)

Data collection frequency Every 4-5 years Frequency of reporting Every 4-5 years Responsible body Ministry of Health Remarks/notes Indicator recommended by MOH Pv4: Percentage of young people aged 15-24 who correctly identify ways of preventing the sexual transmission of HIV and who reject major

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misconceptions about HIV transmission (male/female) Definition Number of young people aged 15-24 years who

correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission, expressed as a proportion of all people who have ever heard of HIV

Calculation Numerator: Number of young men and women who gave correct answers to all five questions relating to transmission of HIV and misconceptions about HIV. Denominator: Total number of young men and women surveyed

Rationale and what is measured

Provides assessment of the progress toward the universal knowledge of the essential facts about HIV transmission

Measurement tool BSS & AIS & MICS Method of measurement This measure is constructed from BSS and AIS data.

The indictor is constructed from responses to the following set of prompted questions:

1) Can the risk of HIV transmission be reduced by having sex with only one faithful, uninfected partner?

2) Can the risk of HIV transmission be reduced by using condoms?

3) Can a healthy-looking person have HIV? 4) Can a person get HIV from mosquito bites? 5) Can a person get HIV by sharing a meal

with someone who is infected?

Data collection frequency Every 4-5 years Frequency of reporting Every 4-5 years Responsible body Ministry of Health Remarks/notes Indicator scores are required for all respondents

aged 15-24 years and for males and females, separately, each by urban/rural residence. Scores for the individual questions themselves as well as the composite score

Indicator recommended by UNGASS; MDG

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Pv5: Number of condoms distributed by the public and private sector in the past 12 months Definition Number of male and femle condoms distributed

through regional and sub-regional sites in the past 12 months

Calculation Total number of condoms that have been distributed by the public and private sector through regional and sub-regional sites in the past three months

Rationale and what is measured

Provides an estimate of the availability of condoms

Measurement tool Program reports and facility surveys Method of measurement Reports of the number of condom distributed by

the central medical supply center at the MOH and private sector outlets

Data collection frequency Monthly Frequency of reporting Quarterly Responsible body NAPS/Ministry of Health Remarks/notes Indicator recommended by MOH Pv6: Number of targeted prevention programs for Most at risk populations (MARPS) Definition Number of vulnerable groups (MARPS) that are

reached with targeted intervention programs aimed at reducing HIV risk

Calculation Total number of targeted intervention programs

Rationale and what is measured

This indicator gives and idea of the number of groups that are reached with targeted intervention programs and assess progress in implementing HIV prevention programs for MARPS

Measurement tool Program reports Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide services to MARPS is recommended.

Data collection frequency Monthly Frequency of reporting Quarterly Responsible body NAPS/MOH Remarks/notes Indicator recommended by MOH Pv7: Percentage of most-at-risk populations - sex workers, men who have sex with men, mobile populations, and other vulnerable groups – who reported using a condom during their last sexual encounter with a regular or non-

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regular partner Definition Number of persons from most-at-risk populations

(MARPS) who reported condom use during their last sexual encounter with their regular and non- regular partner (commercial or noncommercial), expressed as a proportion of all members of the population reporting sexual activity with regular and non-regular partner respectively in the past 12 months

Calculation Numerator: Number of members of most at-risk populations who have reported using a condom during their last sexual encounter with a regular of non-regular partner (commercial or noncommercial) in the past 12 months Denominator: Total number of members of the most- at-risk populations who had sexual intercourse with regular or non-regular partners respectively in the past 12 months

Rationale and what is measured

Provides assessment of the progress towards behavior change among members of most-at-risk populations. This is particularly important for countries with concentrated epidemics and measures the success of targeted intervention programs.

Measurement tool BSS among MARPS Method of measurement This measure is constructed from BSS data among

members of most-at-risk populations in Guyana. It should be noted that even though sex workers and men who have sex with men are mentioned above other populations may also need to be included in these surveys.

Data collection frequency Every 2-5 years Frequency of reporting Every 2-5 years Responsible body Ministry of Health Remarks/notes Separate indicator scores are required for each

population surveyed. Indicator recommended by UNGASS/MOH 5.4.2 PMTCT Pv8: Number of service outlets that offer PMTCT services Definition Number of service outlets that provide PMTCT

services. A service outlet refers to the lowest level of service for which data exists, e.g., hospital, clinic, or mobile unit. PMTCT services are defined as the

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minimum package of services for preventing HIV transmission from mother-to-child, which includes all four of the following:

1) Counseling and testing to prevent MTCT 2) ARV prophylaxis to prevent MTCT 3) Counseling and testing for safe infant

feeding practices 4) Family planning counseling or referral

Calculation Total number of service outlets that provide the minimum package of PMTCT services

Rationale and what is measured

Provides an estimate of the national availability of PMTCT services

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

records of regional health authorities or departments, which may have a list of service outlets, is recommended. Surveys of health facilities are also recommended

Data collection frequency Monthly Frequency of reporting Quarterly Responsible body Regional Health Authority/NAPS/ MCH/MOH Remarks/notes This indicator does not consider the quality of

service provision Indicator recommended by MOH Pv9: Number of pregnant women who received HIV counseling and testing for PMTCT and received their test results Definition The total number of pregnant women who received

HIV counseling and testing at a PMTCT service outlet according to national standards, and received their test results

Calculation Total number of pregnant women who receive HIV counseling and testing at a PMTCT service outlet according to national guidelines, and received their test results

Rationale and what is measured

Provides an estimate of the uptake of PMTCT services

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

records of regional health authorities or departments, which may have a list of service outlets, is recommended. Surveys of health facilities are also recommended

Data collection frequency Monthly

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Frequency of reporting Quarterly Responsible body Regional Health Authority/NAPS/ MCH/MOH Remarks/notes This indicator does not consider the quality of

service provision Indicator recommended by MOH Pv10: Percent of HIV-infected pregnant women who receive a complete course of ARV prophylaxis to reduce MTCT in accordance with a nationally approved treatment protocol Definition The number of HIV-infected pregnant women

provided with complete course of antiretroviral prophylaxis to reduce the risk of mother-to-child transmission in the last 12 months, expressed as a proportion of all HIV-infected pregnant women giving birth in the past 12 months. ARV prophylaxis may be a single dose nevirapine (SD NVP) of short-course combination prophylaxis or highly active anti-retroviral therapy (HAART)

Calculation Numerator: Number of HIV positive pregnant women receiving a complete course of ARV prophylaxis to reduce the likelihood of MTCT in the last 12 months according to national standards Denominator: Estimated number of HIV-infected pregnant women giving birth in the last 12 months

Rationale and what is measured

Assesses the progress in preventing mother-to-child transmission of HIV

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

records of regional health authorities or departments, which may have a list of service outlets with program monitoring records, is recommended. Surveys of health facilities are also recommended

Data collection frequency Annually Frequency of reporting Annually Responsible body Regional Health Authority/NAPS/ MCH/MOH Remarks/notes This indicator does not consider the quality of

service provision Indicator recommended by UNGASS Pv11: Number of health workers trained in the provision of PMTCT according to national guidelines Definition Number of health workers trained in the provision

of PMTCT. Training refers to new training or

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retraining of individuals and assumes that training is conducted according to national standards. A training must have specific learning objectives, a course outline or curriculum, and expected knowledge, skills and/or competencies to be gained by participants. A PMTCT training curriculum should contain at least one of the PMTCT core elements: PMTCT-related counseling and testing, ARV prophylaxis, infant feeding counseling, or family planning counseling or referral

Calculation Persons who have completed at least one or more trainings with content related to the delivery of PMTCT services

Rationale and what is measured

Assesses the progress in preventing mother-to-child transmission of HIV

Measurement tool Program reports and facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide training (public, private, and NGOs) is recommended. Surveys of health facilities providing HPC are also recommended

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority/NAPS/ MCH/MOH Remarks/notes This indicator does not measure the quality of

training, nor does it measure the outcomes of the training in term of the competencies of individuals trained, nor their job performance

Indicator recommended by MOH Pv12: Percentage of babies born to HIV-positive women who are tested before age 18 months Definition Number of babies born to HIV-positive women

who are tested before age 18 months, expressed as a proportion of the number of babies born to HIV- positive mothers

Calculation Numerator: Number of babies born to HIV-positive mothers who are tested for HIV before age 18 months Denominator: Total number of babies born to HIV positive mothers

Rationale and what is measured

Assesses the progress in preventing mother-to-child transmission of HIV and progress in providing appropriate care to babies born to HIV infected women

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Measurement tool Program reports and facility surveys Method of measurement Program reports

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority/NAPS/ MCH/MOH Remarks/notes Indicator recommended by MOH 5.4.3 Orphans and vulnerable children Pv13 Percentage of OVC whose households received free, basic external support in caring for the child Definition The number of OVC who households receive free of

cost, basic external support in caring for the child, expressed as a proportion of all OVC

Calculation Numerator: Number of orphaned and vulnerable children who live in households and a ‘YES’ to at least one of the following four questions by the head of the household:

1) Has this household received medical support, including medical care and/or medical care supplies, within the last 12 months?

2) Has this household received school-related assistance, including school fees, within the last 12 months?

3) Has this household received emotional/psychological support, including counseling from a trained counselor and/or emotional support/companionship, within the last three months?

4) Has this household received other social support, including socioeconomic support (e.g., clothing, extra food, financial support, shelter) and/or instrumental support (e.g., help with household work, training for caregiver, childcare, legal services) within the last three months?

Denominator: Total number of orphaned and vulnerable children

Rationale and what is measured

Provides assessment of the progress in providing support to households that are caring for orphaned

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and vulnerable children Measurement tool MICS Method of measurement Household surveys in which heads of households are

asked four questions about the types and frequency of support received (see above), and the primary source of the help for each orphan and vulnerable child

Data collection frequency Every 4-5 years Frequency of reporting Every 4-5 years Responsible body Ministry of Human Services and Social

Security/Ministry of Health Remarks/notes External support is defined as free help coming from

a source other than friends, family or neighbors unless they are working for a community-base group or organization. This indicator does not measure the needs of the household or the OVC

Indicator recommended by UNGASS Pv14: Number of providers/caretakers trained in the provision of care for OVC Definition Providers and caretakers are anyone who ensures

care for OVC, including those who provide, make referrals to, and/or oversee social services. This may include parents, guardians, other caregivers, extended family, neighbors, community leaders, police officers, social workers, national, district, and/or local social welfare ministry staff, as well as health care workers, teachers, or community workers who receive training on how to address the needs of OVC. Training refers to new training or retraining of individuals and assumes that training is conducted according to national or international standards, if available. A training must have specific learning objectives, a course outline or curriculum, and expected knowledge, skills and/or competencies to be gained by participants

Calculation Providers or caretakers who have completed at least one or more trainings with content related to the delivery of care to OVC

Rationale and what is measured

Assesses the progress in improving the lives of children and families directly affected by AIDS- related mortality and/or morbidity

Measurement tool Program reports and facility surveys

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Method of measurement In order to measure this indicator, reviews of program records of organizations that provide training (public, private, and NGOs) is recommended

Data collection frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority/NAPS/MoH Remarks/notes This indicator does not measure the quality of the

training, nor does it measure the outcomes of the training in terms of the competencies of the individuals trained, nor their performance

Indicator recommended by MOH Blood Safety Pv15: Percent of transfused blood units in the public and private sector in the last 12 months that have been adequately screened for HIV according to national guidelines Definition This indicator gives and idea of the overall

percentage of blood units that have been screened to sufficiently high standards that can be confidently declared HIV free

Calculation Numerator: Number of blood units screened for HIV in the last 12 months using national or international standards Denominator: Number of blood units transfused in the last 12 months in the public and private sector

Rationale and what is measured

This indicator assesses the degree to which blood is screened and compliance with appropriate national and international guidelines.

Measurement tool MEASURE EVALUATION blood safety protocol Method of measurement Facility survey

Data collection frequency Biannual Frequency of reporting Biannual Responsible body MOH/NBTS Remarks/notes This indicator measures compliance with blood

screening guidelines. Indicator recommended by UNAIDS 5.5 Priority Area 4: Surveillance and research Sr1: Percentage of service outlets with record-keeping systems to monitor HIV prevention, care, treatment and support

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Definition Number of service outlets with record-keeping systems for monitoring HIV/AIDS prevention, care, treatment and support. A service outlet refers to the lowest level of service for which data exists, e.g., hospital, clinic, or mobile unit.

Calculation Numerator: Number of service outlets maintaining adequate records on the services provided Denominator: Total number of service outlets surveyed

Rationale and what is measured

This indictor is designed to measure the capacity of health facilities to collect data on care and support services and to compile these data

Measurement tool SPA Method of measurement Health facility surveys that examine records on

HIV/AIDS care and support services and qualitative interviews with people responsible for data collection

Data Collection Frequency Every 2-3 years Frequency of reporting Every 2-3 years Responsible body Regional Health Authority/ NAPS/MOH Remarks/notes Patient record systems are diverse within facilities,

making comparisons across sites difficult. There is also no international (or national) standard for data reporting that can be used whether the record- keeping is adequate

Indicator recommended by UNAIDS Sr2: Number of persons trained in strategic information - monitoring and evaluation and/or surveillance and/or HMIS Definition Individuals may be newly trained or re-trained.

Training refers to new training or retraining of individuals and assumes that training is conducted according to national or international standards, if available. A training must have specific learning objectives, a course outline or curriculum, and expected knowledge, skills and/or competencies to be gained by participants

Calculation Persons who have completed at least one or more trainings with content related to strategic information (monitoring and evaluation, surveillance, or HMIS)

Rationale and what is measured

This indictor is designed to measure progress towards creating a cadre of professionals trained in the collection, analysis, dissemination and use of strategic information for HIV/AIDS programming

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Measurement tool Program reports or facility surveys Method of measurement In order to measure this indicator, reviews of

program records of organizations that provide training (public, private, and NGOs) is recommended

Data Collection Frequency Monthly Frequency of reporting Annual Responsible body Regional Health Authority/ MOH Remarks/notes This indicator does not measure the quality of the

training, nor does it measure the outcomes of the training in terms of the competencies of the individuals trained, nor their job performance

Indicator recommended by MOH

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REFERENCES Bureau of Statistics (2002). “Guyana Population and Housing Census 2002 Preliminary Report.” Government of Guyana. CAREC (2004). “Status and Trend Analysis of the Caribbean HIV/AIDS Epidemic 1982-2002.” Available online at http://www.carec.org/orders/statustrends.html. [Accessed on 29 September 2005]. CHRC (2004). “Assessment of the National HIV/AIDS Programme of Guyana.” Prepared by Jennifer Pierre under the project “Strengthening the Institutional Response to HIV/AIDS/STIs in the Caribbean Project.” GFATM (2003). “Guyana’s National Initiative to Accelerate Access to Prevention, Treatment, and Care, and Support for Persons Affected by HIV/AIDS.” Submitted by Country Coordinating Committee, Guyana. Available online at http://www.theglobalfund.org. [Accessed on 29 September 2005]. GFATM (2004). “Monitoring and Evaluation Toolkit. HIV/AIDS, Tuberculosis, and Malaria.” MOH (2002)a. “Status Report on HIV/AIDS in Guyana 1987-2001.” Government of Guyana. Prepared by Dr. Navindra Persaud. MOH (2002)b. “Guyana’s National Strategic Plan for HIV/AIDS 2002- 2006.”Government of Guyana. MOH (2003). “National Health Plan 2003-2007. The Strategic Plan of the Ministry of Health.” Government of Guyana. Palmer C., et al. (2002). “HIV prevalence in a gold mining camp in the Amazon region, Guyana.” Emerging Infectious Diseases. March. 8(3):330-1. PEPFAR (2005). “The President’s Emergency Plan for AIDS Relief. Indicators, Reporting Requirements, and Guidelines.” Revised for FY2006 reporting. [1 June 2005 Draft]. Persaud, N., et al. (1999). “Drug Use and Syphilis: Co-factors for HIV transmission among commercial sex workers in Georgetown, Guyana.” West Indian Medical Journal. June. 48(2):52-6. WHO (2005). “A Guide to Indicators for Monitoring and Evaluating National Antiretroviral Programmes.” World Bank (2004). “Project Appraisal Document on a Proposed Grant in the amount of SDR 6.7 million (US$10 Million Equivalent) to the Republic of Guyana for a HIV/AIDS Prevention & Control Project.” Report No: 27394.

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UNAIDS (2004). “Guyana Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections.” Available online at http://www.unaids.org. [Accessed on 29 September 2005] UNDP (2005). “Human Development Report 2005: International cooperation at a crossroads: Aid, trade, and security in an unequal world.” Available online at http://hdr.undp.org/reports/global/2005/. [Accessed on 7 October 2005] United Nations General Assembly Special Session (UNGASS) on HIV/AIDS (2006). “Guidelines for Construction of Core Indicators 2006 reporting.” USAID Guyana (2003). “Guyana HIV/AIDS Strategic Plan 2004-2008.” Submitted to the Bureau of Global Health USAID.

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APPENDICES Appendix 1. List of Contributors Principal Leads Dr. Shanti Singh, NAPS/MoH Dr. Frank Anthony, HSDU/MoH Technical Coordinator Dr. Enias Baganizi, PAHO Technical Committee Dr. Navindra Persaud, GHARP James Moore, CDC/Guyana Anthony Willis, UNAIDS Technical Advisors Upama Khatri, MEASURE/JSI Kathryn Boryc, USAID Dr. Ruben Del Prado, UNAIDS Merle Mendonca, GHRA

Appendix 2. GoG HIV/AIDS Program Logic Model

P a g e 1

G o v e r n m e n t o f G u y a n a H I V / A I D S P r o g r a m L o g i c M o d e l

P s y c h o s o c i a l a n d E c o n o m i c S u p p o r t

A c t i v i t i e s

A R V T r e a t m e n t S e r v i c e s

O r p h a n s & V u l n e r a b l e C h i l d r e n

P a l l i a t i v e C a r e & O p p o r t u n i s t i c

I n f e c t i o n s T r e a t m e n t S e r v i c e s

( i n c l u d i n g T B )

S T I a n d H I V / A I D S K n o w l e d g e &

A w a r e n e s s

H u m a n R e s o u r c e s

F i n a n c i a l R e s o u r c e s

I n s t i t u t i o n a l , P o l i t i c a l a n d M a n a g e m e n t S u p p o r t

L a b o r a t o r y S e r v i c e s

S T I T r e a t m e n t S e r v i c e s

C a p a c i t y B u i l d i n g ( e . g . , M O H , m a n a g e r s ,

h e a l t h p r o v i d e r s , N G O s , C B O s , l i n e

m i n i s t r i e s , e t c . )

I N P U T S P R O C E S S E S O U T C O M E S I M P A C T

P R E V E N T I O N T R E A T M E N T ,C A R E & S U P P O R T C R O S S - C U T T I N G

B A S E L I N E S T U D I E S , P R O G R E S S A N D P E R F O R M A N C E M O N I T O R I N G O U T C O M E S & I M P A C T E V A L U A T I O N

M a t e r i a l s & E q u i p m e n t

C o n d o m P r o m o t i o n & D i s t r i b u t i o n o f

Q u a l i t y C o n d o m s

H I V C o u n s e l i n g & T e s t i n g

P r e v e n t i o n o f M o t h e r - t o - C h i l d

T r a n s m i s s i o n

S a f e B l o o d

U n i v e r s a l P r e c a u t i o n s /

S a f e I n j e c t i o n s

S t r a t e g i c I n f o r m a t i o n ( e . g . , s u r v e i l l a n c e ,

M I S , r e s e a r c h , E l e c t r o n i c R e s o u r c e C e n t e r a n d W e b s i t e )

S T I C a s e s

Q u a l i t y o f L i f e f o r P L W H A

H I V I n f e c t i o n s A v e r t e d

A I D S - R e l a t e d M o r t a l i t y

Q u a l i t y o f H I V / A I D S T r e a t m e n t , C a r e a n d

S u p p o r t S e r v i c e s ( e . g . a p p r o p r i a t e

d i a g n o s i s & t r e a t m e n t , h o m e -

b a s e d c a r e )

H e a l t h P r o v i d e r a n d P a t i e n t K n o w l e d g e

o f H I V / A I D S P r e v e n t i o n , C a r e

a n d T r e a t m e n t

S t i g m a & D i s c r i m i n a t i o n

A v a i l a b i l i t y o f H i g h Q u a l i t y C o n d o m s

H I V / A I D S - R e l a t e d M o r b i d i t y

H I V P r e v a l e n c e

Appendix 3. National Indictors for HIV/AIDS M&E System

Level and Area Indicators REF Data Source Impact

Proportion of all deaths attributable to AIDS Imp1 Vital registration system and program reports Percentage of adults and children with HIV alive and known to be on treatment 12 months after initiation of ART Imp2

Vital registration system and program reports

HIV prevalence among persons 15-24 Imp3 Sentinel surveillance at ANC sites

HIV prevalence among most-at-risk populations Imp4 BBSS and AIS with HIV testing and sentinel surveillance at STI and TB

sites Percent of infants born to HIV-infected mothers who are infected Imp5 Program reports and facility surveys

Ratio of current school attendance among orphans to that among non-orphans aged 10-14 Imp6 AIS

Program Outputs Priority 1: Strengthen National Capacity

Amount of national funds distributed by low- and middle-income countries Nc1

National AIDS Spending Assessment (NASA)

Implementation of the “Three Ones” Principle Nc2 Questionnaire National composite policy index Nc3 NCPI questionnaire Policy Formation Percent of schools with teachers who have been trained in life-skills based HIV/AIDS education and who taught it during the last academic year

Nc4 School survey

Partnerships/Multi- sectoral Response

Number of line ministries with HIV work plans and budgets Nc5 Special survey of Line Ministries

Priority 2: Clinical and Diagnostic Management and Access to Care, Treatment, and Support Percent of women, men, and children with HIV infection receiving ART who are eligible according to national guidelines Cts1 Program reports and facility surveys

Number and percent of regions with at least one service outlet providing ART services following national standards Cts2 Program reports and facility surveys

Access to ART

Number of health workers trained on ART delivery according to national guidelines Cts3 Program reports and facility surveys

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Level and Area Indicators REF Data Source Priority 2: Clinical and Diagnostic Management and Access to Care, Treatment, and Support (con’t)

Percent of the general population aged 15-49 receiving HIV test results in the past 12 months Cts4 AIS

VCT Number of individuals trained in the provision of VCT according to national guidelines Cts5

Program reports and facility surveys

Number of regions with service outlets that provide HPC Cts6 Program reports and facility surveys

Number of service outlets that provide HPC Cts7 Program reports and facility surveys

Number of persons trained to provide HPC according to national guidelines Cts8

Program reports and facility surveys

Home and Palliative Care

Number of persons who receive HPC following national guidelines Cts9

Program reports and facility surveys

Percent of men and women with STIs at health care facilities who are appropriately diagnosed, treated, and counseled Cts10

Program reports and facility surveys OIs and STIs

Number of persons trained in the management of STIs according to national guidelines Cts11

Program reports and facility surveys

Percent of HIV-positive registered TB patients given ART during TB treatment Cts12

Program reports and facility surveys Tuberculosis

Percent of registered TB patients tested for HIV Cts13 Program reports and facility surveys Percent of patients on ARVs who receive regular CD4 monitoring following national ARV treatment guidelines Cts14

Program reports and facility surveys

Number of regional labs with the capacity to perform CD4 tests following national standards Cts15

Program reports and facility surveys Lab Support

Number of persons trained to conduct CD4 testing according to national guidelines Cts16

Program reports and facility surveys

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Level and Area Indicators REF Data Source Priority Area 3: Reducing Risk and Vulnerability to HIV infection

Percent of young men and women aged 15-24 who have had sex before age 15 Pv1 BSS

Percent of youth aged 15-24 reporting use of a condom during last sexual intercourse with a non-regular partner Pv2 BSS & AIS & MICS

Percent of people aged 15-49 expressing accepting attitudes toward people with HIV/AIDS Pv3 BSS & AIS & MICS

Percent of people aged 15-24 who correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission

Pv4 BSS & AIS & MICS

Number of condoms (male and female) distributed in the past 12 months Pv5

Program reports and facility surveys

Number of targeted prevention programmes for vulnerable groups Pv6 Program reports

IEC/BCC

Percentage of most-at-risk populations - sex workers, men who have sex with men, mobile populations, and other vulnerable groups – who reported using a condom during their last sexual encounter with a regular or non-regular partner

Pv7 BSS

Number of service outlets that offer PMTCT services Pv8 Program reports and facility surveys Number of pregnant women who receive HIV counseling and testing for PMTCT and receive their test results Pv9

Program reports and facility surveys

Percent of HIV-infected pregnant women who receive a complete course of ARV prophylaxis as part of PMTCT Pv10

Program reports and facility surveys

Number of health workers trained in the provision of PMTCT according to national guidelines Pv11

Program reports and facility surveys

PMTCT

Percent of babies born to HIV-positive women who are tested before age 18 months Pv12

Program reports and facility surveys

OVC Percent of OVC whose households receive free, basic external support in caring for the child Pv13 MICS

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Number of providers trained in the provision of care for OVC Pv14 Program reports and facility surveys

Blood Safety Percent of transfused blood units in the public and private sector in the last 12 months that have been adequately screened for HIV according to national guidelines

PV15 Facility surveys

Level and Area Indicators REF Data Source Priority Area 4: Surveillance and Research

Percent of service outlets with record-keeping systems to monitor HIV/AIDS care and treatment Sr1 SPA

Number of persons trained in strategic information (monitoring and evaluation and/or surveillance and/or HMIS) Sr2

Program reports or facility surveys