Strategic Information: USAID’s Leadership on Monitoring and Evaluation of Global HIV/AIDS Programs
Effective monitoring and evaluation have become increasingly important as the U.S. Agency for International Development (USAID) expands HIV/AIDS prevention, care, and treatment programs under the President’s Emergency Plan for AIDS Relief.
Increasing Surveillance Capacity
USAID has long recognized the importance of supporting high-quality surveillance data collection to track the HIV/AIDS pandemic and to measure prevalence trends in the epidemic, risk behaviors, and coverage of prevention and care services. USAID surveillance activities include support to the U.S. Bureau of the Census to collect and analyze HIV surveillance data and support to ORC Macro/MEASURE DHS to develop and maintain a database of key HIV/AIDS indicators on risk behaviors and HIV-related services from population surveys. The resulting databases make these data easily accessible to the Office of the U.S. Global AIDS Coordinator, countries, donors, nongovernmental organizations, and other stakeholders. USAID is expanding surveillance activities to better capture a diverse and changing pandemic, to strengthen national surveillance programs, and to increase training for epidemiologists and service providers in developing countries. Through collaborative efforts between USAID and the Joint United Nations Programme on HIV/AIDS (UNAIDS), the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention, and other partners, second-generation surveillance systems are linking behavioral and biological data for strategic planning purposes.
Health Management Information System
USAID affirms the concept of implementing the “Three Ones” at the country level: one action framework, one coordinating authority, and one monitoring and evaluation system. In support of this model, USAID provides technical leadership and resources to strengthen national capacity for collecting and compiling HIV/AIDS data at the national level for use by AIDS program managers to improve their programs. Specific achievements include collaborating with the World Health Organization to publish Patient Monitoring Guidelines for HIV Care and Antiretroviral Therapy and developing software and systems to improve data storage and flow from the sub-national to the national level.
Monitoring and Evaluation Systems
USAID supports the development of standardized indicators in consultation with other national governments, multilateral donors, technical experts, and nongovernmental organizations. These indicators enable program managers to track similar results over time and across multiple countries. The system includes three categories of data:
HIV seroprevalence studies. HIV prevalence provides an estimate of the severity of the epidemic and the national-level impact of HIV/AIDS programs over time. USAID’s objective is to reduce the rate of HIV transmission. HIV seroprevalence data are collected through national sentinel surveillance systems or population surveys, along with HIV testing. The International Programs Office of the Bureau of the Census analyzes and disseminates these data. In collaboration with various partners, such as the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention and international donors, USAID will continue to improve and expand national surveillance systems. Because the HIV status of young people is a good proxy for HIV incidence, or new infections, USAID pays particular attention to tracking HIV prevalence for those 15 to 24 years of age.
Surveys. The most important way to slow the epidemic and reduce transmission is to change human sexual behavior. Monitoring changes in behavior also provides a measure of the success of national HIV/AIDS programs and suggests ways to improve prevention and care programs’ efficiency and coverage. USAID supports Demographic and Health Surveys (DHS), AIDS Indicator Surveys (AIS) and Behavioral Surveillance Surveys (BSS). National surveys on sexual behavior are conducted every three to five years. Indicators include sexual debut and age at first sex (measures of abstinence), extramarital sexual activity, number of sexual partners, and condom use. When the HIV epidemic is concentrated or low-level, greater focus is given to sub-populations that are most vulnerable and at risk for transmission.
Additionally, USAID supports MEASURE DHS to field national surveys of health facilities in order to track the scale-up of HIV/AIDS-related care and treatment services by taking inventory of existing policies, services, drugs, trained staff, and laboratory and monitoring capacity. Other studies of AIDS-related mortality are also supported through MEASURE Evaluation and the Bureau of the Census.
Program progress and coverage. USAID measures progress in achieving global targets. USAID Missions report on progress in implementing their HIV/AIDS programs and increasing service coverage to target populations. Key indicators encompass behavior change programs, HIV counseling and testing, community- and home-based care for HIV-infected persons and their families, prevention of mother-to-child transmission, care for orphans and vulnerable children, and provision of antiretroviral therapy.
USAID maintains and analyzes monitoring and evaluation data through an interagency approach in coordination with the Office of the U.S. Global AIDS Coordinator.
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July 2005 |
