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Papua New Guinea

National HIV and AIDS Strategy

2 0 1 1 - 2 0 1 5

Monitoring and Evaluation Framework

Papua New Guinea National HIV and

AIDS Strategy2011-2015

Monitoring and Evaluation Framework

Published in 2010 by the National AIDS Council of Papua New Guinea © Copyright 2010, National AIDS Council of Papua New Guinea All rights reserved.

ISBN: 978-9980-948-53-3

Papua New Guinea: National HIV and AIDS Strategy: 2011-2015: Monitoring and Evaluation Framework

Design and Layout by Mairi Feeger

Printed by Moore Printing, Scratchley Road, Badili, NCD, PNG

The document was developed and written by several groups acknowledged here : National HIV and AIDS Strategy Core Group, National HIV and AIDS Strategy Technical Support Team, National HIV and AIDS Strategy Secretariat and Independent Review Group Key Stakeholders for your contributions and the National AIDS Council Secretariat for your leadership and direction.

We would also like to thank our development partners, AusAID and UN Agencies for your financial and technical support in the development and publication of the National HIV and AIDS Strategy 2011-2015.

iii

ContentsAcronyms iv

Situation analysis of the monitoring and evaluation and surveillance environment in PNG 1

The scope and goals of the National Monitoring and Evaluation Framework 8

Structures for coordination and management of strategic information 9

Flow of data and reports 11

National indicators 15

Definitions for national indicators 22

Strategic information needs not addressed through national indicators 64

Guidelines for developing program monitoring and evaluation plans based on the

National Monitoring and Evaluation Framework 67

Appendix I – Inventory of questions to be included in surveys for measuring

national indicators 68

Appendix II – Repository of additional indicators for monitoring and evaluation

of programs 72

Appendix – III Glossary 80

Contents

iv

Acronyms ADB Asian Development Bank

AIDS acquired immune deficiency syndrome

ANC antenatal care

ART antiretroviral therapy

ARV antiretroviral

AusAID Australian Agency for International Development

BSS behavioural surveillance survey

CBO community based organisation

CRIS Country Response Information System

CTX cotrimoxazole

DHS Demographic Health Survey

FBO faith based organisation

FHI Family Health International

GBV gender based violence

GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria

GoPNG Government of Papua New Guinea

HAMP Act HIV and AIDS Management and Prevention Act

HBC home based care

HCT HIV counselling and testing

HIV human immunodeficiency virus

IBBS Integrated Bio-Behavioural Survey

ICME Intelligence, Cross Cutting Issues and Monitoring and Evaluation Unit

IRG Independent Review Group

MARP more-at-risk population(s)

MCH Maternal and Child Health

M&E monitoring and evaluation

MSM men who have sex with men

NAC National AIDS Council

NACS National AIDS Council Secretariat

NASA National AIDS Spending Assessment

NDoH National Department of Health

NGO non-government organisation

NHIS National Health Information System

NHS National HIV and AIDS Strategy

NOC National M&E Oversight Committee

NRA National Research Agenda

Acronyms

v

NRI National Research Institute

NSO National Statistical Office

PA priority area

PAC Provincial AIDS Committee

PACS Provincial AIDS Committee Secretariat

PACSO PNG Alliance of Civil Society Organisations

PCP pneumocystis jiroveci pneumonia

PEP post-exposure prophylaxis

PHO Provincial Health Office

PLHIV people living with HIV and AIDS

PLLSMA Provincial and Local Level Service Monitoring Authority

PMTCT prevention of mother-to-child transmission

PNG Papua New Guinea

PNGIMR Institute of Medical Research

POC point-of-care

PPTCT prevention of parent-to-child transmission

ProMEST Provincial Monitoring Evaluation and Surveillance Teams

RAC Research Advisory Committee

RCU Research Coordination Unit

SAM service availability mapping

SO strategic objective

SPA service provision assessment

STI sexually transmitted infection

STWG Surveillance Technical Working Group

TA technical assistance

TB tuberculosis

UA universal access

UN United Nations

UNAIDS Joint United Nations Programme on HIV and AIDS

UNDP United Nations Development Programme

UNGASS UNGASS United Nations General Assembly Special Session on HIV and AIDS

USAID United States Agency for International Development

VCT voluntary counselling and testing

WHO World Health Organisation

Acronyms

1

Situation analysis of the monitoring and evaluation and surveillance environment in PNG

The national Monitoring and Evaluation (M&E) system in PNG is guided by the ‘third one’ of the ‘three ones principles’ of having one national M&E system which is linked to the National HIV and AIDS Strategy 2011–2015 (NHS). Like any fully functioning national HIV M&E system, it comprises the following 12 components:

1. Organisational structures with HIV M&E functions2. Human resources capacity for HIV M&E3. Partnerships to plan, coordinate and manage the HIV M&E system4. National, multi-sectoral HIV M&E plan5. Annual costed national HIV M&E work plan6. Advocacy and communications culture for HIV M&E7. Routine HIV program monitoring 8. Surveys and surveillance9. National and sub-national HIV databases10. Supportive supervision and data auditing11. HIV evaluation and research12. Data dissemination and use

These 12 components will be integrated with each other following the three tiers depicted in Figure 1: • people,partnershipsandplanning• collecting,verifyingandanalysingdata• usingdatafordecisionmaking.


2Situation analysis of the monitoring and evaluation and surveillance environment in PNG

Figure 1: Situation analysis of the monitoring and evaluation and surveillance environment in PNG

Costed M&E

work planM&E plan

M&E

par

tner

ships

Human capacity

for M&E

Organisational structures with M&E

M&E

adv

ocac

y,

com

mun

icatio

ns a

nd

cultu

re

Data dissemination and use

Rout

ine p

rogr

amm

e

mon

itorin

gSurveys and

surveillance

M&E datab

ase

HIV evaluation

research and

learning

Supervision and

data auditing

In the National HIV and AIDS Strategy and the accompanying NHS Implementation Framework, M&E is envisaged as an integral part of the NHS and found in many of the strategic objectives and major activity areas. M&E is also specifically addressed in Priority area 3, Systems strengthening.

3

Situational analysis: Integration of the twelve components in national monitoring and evaluation in PNGThis section conducts a situation analysis for each of the 12 components listed above that make up a functioning national HIV M&E system. The situational analysis was current at June 2010.

1. Organisational structures for HIV M&E functions

There has been a lot of progress in ensuring that all M&E functions are realigned to existing structures and that these functions are strengthened and fully implemented.

The NACS Intelligence, Cross Cutting Issues and Monitoring and Evaluation Unit (ICME) at the National AIDS Council Secretariat (NACS), the Surveillance Unit at the National Health Information System (NHIS) and the Surveillance and Monitoring and Evaluation Unit within the National STI and HIV and AIDS Program at the National Department of Health (NDoH) are the three main national structures with HIV M&E functions. At the sub-national level, Provincial Monitoring Evaluation and Surveillance Teams (ProMEST) have been established.

The NACS Research Coordination Unit (RCU) is the main coordinating body for all HIV related research in PNG. The National Research Institute (NRI) and the PNG Institute of Medical Research (PNGIMR) are the two main research institutions that design and implement many of the HIV-related surveillance and survey studies.

The main challenge is to ensure that there is regular and meaningful communication between the coordinating bodies and with all stakeholders to ensure that the comprehensive HIV and AIDS response is monitored through this structure and monitoring reports are utilised to inform programming.

2. Human resource capacity for HIV M&E

The NACS ICME and the NDoH Surveillance/NHIS units are struggling to address the planning, programming and logistical demands involved in coordinating the national M&E framework. NDoH has strived to increase its capacity to strengthen the STI, HIV and AIDS surveillance and M&E program. Staff have expertise in epidemiology, demography, statistics and mathematics. Four regional program M&E staff have been recruited to support M&E and surveillance at the sub-national level. Continuous short- and long-term capacity building of staff involved in M&E at national and sub-national levels is critical to ensure quality monitoring outcomes.

At the provincial level most Provincial AIDS Committee Secretariats (PACS) do not have positions or staff dedicated to M&E. There is a need for ongoing capacity development for all people engaged in HIV M&E, including partners in civil society. Although development partners have invested heavily in this area, a more coordinated approach to capacity development within the national M&E framework is required and needs to be a higher priority for stakeholders, especially development partners.


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3. Partnerships to plan, coordinate and manage the HIV M&E system

The National Monitoring and Evaluation Oversight Committee (NOC) is still in its initial stages of development. The key task for this committee is to coordinate all HIV and AIDS related M&E activities amongst all stakeholders at national and sub-national levels.

At the technical level, a Surveillance Technical Working Group (STWG) exists at NDoH which is responsible for providing coordinated technical oversight for all STI, HIV and AIDS data gathering and management requirements, guidelines, and procedures. The STWG is chaired by NDoH and comprises representatives from NDoH, NACS, NRI, Asian Development Bank (ADB), World Health Organisation (WHO), Joint United Nations Programme on HIV and AIDS (UNAIDS), United Nations Development Programme (UNDP), Family Health International (FHI), Igat Hope (an organisation of people living with HIV), PNGIMR, the University of PNG and the Australian Agency for International Development (AusAID). Currently, the STWG only deals with technical issues specific to program monitoring data for the health sector and HIV and AIDS behavioural and biological surveillance.

The key challenge for the HIV and AIDS M&E system in this area is to ensure adequate coordination at both high and technical levels and ensure provision of necessary M&E support to sub-national levels, where implementation occurs.

4. National multi-sectoral HIV M&E plan

A key achievement of the National Strategic Plan for HIV/AIDS, 2005-2010 was the development of an overarching M&E framework that formed the basis for monitoring of the HIV response.

This new national HIV M&E framework has been developed in alignment with the new National HIV Strategy, 2011-2015 and will form the basis of monitoring the national response to the epidemic over the next five years.

The main challenge for the NHS and its implementers will be to ensure that the M&E framework is target driven and realistic enough to adequately monitor the trends in HIV and its associated risk behaviours to enable a better response. Another important challenge is for the M&E plan to embrace, to the extent possible, all the reporting commitments of PNG and for the development partners to limit their reporting requirements to the national HIV M&E plan.

5. Annual costed national HIV M&E work plan

Although annual work plans have been developed they have never been successfully costed. In addition to costing a plan, the main challenge is to mobilise resources based on that plan and effectively use them for achieving M&E targets. The HIV-STI surveillance plan for 2007–2010 was costed and this facilitated resource mobilisation for its implementation.


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6. Advocacy and communications culture for HIV M&E

There is an increasing receptiveness to the incorporation on M&E into HIV programming. The new NHS places a strong emphasis on communication of strategic information as the basis for evidence-informed interventions in its three priority areas.

7. Routine HIV program monitoring

The ProMEST coordinating mechanism is only functioning in a small number of provinces. Those provinces that have a well functioning ProMEST are generally better at reporting HIV-related data than provinces where ProMEST is not functioning.

One of the overall challenges for routine HIV program monitoring is the existence of parallel reporting mechanisms. In addition to ProMEST and provincial surveillance systems, many implementing partners, particularly non-government organisations (NGOs) and faith based organisations (FBOs), have their own reporting systems and have not been using ProMEST monitoring tools and guidelines to report to provincial and national levels. Instead they report using other formats and frameworks, in line with the conditions set by their parent organisation or donor(s).

8. Surveys and surveillance

NDoH is responsible for national coordination of all surveillance activities for STI, HIV and AIDS. Its core mandates include:

1. Routine surveillance of STI, HIV and AIDS through case reporting. 2. Development of estimates and projections for HIV and AIDS, with the

assistance of a panel of experts. 3. Conducting annual sentinel surveys of STI clients, antenatal care (ANC) clients

and tuberculosis (TB) patients. 4. Conducting behavioural surveillance surveys (BSS).

Reports on all of these activities are available. Three rounds of BSS surveys have been conducted between 2006–2010 at various sites targeting more-at-risk populations (MARPs) such as youth, sex workers, economic enclave workers and truck drivers. NDoH works in partnership with NRI in designing and conducting behavioural and bio-behavioural surveys. The BSS component of the surveillance system has been sub-contracted to NRI. NDoH intends to initiate similar arrangements with IMR to support BSS as part of implementing comprehensive second generation surveillance. An integrated bio-behavioural survey among the general population is being planned for 2011.

The Independent Review Group’s (IRG) 2010 report noted that the HIV surveillance system in NDoH has been steadily improving. This is a result of the increase in HIV testing sites and the establishment of a sentinel surveillance system. The IRG also found that the quality of HIV surveillance reporting has improved, with a greater number of sites reporting more complete information.


6

A significant challenge is limited surveillance of MARPs by either NDoH or other institutions which limits comprehensive programming targeting these groups. Other key challenges include the need for surveys to be gender and age sensitive and the importance of disaggregating data to assist with analysis.

9. National and sub-national HIV databases

With technical and financial support from development partners, ICME has established the National HIV and AIDS Database using the Country Response Information System (CRIS). Aligning all HIV and AIDS data from all sources is still in train. Data needs to be more widely available to all partners.

10. Supportive supervision and data auditing

NACS policy is to decentralise many M&E and surveillance functions to the provinces, including the reallocation of resources, delegation of power, infrastructure support and local capacity building. Implementing this policy faces many challenges. There are ongoing issues related to the quality management of data coming from the provinces. Specific data quality assurance and control mentoring programs for staff are required.

The NDoH Surveillance Unit, with the assistance of WHO and the United States Centres for Disease Control’s regional program, is currently piloting quality assurance and data quality improvement tools.

11. HIV evaluation and research

A prioritised National HIV/AIDS Research Agenda (2008–2013) was launched in 2008. In addition, the NACS RCU conducted a thorough and systematic review of 62 studies carried out or published in 2007 and 2008 and synthesised findings in a published report.

A national Research Advisory Committee (RAC) has been established and is functioning to ensure ethical design and implementation of HIV and AIDS research and compatibility of research with the HIV and AIDS Management and Prevention Act, 2003 (HAMP). The RAC comprises members from PNG research and academic institutions, NGOs, community based organisations (CBOs), donor organisations and NDoH, as well as representation of people living with HIV and AIDS (PLHIV).

The Independent Review Group (IRG) also contributes to ongoing M&E of PNG’s national HIV response. This is a group of inter-disciplinary international experts engaged by NACS, with funding support from AusAID and the United Nations (UN). The IRG carries out regular assessments of progress in implementing various aspects of the national response and publishes reports of its findings.

The AusAID-funded Strengthening HIV Social Research Capacity in Papua New Guinea Project is a collaboration between IMR and the National Centre in HIV Social Research at the University of New South Wales. The project is contributing to building the capacity for HIV social research in PNG. It is designed to position social research as a central component of the evidence base for effective, sustainable responses to the HIV epidemic through a cadetship program and the dissemination of findings.


7

An important challenge is the translation of research into the day-to-day practice of service providers. Additionally, operations research is not being conducted by either service providers or researchers.

12. Data dissemination and use

While relatively good-quality data and information is being produced in PNG it is not consistently or systematically being passed on and promoted to program planners and managers. There is a demonstrated need for an agreed plan on how to regularly update policies and programs based on the regular review of available knowledge of the HIV epidemic and response in PNG.

Although there has been a lot of information generated and written about the epidemic in PNG, having program planners and policy makers use this information has been a challenge.


8

The scope and goals of the National Monitoring and Evaluation Framework

This framework has been developed to guide STI, HIV and AIDS monitoring, evaluation and surveillance activities in PNG. The scope of this framework is the national response to STI and HIV epidemics. As such the framework measures the totality of the national response and is not designed to be an M&E framework for any one program.

The goals of the National Monitoring and Evaluation FrameworkThe goals of the framework are to:

1. direct the M&E of the NHS2. guide the development of M&E plans for programs under the NHS3. harmonise the implementation of strategic objectives and major activity areas of

the NHS related to strategic information, surveillance and M&E.

Based on the above-mentioned scope and goal, this framework:• shouldnotbeusedasastep-by-stepguidelinefordevelopingprogram-and

project-level M&E plans• willnotprovideafulllistofindicatorstobeusedinmonitoringandevaluating

different programs and projects, especially at the input and output levels• willnotreplacetheNationalResearchAgenda(NRA).

The scope and goals of the National Monitoring and Evaluation Framework

9

Structures for coordination and management of strategic information

One of the strategic priorities of the NHS is to improve strategic information systems, which includes M&E, surveillance, research and utilisation of evidence. This requires an emphasis on ensuring effective management and coordination of strategic information.

Responsibility at the national level for data collection, management and analysis is split between NACS and NDoH. NACS is responsible for strategic information for all HIV-related activities outside the health sector, whilst NDoH has responsibility in relation to strategic information for health-sector activities and surveillance of the HIV epidemic. Within NACS, the ICME is the responsible entity. At NDoH, there are two responsible units. Firstly there is the Surveillance Unit which is responsible for monitoring of HIV testing, care and treatment services and surveillance activities (including HIV case reporting, sentinel surveillance and survey-based surveillance). Secondly, the Monitoring and Evaluation and Research Unit is responsible for the surveillance system for STIs.

The NACS RCU is the main coordinating and supervisory body for all HIV-related research in PNG. The NACS RAC oversights ethical aspects of research conduct and application of the HAMP Act’s provisions in research practice. The NRI and the PNG IMR are the two main research institutions that design and implement many of the HIV-related surveillance and research studies.

The NOC has overarching responsibility for coordination of all activities related to M&E, surveillance and strategic information. The Committee is chaired by the Director of NACS and has representation from NDoH, NRI, IMR, the National Statistical Office, key government departments, the PNG Alliance of Civil Society Organisations, the Business Alliance Against HIV and AIDS, FBOs, international NGOs and the Development Partner’s Forum. The NOC reports to NAC and NACS.

There are two other national-level, multisectoral technical working groups that provide advice on the development of data collection tools, data collection activities, data management, analysis and reporting. The STWG provides technical advice on strategic information for all health sector and epidemiological surveillance activities. Its secretariat is provided by the NDoH Surveillance Unit. The Monitoring and Evaluation Technical Working Group provides technical advice on strategic information for all HIV-related activities outside the health sector. Its secretariat is provided by the ICME. Both of these technical working groups report to the NOC as well as NAC, NACS and NDoH.

NOC’s key areas of responsibility are to: 1. Coordinate and provide high-level oversight to ensure that the M&E framework

for the NHS is being effectively implemented, consistent with the aim of one national M&E system.


10

2. Promote better collaboration and coordination amongst multi-sectoral agencies in regular data reporting and data use.

3. Ensure the multi-sectoral M&E and surveillance technical working groups have functional secretariats at NACS and NDoH respectively, and report on their progress and obstacles to NOC, NACS and NDoH.

4. Ensure that all stakeholders in the HIV and AIDS response who collect data based on either routine reporting of service delivery activities or other means (including research), comply with reporting deadlines, guidelines, tools and reporting lines and procedures as developed by the two technical working groups.

5. Report to NAC and all stakeholders about the situation of the HIV and AIDS epidemic and the response.

6. Mobilise financial and other resources for the development and operation of the M&E system and monitor the functionality and sustainability of the system.

7. Advocate at all policy-making levels for an evidence-informed approach in decision making and management of the HIV response.

8. Ensure that all stakeholders at national and provincial levels have been informed about reports and analyses relevant to them.

Joint ProMESTs have been established at the sub-national level. These teams consist of the Provincial Health Office (PHO), the Provincial AIDS Council Secretariat (PACS) and key program implementers and service providers within the province. Each team is mandated to collect data from all service providers and to ensure quality and completeness of data. Summarised data reports are sent to the NACS ICME each quarter.

The NOC, the two national technical working groups and the ProMESTs are the key multi-sectoral committees supporting and oversighting HIV and AIDS M&E activities. The functions of these groups, NACS, NDoH and provincial level bodies in relation to data flow activities are shown in Figure 2.


11

Flow of data and reports

HIV and AIDS data and reports related to M&E and strategic information in PNG originate from a wide range of activities including delivering services, conducting nation-wide studies and compiling secondary information. There is a division of labour between NACS and NDoH in managing data and information related to the HIV response. NDoH is the custodian and manager of epidemiological data and data related to providing services in health care facilities and NACS deals with data from all other sources (that is, data from non-health sector services).

Health facility services include HIV counselling and testing (HCT), treatment and care of HIV infection, STI diagnosis, care and treatment, and some prevention activities like prevention of parent-to-child transmission (PPTCT) and post-exposure prophylaxis. On the other hand, non-health sector services include social support and protection for people living with or affected by HIV, prevention interventions through awareness-raising among the general population and key populations at higher risk, and other targeted promotion and education interventions. Some service delivery, like condom provision to the general population and key populations at higher risk, may be provided by both health care facilities and non-health services.

Data flow is affected by the presence of multiple funding agencies and the operations of NGOs and FBOs which are conducting projects in multiple provinces. These organisations need to report their M&E data to provincial and in some cases national authorities as well as their funding agencies and governing NGOs or FBOs.

The national M&E framework will follow the data flow systems summarised in Figure 2.

Data flow for monitoring of services provided by health care facilitiesIn each province, the PHO is the authority receiving data based on national M&E indicators and program specific indicators. Data comes from facilities providing the following services:

1. HCT, including rapid testing, followed by laboratory confirmation or point-of-care (POC) rapid testing and use of another rapid test for confirmation. HCT is provided through voluntary counselling and testing (VCT) in stand-alone sites or other testing facilities or through provider-initiated testing and counselling in ANC clinics, STI or TB or other clinical facilities, as well as screening of all blood donors.

2. Anti-retroviral therapy (ART), including adult and paediatric regimens as well as providing anti-retroviral (ARV) drugs for prevention of mother-to-child transmission (PMTCT) and post-exposure prophylaxis.

3. Diagnosis (syndromic and aetiological) and treatment of STIs .


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4. Case reports of new diagnoses of HIV are sent to the PHO on a monthly basis. Unified data collection forms for each centre are provided by NDoH or the PHO to reflect the data collection needs at provincial, program or national level.

The PHO compiles provincial summaries from service providers and shares these with all stakeholders at provincial level through ProMEST. Summarised reports, based on national indicators for services 1, 2 and 4 above, are sent to the Surveillance Unit at NDoH. Data on service 3 above are sent to the Monitoring and Evaluation and Research Unit (also known as NHIS).

In some circumstances, health services may be required to send a copy of their reports directly to relevant units at NDoH. Where this occurs the Surveillance, M&E and Research Units compile provincial reports and send them to the PHO.

In summary, health service providers send data to the PHO as their first-line M&E reporting authority. In addition, some data is sent to NDoH as the second line or national authority, as a backup in situations when the reporting to PHO is not working properly. The PHO reports summarised information to provincial stakeholders through ProMEST and to NDoH. NDoH sends summary provincial and national reports to the PHO and they have to share them with stakeholders through ProMEST.

Data flow for monitoring non-health sector services In each province, the PACS is the authority receiving data based on national M&E indicators and other program-specific indicators. These data have to be sent to the PACS on a quarterly basis. Unified data collection forms for each service will be provided by the NACS ICME or the PACS to reflect data collection needs at provincial, program and national levels.

The PACS compiles provincial summaries from the service providers and share these with all stakeholders at provincial level through ProMEST. The PACS sends a summarised report, based on national indicators to ICME. ICME sends summary provincial and national reports to the PACS, which share these with stakeholders though ProMEST.

Data flow for research and study resultsAll researchers are required to send a copy of their research reports to the RCU. The RCU shares a copy of these findings with the PACS in the province(s) where the study was conducted or requests the principal investigator to share the findings.

Management of data and information at provincial and national levelsThe PACS and PHO in each province receive monitoring data from service providers throughout the province. All data and information are entered into a single database at provincial level and shared with stakeholders through ProMEST or other mechanisms


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suitable for that province. This database should be the basis for developing summarised reports which are sent to the national level. To standardise the structure of the database and format of the reports the CRIS should be used to develop all provincial databases. This would enhance consistency with the data held at the national level. At national level, a CRIS database is used for all data coming from the provinces, NDoH and the RCU. This National HIV and AIDS Database is the data centre for all HIV-related reports produced through service provision, surveillance and studies. This data centre is used for all national and international reporting, unless other sources of data are needed.


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Figure 2: HIV and AIDS data flow in PNG

National Oversight Committee

National Level

Provincial Level

Service type

Surveillance Unit NDoH

NACS1: NACS Quarterly Reporting Form for Non-Health Agencies NACS2: NACS Quarterly Reporting Form for Non-Health Agencies NHIS1: National Health Information System Monthly Report SURV1: HIV Monthly Testing Summary FormSURV2: HIV/ART Monthly Data Collection Sheet SURV3: STI Clinic Patient Record Form (this form will be kept at health facilities) SURV4: Notification Form for HIV and AIDS CasesSURV4.1: Laboratory Request Form for HIV Confirmatory Test SURV5.1: HIV Sentinel Surveillance Form for ANC/PPTCT Clinic SURV5.2: HIV Sentinel Surveillance Form for STI Clinic SURV5.3: HIV Sentinel Surveillance Form for TB Clinic

Non-Health services data

(GLA, NGOs, CBOs, FBOs, PS, and D/FAs)

DHS, BSS & IBBS other researches

National HIV and AIDS Database

ProMEST

Data Sharing /Coordination

NHIS Unit M & E Unit NACS

Reporting

Feedback

Surveillance Technical Working Group

M&E Technical Working Group

Provincial Lab

Health services data

(VCT, ANC, STI, TB clinics, Hospitals, Clinics, Health Centre,

sentinel sites, Blood Banks)

Academic, Research & Statistic Institutes

(NRI, IMR, NSO)

SURV4.1SURV4.1

SURV4

SURV4 NHIS1 NACS2

NHIS1 NACS1

SURV1 SURV5.1 SURV5.2 SURV5.3

SURV1 SURV5.1 SURV5.2 SURV5.3

SURV2

SURV4

PHO PAC


15

National indicators

The list of national indicators (see Table 1) is limited to 39 core indicators that are essential for high-level monitoring of STI, HIV and AIDS epidemiology and PNG’s national response.

Of the 39 national indicators, most are taken from the United Nations General Assembly Special Session on HIV and AIDS (UNGASS) core indicators. Others are taken from the Universal Access indicators list and the additional recommended UNGASS indicators list (UNGASS+). Detailed information about the definitions of the national indicators is in the next section.

It should be noted that in addition to the suggested disaggregation levels for the national indicators, geographical disaggregation is also needed, usually at the level of province whenever possible.

Questions that should be included in survey questionnaires for measuring some of these indicators are presented in Appendix I – Inventory of questions to be included in surveys measuring national indicators.

In addition to the national indicators other indicators have been developed or chosen from indicators already in use at the national and international level for program monitoring purposes. These additional indicators are presented in Appendix II – Repository of indicators suggested for monitoring and evaluation of programs. These additional indicators can be used, as appropriate, by projects and programs for their own internal M&E. However, there is no requirement to report to PACS, NACS and/or NDoH on performance against these additional indicators.

National indicators

16

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ths

and

who

repo

rt th

e us

e of

a c

ondo

m d

urin

g la

st in

terc

ours

eS

ex

Age

PA1

- 1.1

.2U

NG

AS

S

Spe

cial

pop

ulat

ion

BS

S

Yout

h an

d ge

nera

l po

pula

tion

surv

ey

Eve

ry th

ree

to

five

year

s

Indi

cato

rs fo

r the

top

10 in

terv

entio

ns

1 N

HS

Prio

rity

area

1

Tabl

e 1:

Th

e lis

t of n

atio

nal i

ndic

ator

s

National indicators

17

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Indi

cato

r lin

kage

Dat

a co

llect

ion

met

hod/

sour

ceD

ata

colle

ctio

n fr

eque

ncy

5P

erce

ntag

e of

fem

ale

and

mal

e se

x w

orke

rs re

porti

ng th

e us

e of

a c

ondo

m w

ith th

eir m

ost r

ecen

t clie

ntS

ex

Age

G

ende

rPA

1 - 1

.1.6

UN

GA

SS

Spe

cial

pop

ulat

ion

BS

SE

very

two

to

thre

e ye

ars

6P

erce

ntag

e of

men

and

wom

en w

ho h

ave

parti

cipa

ted

in

trans

actio

nal s

ex in

the

last

12

mon

ths

and

who

repo

rt co

ndom

use

at l

ast t

rans

actio

nal s

exS

ex

Age

PA1

- 1.1

.7–

Spe

cial

pop

ulat

ion

BS

S

Yout

h an

d ge

nera

l po

pula

tion

surv

ey

Eve

ry tw

o to

th

ree

year

s

7P

erce

ntag

e of

men

repo

rting

con

dom

use

the

last

tim

e th

ey

had

anal

sex

with

a m

ale

partn

erA

ge

Gen

der

PA1

- 1.1

.8U

NG

AS

SS

peci

al p

opul

atio

n B

SS

Eve

ry tw

o to

th

ree

year

s

8P

erce

ntag

e of

men

and

wom

en a

ged

15 to

59

who

repo

rt co

ndom

use

dur

ing

last

tim

e of

ana

l sex

Sex

A

ge

Par

tner

sex

PA1

- 1.1

.3–

Yout

h an

d ge

nera

l po

pula

tion

surv

eyE

very

thre

e to

fiv

e ye

ars

9P

erce

ntag

e of

men

and

wom

en a

ged

15 to

59

who

repo

rt co

ndom

use

dur

ing

last

tim

e of

ana

l sex

AR

V re

gim

en ty

pePA

1 - 1

.2.2

UN

GA

SS

Pro

gram

dat

a E

stim

atio

nA

nnua

l

10P

erce

ntag

e of

pre

gnan

t wom

en w

ho w

ere

test

ed fo

r HIV

an

d re

ceiv

ed th

eir r

esul

ts -

durin

g pr

egna

ncy,

dur

ing

labo

ur

and

deliv

ery,

and

dur

ing

the

post

-par

tum

per

iod

(<72

ho

urs)

, inc

ludi

ng th

ose

with

pre

viou

sly

know

n H

IV s

tatu

s

Pre

gnan

cy s

tage

PA1

- 1.2

.3U

nive

rsal

ac

cess

(UA

)P

rogr

am d

ata

Ann

ual

11N

umbe

r of o

pera

tiona

l Fam

ily S

uppo

rt C

entre

s–

PA1

- 2.1

.3

PA3

- 2.1

.7–

Pro

gram

dat

aA

nnua

l

12P

erce

ntag

e of

wom

en a

nd m

en a

ged

15 to

59

who

rece

ived

an

HIV

test

in th

e la

st 1

2 m

onth

s an

d w

ho k

now

the

resu

ltsS

ex

Age

PA22 -

1.1.

1 PA

2 - 1

.1.2

UN

GA

SS

Yout

h an

d ge

nera

l po

pula

tion

surv

eyE

very

thre

e to

fiv

e ye

ars

2 N

HS

Prio

rity

area

2

National indicators

18

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Indi

cato

r lin

kage

Dat

a co

llect

ion

met

hod/

sour

ceD

ata

colle

ctio

n fr

eque

ncy

13P

erce

ntag

e of

mor

e-at

-ris

k po

pula

tions

that

hav

e re

ceiv

ed

an H

IV te

st in

the

last

12

mon

ths

and

know

the

resu

ltsS

ex

Age

G

ende

rPA

2 - 1

.1.3

UN

GA

SS

Spe

cial

pop

ulat

ion

BS

SE

very

two

to

thre

e ye

ars

14P

erce

ntag

e of

TB

clie

nts

who

had

an

HIV

test

resu

lt re

cord

ed in

the

TB re

gist

erS

ex

Age

TB

dia

gnos

isPA

2 - 1

.1.7

UN

GA

SS

+,

UA

Hea

lth m

anag

emen

t in

form

atio

n sy

stem

Ann

ual

15P

erce

ntag

e of

STI

clie

nts

who

had

an

HIV

test

Sex

A

ge

STI

dia

gnos

isPA

2 - 1

.1.7

–he

alth

man

agem

ent

info

rmat

ion

syst

emA

nnua

l

16P

erce

ntag

e of

adu

lts a

nd c

hild

ren

with

adv

ance

d H

IV

infe

ctio

n re

ceiv

ing

antir

etro

vira

l the

rapy

Sex

A

gePA

2 - 2

.1.1

UN

GA

SS

Pro

gram

dat

aE

stim

atio

nA

nnua

l

17P

erce

ntag

e of

est

imat

ed H

IV-p

ositi

ve in

cide

nt T

B c

ases

th

at re

ceiv

ed tr

eatm

ent f

or T

B a

nd H

IVS

ex

Age

PA2

- 2.1

.3U

NG

AS

SP

rogr

am d

ata

Est

imat

ion

Ann

ual

18P

erce

ntag

e of

adu

lts a

nd c

hild

ren

with

HIV

kno

wn

to b

e on

trea

tmen

t at 1

2/24

/36/

48 m

onth

s af

ter i

nitia

tion

of

antir

etro

vira

l the

rapy

Sex

A

gePA

2 - 2

.1.1

0U

NG

AS

S –

U

AA

RT

repo

rting

Ann

ual

19P

erce

ntag

e of

NG

Os,

FB

Os

and

CB

Os

subm

ittin

g th

eir

plan

s an

d re

ports

to th

eir P

AC

S o

r NA

CS

on

time

Age

ncy

type

S

ubm

issi

on ty

pePA

33 - 3

.1.3

–N

HS

man

agem

ent

repo

rtA

nnua

l

20P

erce

ntag

e of

tech

nica

l ass

ista

nce

depl

oyed

to s

uppo

rt th

e N

HS

impl

emen

tatio

n at

sub

-nat

iona

l lev

el c

ompa

red

to th

e to

tal T

AD

urat

ion

of T

APA

3 - 3

.1.4

–N

HS

man

agem

ent

repo

rtA

nnua

l

21P

erce

ntag

e of

pro

vinc

ial g

over

nmen

ts th

at re

port

to th

e P

rovi

ncia

l and

Loc

al L

evel

Ser

vice

Mon

itorin

g A

utho

rity

(PLS

SM

A) o

n th

eir s

peci

fic H

IV re

spon

sibi

litie

s un

der t

he

Det

erm

inat

ion

on S

ervi

ce D

eliv

ery

–PA

3 - 3

.2.3

–N

HS

man

agem

ent

repo

rtA

nnua

l

3 N

HS

Prio

rity

area

3

National indicators

19

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Indi

cato

r lin

kage

Dat

a co

llect

ion

met

hod/

sour

ceD

ata

colle

ctio

n fr

eque

ncy

22P

erce

ntag

e of

wom

en a

nd m

en w

ho a

re H

IV in

fect

ed

Age

Impa

ct o

f the

N

HS

UN

GA

SS

Ant

enat

al c

are

(AN

C)

serv

ices

IBB

S

Ann

ual f

or A

NC

da

ta a

nd e

very

th

ree

to fi

ve

year

for g

ener

al

popu

latio

n in

tegr

ated

bi

o-be

havi

oura

l su

rvey

(IB

BS

)

23P

erce

ntag

e of

mor

e-at

-ris

k po

pula

tions

who

are

HIV

in

fect

edS

ex

Age

Impa

ct o

f the

N

HS

UN

GA

SS

Spe

cial

pop

ulat

ion

IB

BS

Eve

ry tw

o to

th

ree

year

s

24D

omes

tic a

nd in

tern

atio

nal A

IDS

spe

ndin

g by

cat

egor

ies

and

finan

cing

sou

rces

–

Cro

ss-c

uttin

g ac

ross

sev

eral

st

rate

gic

obje

ctiv

es,

spec

ifica

lly:

PA3

- 2.3

.4

PA3

- 3.2

.4

UN

GA

SS

Nat

iona

l AID

S S

pend

ing

Ass

essm

ent

Eve

ry tw

o to

th

ree

year

s

25N

atio

nal C

ompo

site

Pol

icy

Inde

x (N

CP

I) (A

reas

cov

ered

: pr

even

tion,

trea

tmen

t, ca

re a

nd s

uppo

rt, h

uman

righ

ts, c

ivil

soci

ety

invo

lvem

ent,

gend

er, w

orkp

lace

pro

gram

s, s

tigm

a an

d di

scrim

inat

ion

and

M&

E)

–

Cro

ss-c

uttin

g ac

ross

man

y st

rate

gic

obje

ctiv

es,

spec

ifica

lly:

PA3

- 1.1

.1

PA3

- 1.1

.2

PA3

- 1.1

.5

UN

GA

SS

Des

k re

view

N

CP

I int

ervi

ews

Eve

ry tw

o ye

ars

26Th

e de

gree

of s

tigm

a an

d di

scrim

inat

ion

as id

entifi

ed b

y th

e P

eopl

e Li

ving

with

HIV

Stig

ma

Inde

x

–

Cro

ss-c

uttin

g ac

ross

sev

eral

st

rate

gic

obje

ctiv

es,

spec

ifica

lly:

PA1

- 2.4

.2

PA3

- 2.5

.4

–P

eopl

e Li

ving

with

HIV

S

tigm

a In

dex

inte

rvie

wE

very

thre

e ye

ars

Indi

cato

rs fo

r mon

itorin

g th

e re

spon

se e

nviro

nmen

t and

inpu

ts

National indicators

20

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Indi

cato

r lin

kage

Dat

a co

llect

ion

met

hod/

sour

ceD

ata

colle

ctio

n fr

eque

ncy

27P

erce

ntag

e of

hea

lth fa

cilit

ies

with

pos

t-exp

osur

e pr

ophy

laxi

s (P

EP

) ava

ilabl

eTy

pe o

f hea

lth

faci

lity

PA1

- 1.1

.5

PA1

- 1.3

.2U

GA

SS

+ U

AH

ealth

faci

lity

revi

ewE

very

two

to

thre

e ye

ars

28P

erce

ntag

e of

don

ated

blo

od u

nits

scr

eene

d fo

r HIV

in a

qu

ality

ass

ured

man

ner

–PA

1 - 1

.3.3

UN

GA

SS

Blo

od b

ank

revi

ewA

nnua

l

29P

erce

ntag

e of

sch

ools

that

pro

vide

d lif

e-sk

ills

base

d H

IV

educ

atio

n w

ithin

the

mos

t rec

ent a

cade

mic

yea

rLe

vel

PA1

- 2.2

.5

PA1

- 2.3

.4U

NG

AS

SS

choo

l prin

cipa

ls s

urve

yE

very

two

year

s

30P

erce

ntag

e of

mor

e-at

-ris

k po

pula

tions

reac

hed

with

HIV

pr

even

tion

prog

ram

sS

ex

Age

G

ende

r

PA1

- 1.1

.9

PA1

- 2.4

.1

PA1

- 2.4

.4

PA1

- 2.4

.5

UN

GA

SS

Spe

cial

pop

ulat

ion

BS

SE

very

two

to

thre

e ye

ars

31N

umbe

r of d

istri

ct le

vel A

RT

site

sTy

pe o

f hea

lth

faci

lity

Type

of A

RT

serv

ice

PA2

- 2.1

.2–

Pro

gram

repo

rtA

nnua

l

32P

erce

ntag

e of

hea

lth fa

cilit

ies

that

offe

r pae

diat

ric A

RT

(that

is

, pre

scrib

e an

d/or

pro

vide

clin

ical

follo

w-u

p)P

ublic

and

priv

ate

sect

or s

ites

PA2

- 2.2

.1U

AP

rogr

am re

port

Ann

ual

33P

erce

ntag

e of

infa

nts

born

to H

IV in

fect

ed w

omen

who

are

st

arte

d on

cot

rimox

azol

e pr

ophy

laxi

s w

ithin

two

mon

ths

of

birth

Sex

PA2

- 2.2

.2U

NG

AS

S +

U

AP

rogr

am re

port

Ann

ual

34P

erce

ntag

e of

hea

lth fa

cilit

ies

that

pro

vide

STI

scr

eeni

ng

and

synd

rom

ic m

anag

emen

tP

ublic

and

priv

ate

sect

or s

ites

PA2

- 2.3

.1–

Nat

iona

l Hea

lth

Info

rmat

ion

Sur

vey

Ann

ual

35P

erce

ntag

e of

AR

T se

rvic

es th

at a

re li

nked

to H

BC

and

ot

her f

amily

and

com

mun

ity s

uppo

rt se

rvic

esP

ublic

P

rivat

eFB

Os

PA2

- 2.4

.1

Glo

bal F

und

to F

ight

AID

S

Tube

rcul

osis

an

d M

alar

ia

gran

t pro

posa

l

Sur

vey

amon

g A

RT

site

sA

nnua

l

36P

erce

ntag

e of

HIV

cou

nsel

ling

and

test

ing

(HC

T) s

ervi

ces

usin

g th

e 20

09 n

atio

nal p

oint

-of-c

are

algo

rithm

Pub

lic

Priv

ate

FBO

sPA

2 - 1

.1.1

0–

Pro

gram

repo

rtA

nnua

l

Indi

cato

rs fo

r mon

itorin

g th

e na

tiona

l res

pons

e ou

tput

s

National indicators

21

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Indi

cato

r lin

kage

Dat

a co

llect

ion

met

hod/

sour

ceD

ata

colle

ctio

n fr

eque

ncy

37P

erce

ntag

e of

wom

en a

nd m

en w

ho b

oth

corr

ectly

iden

tify

way

s of

pre

vent

ing

the

sexu

al tr

ansm

issi

on o

f HIV

and

who

re

ject

maj

or m

isco

ncep

tions

abo

ut H

IV tr

ansm

issi

onS

ex

Age

PA1

- 1.1

.1

PA1

- 2.2

.1U

NG

AS

S

Yout

h an

d ge

nera

l po

pula

tion

surv

ey

Dem

ogra

phic

and

hea

lth

surv

ey

Eve

ry th

ree

to

five

year

s

38P

erce

ntag

e of

mor

e-at

-ris

k po

pula

tions

who

bot

h co

rrec

tly

iden

tify

way

s of

pre

vent

ing

the

sexu

al tr

ansm

issi

on o

f H

IV a

nd w

ho re

ject

maj

or m

isco

ncep

tions

abo

ut H

IV

trans

mis

sion

Sex

A

ge

Gen

der

PA1

- 1.1

.6

PA1

- 1.1

.8U

NG

AS

SS

peci

al p

opul

atio

n B

SS

Eve

ry tw

o to

th

ree

year

s

39P

erce

ntag

e of

you

ng w

omen

and

men

who

hav

e ha

d se

xual

inte

rcou

rse

befo

re th

e ag

e of

15

Sex

A

gePA

1 - 2

.2.9

UN

GA

SS

Yout

h su

rvey

Dem

ogra

phic

and

hea

lth

surv

eyO

ther

rela

ted

surv

eys

Eve

ry th

ree

to

five

year

s

Indi

cato

rs fo

r mon

itorin

g kn

owle

dge

and

beha

viou

rs

National indicators

22

Definitions for national indicators

Indicator 1: Percentage of women and men aged 15–59 with more than one ongoing sexual partnership at the point in time during the past three months

Concurrent sexual partnerships potentially increase the spread of HIV by creating more connected sexual networks, reducing the time until onward HIV transmission after acquisition, and eliminating the ‘protective sequencing’ provided by serial monogamy. Concurrent sexual partnerships are defined as: Overlapping sexual partnerships where sexual intercourse with one partner occurs between two acts of intercourse with another partner.

Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and addressing it is one of the Top 10 interventions.

To assess progress in reducing the percentage of people who have concurrent sexual partnerships.

Every three to five years.

Youth and general population surveys, Demographic and Health Survey or other household surveys among the general population. Special population surveys among MARPs.

Number of respondents aged 15–59 with more than one ongoing partnership three months before the interview. In the case that one partnership ends and another begins in the third month before the interview, this individual will not be included in the numerator as it cannot be determined whether this is actual concurrency or serial monogamy.

Number of respondents aged 15–59.

Respondents are asked whether or not they have ever had sexual intercourse. If yes, they are asked how long ago they last had sexual intercourse, and how long ago they first had sexual intercourse with that person. If the last intercourse occurred in the past three months, they are asked if they have had intercourse with any other person in the past three months, and if so, they are asked to give the time of last and first sex with that second partner.

This question is repeated for a third partner if one exists. The proportion of individuals who had more than one ongoing partnership at the exact point in time three months before the interview is calculated based on the dates of first and last intercourse with up to the last three partners in the past three months. See Appendix 1 – Inventory of standardised questions to be included in surveys measuring national indicators.

PURPOSE

DATA COLLECTION FREQUENCY

MEASUREMENT TOOL

Numerator

Denominator

Sex (male, female). Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59).Disaggregation

METHOD OF MEASUREMENT


23

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

To assess progress in reducing the percentage of people who have concurrent sexual partnerships.


Youth and general population surveys, Demographic and Health Survey or other household surveys among the general population. Special population survey among MARPs.

Number of respondents aged 15–59 with more than one ongoing partnership 12 months before the interview. In the case that one partnership ends and another begins in the 12th month before the interview, this individual will not be included in the numerator as it cannot be determined whether this is actual concurrency or serial monogamy.


Respondents are asked whether or not they have ever had sexual intercourse. If yes, they are asked how long ago they last had sexual intercourse, and how long ago they first had sexual intercourse with that person. If the last intercourse occurred in the past year, they are asked if they have had intercourse with any other person in the past 12 months, and if so, they are asked to give the time of last and first sex with that second partner.

This question is repeated for a third partner if one exists. The proportion of individuals who had more than one ongoing partnership at the exact point in time three months before the interview is calculated based on the dates of first and last intercourse with up to the last three partners in the past year.

See Appendix 1 – Inventory of standardised questions to be included in surveys measuring national indicators.



Indicator 2: Percentage of women and men aged 15–59 with more than one ongoing sexual partnership at the point in time during the past 12 months

Concurrent sexual partnerships potentially increase the spread of HIV by creating more connected sexual networks, reducing the time until onward HIV transmission after acquisition, and eliminating the ‘protective sequencing’ provided by serial monogamy. Concurrent sexual partnerships are defined as: Overlapping sexual partnerships where sexual intercourse with one partner occurs between two acts of intercourse with another partner.

Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and addressing it is one of the Top 10 interventions.


24

To assess progress in reducing the percentage of people who have multiple sexual partners.



Number of respondents aged 15–59 who have had sexual intercourse with more than one partner in the last 12 months.


Respondents are asked whether or not they have ever had sexual intercourse and, if yes, they are asked: In the last 12 months, how many people have you had sexual intercourse with?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator



Indicator 3: Percentage of women and men aged 15–59 who have had sexual intercourse with more than one partner in the last 12 months

The spread of HIV largely depends upon unprotected sex among people with a high number of partners. Individuals who have multiple partners (concurrently or sequentially) have a higher risk of HIV transmission than individuals who do not link into a wider sexual network.

Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and addressing it is one of the Top 10 interventions. While this indicator cannot discriminate between concurrent and serial multiple sexual partnerships, it can measure the overall prevalence of multiple sexual partnerships.


25

To assess progress towards increasing the percentage of people with multiple sexual partners who used a condom during last intercourse.



Number of respondents (aged 15–59) who reported having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex.

Number of respondents (15–59) who reported having had more than one sexual partner in the last 12 months.

Respondents are asked whether or not they have ever had sexual intercourse and, if yes, they are asked: 1. In the last 12 months, how many different people have you had sexual intercourse with?

If more than one, the respondent is asked: 2. Did you or your partner use a condom the last time you had sexual intercourse?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator



Indicator 4: Percentage of men and women aged 15–59 who had more than one sexual partner in the past 12 months who report the use of a condom during last intercourse

The spread of HIV largely depends upon unprotected sex among people with a high number of partners. Individuals who have multiple partners (concurrently or sequentially) have a higher risk of HIV transmission than individuals who do not link into a wider sexual network.

Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and is one of the Top 10 interventions. Condom use is an important measure of protection against HIV, especially among people with multiple sexual partners.


26

To assess progress in increasing the percentage of sex workers who used a condom with their most recent client.

Every two to three years.

Special surveys for the numerator and denominator, including the FHI BSS for sex workers.

Number of respondents who reported that a condom was used with their last client.

Number of respondents who reported having commercial sex in the last 12 months.

Respondents are asked the following question: Did you use a condom with your most recent client?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Sex (male, female). Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59). Gender (man, woman, male-to-female transgender, female-to-male transgender).

Disaggregation


Indicator 5: Percentage of female and male sex workers reporting the use of a condom with their most recent client

Various factors increase the risk of exposure to HIV among sex workers, including multiple, non-regular partners and more frequent sexual intercourse. However, sex workers can substantially reduce the risk of HIV transmission, both from clients and to clients, through consistent and correct condom use.

Countries with generalised epidemics may also have a concentrated sub-epidemic among sex workers, making it valuable to report on this indicator.


27

To assess progress in increasing the percentage of people who engage in transactional sex who used a condom at last transactional sex.


Special surveys for the numerator and denominator, including the FHI BSS for sex workers or adaptations based on the NHS definition of transactional sex.

Number of respondents who reported that a condom was used with their last transactional sex partner.

Number of respondents who reported having transactional sex in the last 12 months.

Respondents are asked the following questions:

1. Have you had sexual intercourse in the last 12 months with anybody beside your spouse in exchange for money, gifts, food, shelter or any other services? (If yes continue)

2. For the last time you had sexual intercourse in exchange for money, gifts, food, shelter or any other services, did you or your partner use a condom?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator



Indicator 6: Percentage of men and women who have participated in transactional sex in the last 12 months, reporting condom use at last transactional sex

Various factors increase the risk of exposure to HIV among people who engage in transactional sex. Transactional sex is defined as providing sexual services in exchange for money, goods, services or other favours. This can be a frequent practice or on an occasional basis in response to a particular need. However, those who engage in transactional sex can substantially reduce the risk of HIV transmission through consistent and correct condom use.

Countries with generalised epidemics may also have a concentrated sub-epidemic among those engaged in transactional sex, making it valuable to report on this indicator.


28

To assess progress in increasing the percentage of men reporting condoms use the last time they had anal sex with a male partner.


Special surveys including the FHI BSS for men who have sex with men.

Number of male respondents who reported that a condom was used the last time they had anal sex with a male partner.

Number of respondents who reported having had anal sex with a male partner in the last six months.

In a behavioural survey of a sample of men who have sex with men, respondents are asked about sexual partnerships in the preceding six months, about anal sex within those partnerships and about condom use when they last had anal sex.


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59). Gender (man, male-to-female transgender, female-to-male transgender).Disaggregation


Indicator 7: Percentage of men reporting condom use the last time they had anal sex with a male partner

Condoms can substantially reduce the risk of the sexual transmission of HIV. Consequently, consistent and correct condom use is important for men who have sex with men because of the high risk of HIV transmission during unprotected anal sex. In addition, men who have anal sex with other men may also have female partners, who could also become infected. Condom use with their most recent male partner is considered a reliable indicator of longer-term behaviour.

Countries with generalised epidemics may also have a concentrated sub-epidemic among men who have sex with men, making it valuable to report on this indicator.


29

To assess progress in increasing the percentage of men and women reporting condoms use the last time they had anal sex.



Number of respondents who reported that a condom was used the last time they had anal sex.

Number of respondents who reported having had anal sex with a partner in the last 12 months.

Respondents are asked:

• In the last 12 months, have you ever had anal intercourse with another person (man or woman)?

If yes, the respondent is asked:

• Did you or your partner use a condom the last time you had anal intercourse?• What was your partner’s sex?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Sex (male, female). Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59). Sex of partner (male, female).

Disaggregation


Indicator 8: Percentage of men and women aged 15–59 who reported condom use during last time of anal sex

Anal sex is not only restricted to men who have sex with men; it is also practiced among heterosexual partners and it carries the same risk of HIV transmission. Condoms can substantially reduce the risk of the sexual transmission of HIV. Consequently, consistent and correct condom use is important for those having anal sex because of the relatively higher risk of HIV transmission during unprotected anal sex. Condom use with their most recent anal sex partner is considered a reliable indicator of longer-term behaviour.


30

Indicator 9: Percentage of HIV-positive pregnant women who receive ARV medicines to reduce the risk of mother-to-child transmission

In the absence of any preventative intervention, infants born to and breastfed by HIV-infected women have roughly a one-in-three chance of acquiring infection. This can happen during pregnancy, during labour and delivery or after delivery through breastfeeding. The risk of mother-to-child transmission can be significantly reduced through the complementary approaches of ARV regimens for the mother with or without prophylaxis to the infant, implementation of safe delivery practices and use of safer infant feeding practices.

To assess progress in increasing the percentage of HIV-positive pregnant women who receive ART to reduce mother-to-child HIV transmission.

Data should be collected continuously at the facility level and should be aggregated at least annually.

For the numerator: program monitoring tools, such as patient registers and summary reporting forms.

For the denominator: antenatal clinic surveillance surveys in combination with demographic data, or estimation models such as Spectrum.

Number of HIV-infected pregnant women who received ARV medicines to reduce the risk of mother-to-child transmission in the last 12 months.

Estimated number of HIV-infected pregnant women in the last 12 months.

Program monitoring and HIV surveillance.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

ARV regimen type:

• single-dose Nevirapine only• prophylactic regimens using a combination of two ARV drugs• prophylactic regimens using a combination of three ARV drugs

ARV for HIV-infected pregnant women eligible for treatment.

Disaggregation



31

Indicator 10: Percentage of pregnant women who were tested for HIV and received their results—during pregnancy, during labour and delivery, and during the post-partum period (<72 hours), including those with previously known HIV status

Identification of a pregnant woman’s HIV serological status provides an entry point for other services for the PPTCT of HIV and to tailor prevention, care and treatment to her needs.

This indicator measures the percentage of pregnant women who were tested for HIV and received their results.


The numerator is calculated from national program records aggregated from facility registers for ANC, labour and delivery and postpartum care. Health facility registers should record known HIV infection in pregnant women coming to ANC clinics for a new pregnancy, so that they receive services for PMTCT of HIV. All public, private and NGO health care facilities that are providing testing and counselling for pregnant women should be included.

The denominator is derived from a population estimate of the number of pregnant women giving birth in the past 12 months. This can be obtained from estimates of births from the central statistics office or from the UNPD or pregnancy registration systems with complete data.

Number of pregnant women of known HIV status.

This is compiled from: 1. the number of women of unknown HIV serological status attending ANC, labour and

delivery and postpartum services, who have been tested for HIV and know their results and

2. women with known HIV infection attending ANC for a new pregnancy in the past 12 months.

The numerator is the sum of the four categories below:a) pregnant women who have an HIV test and receive the result during ANCb) pregnant women of unknown HIV serological status attending labour and delivery who

were tested and received resultsc) women of unknown HIV serological status attending postpartum services within 72

hours of delivery who were tested and received resultsd) pregnant women with known HIV infection attending ANC for a new pregnancy.

Pregnant (and postpartum) women of unknown serological status: women who were not tested during ANC or at labour and delivery for this pregnancy or who do not have documented proof of having been tested during this pregnancy.

Pregnant women with known HIV infection: women who were tested and confirmed to be HIV-positive at any time before the current pregnancy, who are attending ANC for a new pregnancy. These women do not need to be retested if there is documented proof of their positive status, in line with national guidelines on testing pregnant women. These women do, however, need services for the PMTCT of HIV and are counted in the numerator.

Estimated number of HIV-infected pregnant women who gave birth in the past 12 months. This is a proxy measure of the number of infants born to HIV-infected women.

Program monitoring.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Pregnancy stage (ANC, labour and delivery, post partum).Disaggregation



32

To assess the construction, quality and utilisation of Family Support Centres (FSCs) in hospitals in all provinces and their progress in providing quality, coordinated services for survivors of family and sexual violence.

Data should be collected continuously at the facility level and should be aggregated quarterly. The third quarter data will be used for measuring the indicator annually.

Program monitoring tools such as client registers and summary reporting forms.

Number of FSCs which have referred at least three clients per month in the past quarter.

Not applicable.

Number of FSCs that refer clients to their partner organisations, which include Department of Justice and Attorney General, Family and Sexual Violence Action Committees and health services.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Not applicable.Disaggregation


Indicator 11: Number of operational Family Support Centres

Violence against women, including gender-based violence, is among the important vulnerability factors putting many women at higher risk of HIV infection. It also hampers access by women to prevention, treatment and care services. Increasing the availability of services for survivors of violence can help them decrease their vulnerability to HIV as well as decrease the risk of repetition of violence.


33

This indicator measures the percentage of people who had an HIV test in the previous 12 months and received their result.


Population-based surveys (Demographic Health Survey, AIDS Indicator Survey, Multiple Indicator Cluster Survey or other representative survey).

Number of respondents aged 15–59 who have been tested for HIV during the last 12 months and who know their result.

Number of all respondents aged 15–59.


1. I don’t want to know the results, but have you been tested for HIV in the last 12 months?

2. If yes: I don’t want to know the results, but did you get the result of that test?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator



Indicator 12: Percentage of women and men aged 15–59 who received an HIV test in the last 12 months and who know the result

In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. Knowledge of one’s HIV status enables regular monitoring of immune status and seeking treatment at the clinically appropriate time.


34

This indicator measures the percentage of MARPs who had an HIV test in the previous 12 months and received their result.


Behavioural surveillance or other special surveys.

Number of MARPs aged 15–59 who have been tested for HIV during the last 12 months and who know their result.

Number of all MARPs aged 15–59.


1. I don’t want to know the results, but have you been tested for HIV in the last 12 months?

2. If yes: I don’t want to know the results, but did you get the result of that test?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator


Disaggregation


Indicator 13: Percentage of MARPs that have received an HIV test in the last 12 months and know the result

In order to protect themselves and to prevent infecting others, it is important for MARPs to know their HIV status. Knowledge of one’s HIV status enables regular monitoring of immune status and seeking treatment at the clinically appropriate time.

The NHS defines MARPs as groups of people that have a common HIV risk behaviour and often some other defining characteristic, such as selling sex, and that have an existing rate of HIV infection. In PNG, MARPs include: women and men involved in sex work and transactional sex, men who have sex with men, migrant workers, enclave workers, prisoners, and mobile men with money (such as public servants, police, politicians, landowners, cash crop buyers and sellers, transport sector workers and business men). The populations who are more-at-risk vary over time as the dynamics of an epidemic change. In other countries the term ‘most’ at risk populations is generally used. There is currently insufficient epidemiological data in PNG to determine which populations are ‘most’ at risk so the term ‘more’ at risk has been used.

This indicator should be calculated separately for each population group considered more-at risk, like sex workers, injecting drug users and men who have sex with men.

Countries with generalised epidemics may also have a concentrated sub-epidemic(s) among one or more MARPs, making it valuable to report on this indicator.


35

This indicator measures the coverage of HIV testing among TB clinic clients.


Program monitoring tools, such as client registers and summary reporting forms.

Number of TB clinic clients registered during a given time period who had an HIV test result recorded in the TB register.

Total number of TB clinic clients registered during the same time period.

Data for this indicator can be collected using national program records aggregated from facility registers; either the TB register or a separate HIV counselling and testing register. Where available, data should come from the national TB control program surveillance system and should include data from TB services delivered in public and private health care facilities and prisons, as well as from TB services delivered by FBOs and NGOs.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Sex (male, female). Age (0–4, 5–14, 15 and above). TB status (positive, negative).

Disaggregation


Indicator 14: Percentage of TB clients who had an HIV test result recorded in the TB register

TB is the leading cause of morbidity and mortality among people living with HIV in many countries. In addition, high rates of HIV co-infection are found among TB patients in settings with high HIV prevalence. In these settings, ensuring that TB patients receive HIV counselling and testing services should be a high priority. Knowledge of HIV status enables HIV-positive TB patients to access the most appropriate HIV prevention, treatment, care and support services. Trends over time will demonstrate progress towards national and international targets.


36

This indicator measures the coverage of HIV testing among STI clinic clients.


Program monitoring tools, such as client registers and summary reporting forms.

Number of STI clinic clients registered during a given time period who had an HIV test result recorded in the STI register.

Total number of STI clinic clients registered during the same time period.

Data for this indicator can be collected using national program records aggregated from facility registers; either the STI register or a separate HIV counselling and testing register. Where available, data should come from the national STI control program surveillance system and should include data from STI services delivered in public and private health care facilities and prisons, as well as from STI services delivered by FBOs and NGOs.


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Sex (male, female) Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59) STI status (positive, negative)

Disaggregation


Indicator 15: Percentage of STI clients who had an HIV test

STIs are a factor in facilitating HIV transmission; moreover, people having any type of STI are at a higher risk of having HIV because of the same behaviours that put them at the risk of acquiring the other STI. HCT of clients at STI clinics is a strategic targeting of people at higher risk of being infected with HIV.


37

This indicator measures the percentage of people with advanced HIV infection receiving ART.


For the numerator: facility-based ART registers or drug supply management systems.

For the denominator: HIV prevalence estimation models such as Spectrum.

Number of adults and children with advanced HIV infection who are currently receiving ART combination therapy in accordance with the nationally approved treatment protocol at the end of the reporting period.

Estimated number of adults and children with advanced HIV infection.

Program monitoring and HIV surveillance.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Sex (male, female). Age (0–14, 15 and above).Disaggregation


Indicator 16: Percentage of adults and children with advanced HIV infection receiving ART

As the HIV epidemic matures, increasing numbers of people are reaching advanced stages of HIV infection. ART has been shown to reduce mortality amongst those infected. ARV combination therapy should always be provided in conjunction with broader care and support services including counselling for family caregivers.


38

This indicator measures the percentage of HIV-positive incident TB cases that received treatment for TB and HIV.


Facility ART registers and reports; program monitoring tools.

Number of adults with advanced HIV infection who received ARV combination therapy in accordance with the nationally approved treatment protocol (or WHO-UNAIDS standards) and who were started on TB treatment (in accordance with national TB program guidelines), within the reporting year.

Estimated number of incident TB cases in people living with HIV.

Program data and estimates of incident TB cases in people living with HIV.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator



Indicator 17: Percentage of estimated HIV-positive incident TB cases that received treatment for TB and HIV

TB is a leading cause of morbidity and mortality in people living with HIV, including those on ART. Intensified TB case-finding and access to quality TB treatment is essential for improving the quality and quantity of life for people living with HIV. A measure of the percentage of HIV-positive TB cases that access appropriate treatment for their TB and HIV is important.


39

To assess progress in increasing retention of PLHIV on ART and survival.

As PLHIV start ART, monthly cohort data should be collected continuously. Data for monthly cohorts that have completed at least 12/24/36/48 months of treatment should then be aggregated, at least annually.

Program monitoring tools; cohort and group analysis forms.

Number of adults and children who are alive and still on ART at 12/24/36/48 months after initiating treatment.

The numerator requires that adult and child patients must be alive and on ART at 12/24/36/48 months after their initiation of treatment. For a comprehensive understanding of retention and survival, the following data must be collected:

1. Number of adults and children in the ART start-up groups initiating therapy at least 12/24/36/48 months prior to the end of the reporting period.

2. Number of adults and children who are alive and still on ART at 12/24/36/48 months after initiating treatment.

(refer to: http://www.unaids.org/en/HIV_data/Methodology/default.asp

The numerator does not require patients to have been on ART continuously for the 12/24/36/48-month period. Patients who may have missed one or two appointments or drug pick ups, and temporarily stopped treatment during the 12/24/36/48 months since initiating treatment but are recorded as still being on treatment at month 12/24/36/48 are included in the numerator. However, those patients who have died, stopped treatment or been lost to follow up at 12/24/36/48 months since starting treatment are not included in the numerator.

For example, for a patient who started ART in May 2011: if at any point during the period May 2011 to May 2012 the patient dies, is lost to follow-up (and does not return), or stops treatment (and does not restart), then at month 12 (May 2012), the patient is not on ART, and not included in the numerator.

Conversely, a patient who started ART in May 2011 and who missed an appointment in June 2011, but is recorded as being on ART in May 2012 (at month 12) is on ART and will be included in the numerator. What is important is that the patient who started ART in May 2011 is recorded as alive and on therapy after 12 months, regardless of what happens from May 2011 to May 2012.

ART registers and ART cohort analysis report form.

PURPOSE


MEASUREMENT TOOL

Numerator


Indicator 18: Percentage of adults and children with HIV known to be on treatment at 12/24/36/48 months after initiation of ART

One of the goals of any ART program is to increase survival among PLHIV. As provision of ART is scaled-up, it is important to understand why and how many people drop out of treatment programs. These data can be used to demonstrate the effectiveness of programs and highlight obstacles to expanding and improving them.


40

Total number of adults and children who initiated ART who were expected to achieve 12/24/36/48-month outcomes within the reporting period, including those who have died since starting therapy, those who have stopped therapy, and those recorded as lost to follow up at month 12/24/36/48.

The denominator is the total number of adults and children in the ART start-up groups who initiated therapy at any point during the 12/24/36/48 months prior to the beginning of the reporting period, regardless of their 12/24/36/48-month outcome. For example, for the reporting period 1 January to 31 December 2011, this will include all patients who started ART during the 12-month period from 1 January to 31 December 2010. This includes all patients, both those on ART as well as those who are dead, who have stopped treatment or are lost to follow up at month 12.

At the facility level, the number of adults and children on ART at 12/24/36/48 months includes patients who have transferred in at any point from initiation of treatment to the end of the 12-month period and excludes patients who have transferred out during this same period to reflect the net current cohort at each facility. In other words, at the facility level, patients who have transferred out will not be counted either in the numerator or the denominator. Similarly, patients who have transferred in will be counted in both the numerator and denominator.

At the national level, the number of transferred-in patients should match the number of transferred-out patients. Therefore, the net current cohort (the patients whose outcomes the facility is currently responsible for recording – the number of patients in the start-up group plus any transfers in, minus any transfers out) at 12/24/36/48 months should equal the number in the start-up cohort group 12/24/36/48 months prior.

Denominator



41

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

To assess progress in increasing the number of NGOs, FBOs and CBOs that submit their HIV plans and reports to NACS and PACS on time.

Quarterly and annually. The third quarter data will be used for national reporting.

NACS and PACS records or files of NGOs, FBOs and CBOs submitted HIV plans, activity progress reports and program indicator reports. There will be a numerator and denominator for submissions (plans and reports) to NACS and another set for PACS.

1. Number of NGOs, FBOs and CBOs that submit their HIV plans for grants of less than the financial cap to the PACS of the province they operate in, on time.

2. Number of NGOs, FBOs and CBOs that submit their reports for their HIV grants of less than the financial cap to the PACS of the province they operate in, on time.

3. Number of NGOs, FBOs and CBOs that submit their HIV plans for grants of over the financial cap to the NACS, on time.

4. Number of NGOs, FBOs and CBOs that submit their reports for their HIV grants of over the financial cap to the NACS, on time.

Total number of NGOs, FBOs and CBOs involved in the HIV response in each province.

NACS and PACS records, files and registers of the number of NGOs, FBOs and CBOs that submit their annual plans, activity progress reports and program indicator reports on time.

Agency type (FBO/NGO). Submission type (plan/report).Disaggregation


Indicator 19: Percentage of NGOs, FBOs and CBOs submitting their plans and reports to their PACS or NACS on time

Under the NHS, coordination will be strengthened to ensure all agencies align their plans with NACS and PACS and report on a specified periodic basis.

NGOs, FBOs and CBOs will continue to submit reports to their respective funding agencies and headquarters, in addition to this required reporting to PACS. Submitting plans and reports to PACS ensure one national reporting system for HIV and AIDS, which is consistent with the third principle of the three-ones principles.

The current practice is that CBOs submit their plans for grants of up to K300,000 to PACS, and plans for grants of more than K300,000 to NACS.

NACS and all PACS M&E focal points will develop and keep up-to-date a database of all NGOs, FBOs and CBOs.


42

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

To assess the progress in deploying more TA to the sub-national level

Annually – data should be collected continuously and should be aggregated annually.

Donors, development partners and NACS respective records, registers and reports.

The total monetary cost of TA deployed to the sub-national level to support the NHS implementation.

The total monetary cost of TA provided in the country.

PACS and NACS will require development partners that fund TA to provide an annual update on the placement of TAs (as per the disaggregation categories below).

Duration of TA (less than four weeks; four to 12 weeks; more than 12 weeks).Disaggregation


Indicator 20: Percentage of technical assistance (TA) deployed to support the NHS implementation at sub-national level compared to the total TA

Since the first case of AIDS in PNG was identified in 1987, TA has steadily increased. It has increasingly become evident that a large proportion of TA is provided at the national level, with insufficient TA at the sub-national level.

One of the strategies of the NHS is to ensure a significant increase in the TA provided at the sub-national level. NACS will keep an up-to-date database of TA provided for the HIV and AIDS response so as to be in a position to measure the proportion of TA provided at national and sub-national levels.


43

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

To assess the extent to which provinces are implementing their HIV service responsibilities under the PLLSMA Determination on Service Delivery.

Annually.

Provincial Coordinating and Monitoring Committee reports submitted to PLLSMA by provincial governments.

Number of provincial governments that report to PLLSMA on their specific HIV responsibilities under the Determination on Service Delivery.

Total number of provinces.

Provincial government data on which agencies are providing which HIV and AIDS services and levels of funding.



Indicator 21: Percentage of provincial governments that report to PLLSMA on their specific HIV responsibilities under the Determination on Service Delivery

The Department of Provincial and Local Government Affairs (DPLGA) has, by way of an National Executive Committee Determination, delineated and assigned the service delivery functions and responsibilities for provincial and local-level governments. The Determination identifies what services each level of government is accountable for and who is responsible for funding. The HIV services to be provided by different sectors – such as health, education and community development – is also delineated. The Determination also includes development of policies and plans such as district HIV and AIDS plans.

National-level coordination and monitoring of the implementation of national policies and programs is overseen by the PLLSMA, which was established under the DPLGA. Each province has established a Provincial Coordinating and Monitoring Committee which brings together the provincial government, businesses and civil society groups to monitor progress in implementing programs and improving services. The PACS and sectors responsible for providing HIV and AIDS services under the Determination report to these Committees in regards to their provincial-level response to HIV and AIDS.


44

To assess progress in reducing HIV infection.

Annual.

WHO guidelines for HIV sentinel surveillance or PPTCT program data.

Number of antenatal clinic attendees tested whose HIV test results are positive.

Number of antenatal clinic attendees tested for HIV.

This indicator is calculated using data gathered from pregnant women attending antenatal clinics in HIV sentinel surveillance sites in the capital city, other urban areas and rural areas.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49).Disaggregation


Indicator 22: Percentage of women and men who are HIV infected

A key goal of the NHS is to reduce transmission of HIV.


45

To assess progress on reducing HIV prevalence among MARPs.


Repeated biological or integrated bio-behavioural surveys among MARPs.

Number of members of the MARP who test positive for HIV.

Number of members of the MARP tested for HIV.

This indicator is calculated using data from HIV tests conducted among members of MARP groups in the primary sentinel site or sites.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Sex (male, female). Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49).Disaggregation


Indicator 23: Percentage of MARPs who are HIV infected

MARPs typically have the highest HIV prevalence in countries with either concentrated or generalised epidemics. In many cases, prevalence among these populations can be more than double the prevalence among the general population. Reducing prevalence among MARPs is a critical measure of a national-level response to HIV.

The NHS defines MARPs as groups of people that have a common HIV risk behaviour and often some other defining characteristic, such as selling sex, and that have an existing rate of HIV infection. In PNG, MARPs include: women and men involved in sex work and transactional sex, men who have sex with men, migrant workers, enclave workers, prisoners and mobile men with money (such as public servants, police, politicians, landowners, cash crop buyers and sellers, transport sector workers and business men). The populations more-at-risk vary over time as the dynamics of an epidemic change. In other countries the term ‘most’ at risk populations is generally used. There is currently insufficient epidemiological data in PNG to determine which populations are ‘most’ at risk so the term ‘more’ at risk has been used.

This indicator should be calculated separately for each population that is considered more-at-risk.

Countries with generalised epidemics may also have a concentrated sub-epidemic among one or more MARP, making this an important indicator. If so, it would be valuable for them to calculate and report on this indicator for those populations.


46

To collect accurate and consistent data on how funds are spent and where those funds are sourced.


Primary tool/method: National AIDS Spending Assessment

Alternative tools/methods:

1. National Health Accounts – AIDS sub-accounts: There should not be any difference in the AIDS health spending measured by NASA or by the National Health Accounts sub-accounts. However, activities performed outside the health system might not be included in National Health Accounts.

2. Resource Flows Survey: Some activities performed outside the health system might not be included in this Resource Flows Survey. In addition, some population-related actions should be excluded from the total for AIDS.

The outputs from any of these measurement tools are to be used to complete the National Funding Matrix.

Actual expenditures classified by eight AIDS spending categories and by financing source, including public expenditure from its own sources (that is, government revenues such as taxes) and from international sources:

1. Prevention2. Care and treatment3. Orphans and vulnerable children4. Program management and administration strengthening5. Incentives for human resources6. Social protection and social services (excluding orphans and vulnerable children)7. Enabling environment and community development8. Research (excluding operations research included under program management).Three main groups of financing sources:1. Domestic public2. Domestic private3. International

PURPOSE


MEASUREMENT TOOL


Indicator 24: Domestic and international AIDS spending by categories and financing sources

As the national response to HIV and AIDS continues to scale up, it is increasingly important to accurately track in detail how funds are spent and where the funds originate. The data are used to measure PNG’s commitment and action, which is an important component of the country’s obligations under the UNGASS Declaration of Commitment on HIV/AIDS. In addition, the data help national-level decision makers monitor the scope and effectiveness of programs. This piece of strategic information also supports the coordination role of NACS and provides the basis for resource allocation and improved strategic planning processes. When aggregated across multiple countries, the data also help the international community evaluate the status of the global response.

Not applicable.Numerator

Not applicable.Denominator



47

PURPOSE


MEASUREMENT TOOL

To assess progress in the development and implementation of national-level HIV and AIDS policies, strategies and laws.

Every two years.

National Composite Policy Index questionnaire.

The National Composite Policy Index questionnaire is divided in two parts which cover the following areas:

Part A – to be administered to government officials:

1. Strategic plan2. Political support3. Prevention4. Treatment, care and support5. M&E.

Part B – to be administered to representatives from civil society organisations, bilateral agencies, and UN organisations:

1. Human rights2. Civil society involvement3. Prevention4. Treatment, care and support.

Some questions are asked in both Part A and Part B to ensure that the views of both the national government and non-government respondents, whether in agreement or not, are obtained.

Each section should be completed by (a) conducting a desk review of relevant documents and (b) interviewing key people most knowledgeable about the topic.

It is important to fully complete the National Composite Policy Index by checking the relevant standardised responses and providing further information in the open text boxes, where requested. This will facilitate a better understanding of the current situation, provide examples of good practice for others to learn from, and pinpoint some issues for further improvement.


Indicator 25: National Composite Policy Index (areas covered: prevention, treatment, care and support, human rights, civil society involvement, gender, workplace programs, stigma and discrimination and M&E)

An effective national response to the HIV epidemic is only achievable in a supportive and conducive environment. Such an environment includes different elements ranging from over-arching issues like human rights and stakeholder participation in the national response at all levels, to more specific programming issues. Monitoring the evolving policy environment helps the stakeholders at the national level to identify the weaknesses and strengths of the supportive environment and to take remedial action as needed.


48

Numerator Not applicable.

Denominator Not applicable.


National Composite Policy Index responses reflect the overall policy, strategy, legal and program implementation environment of the HIV response. The open text boxes provide an opportunity to comment on issues that are perceived as important but that are insufficiently captured in the questions (for example, important sub-national variations; the level of implementation of strategies, policies, laws or regulations; explanatory notes; comments on data sources). In general, draft strategies, policies, or laws are not considered to be ‘in existence’ so questions about whether such a document exists should be answered with a ‘no’. It is, however, useful to state that such documents are in draft form in the relevant open text box.


49

To measure the extent and forms of stigma and discrimination faced by people living with HIV.

Every three years.

People Living with HIV Stigma Index.

Not applicable.

Not applicable.

As detailed in the Stigma Index guidelines.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator



Indicator 26: The degree of stigma and discrimination as identified by the People Living with HIV Stigma Index

People living with HIV often face stigma and discrimination. Many do not know what their rights are and how they can help to change things for the better. There are a number of organisations that are campaigning against stigma and discrimination and fighting for improved rights for people living with HIV. This index aims to collect information on stigma, discrimination and the rights of people living with HIV that will help in these advocacy efforts.


50

This indicator measures the availability of PEP in health care facilities.

Annual for program records; every 2 to 3 years for facility survey/census.

For health-facility surveys or censuses, tools such as the Service Provision Assessment (SPA) or the Service Availability Mapping (SAM) can be used.

Number of health care facilities with PEP available for those who are at risk of HIV infection through occupational and/or non-occupational exposure to HIV.

Total number of health care facilities.

Percentage of health care facilities with PEP services available for those at risk of HIV infection through occupational and/or non-occupational exposure to HIV. Health care facilities include public and private facilities, health centres and clinics (including TB centres), as well as health care facilities that are run by FBOs or NGOs.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Type of health facility (government, FBO, NGO, private).Disaggregation


Indicator 27: Percentage of health care facilities with post-exposure prophylaxis available

Post-exposure prophylaxis (PEP) reduces the probability of HIV infection after exposure to potentially HIV-infected blood or body fluids. For maximum effectiveness, PEP should be provided as soon as possible after exposure and no later than 72 hours following exposure. PEP may be provided following occupational exposure (for example, in healthcare facilities) or non-occupational exposure (such as after sexual assault).

Within the health sector, PEP should be provided as part of a comprehensive standard precautions package that reduces staff and patient exposure to infectious hazards. PEP for non-occupational exposure should be considered for sexual assault survivors, particularly in high HIV-prevalence settings.


51

To measure the percentage of donated blood units screened for HIV in a quality-assured manner.

Annual.

FRAME Tool (Framework for Assessment, M&E of blood transfusion services): a rapid assessment tool used by the WHO Global Database on Blood Safety.

The information relates to data from the previous 12 months (January to December). It should be available from the National Blood Transfusion Service or the officers responsible for the National Blood Program in NDoH.

The following information is required to measure this indicator:

• The total number of blood units that were donated in the country.• For each blood centre and blood screening laboratory that screens donated blood

for HIV:1. The number of units of blood donated in each blood centre/blood screening

laboratory2. The number of donated units screened in the blood centre/blood screening

laboratory3. If the blood centre/blood screening laboratory followed documented standard

operating procedures for HIV screening4. If the blood centre/blood screening laboratory participated in an External Quality

Assessment Scheme for HIV screening.

From this information, the indicator can be calculated.

PURPOSE


MEASUREMENT TOOL


Indicator 28: Percentage of donated blood units screened for HIV in a quality assured manner

Blood safety programs aim to ensure that all blood units are screened for transfusion-transmissible infections, including HIV, and that only those units that are non-reactive on screening tests are released for clinical use.

Universal (100%) screening of donated blood for HIV and other transfusion-transmissible infections cannot be achieved without mechanisms to ensure quality and continuity in screening. Interruptions to supplies of test kits and reagents, or emergency situations, can result in the use of blood for transfusion without screening for transfusion-transmissible infections. The development of systems for reliable and regular supplies of low-cost, high-quality test kits and reagents as well as effective stock management are therefore essential to ensure universal quality screening of blood units. Thus, it is crucial that all donated blood units be screened for HIV in a quality-assured manner.

The following methodologies are two key components of quality assurance in screening:

1. The use of documented and standardised procedures (standard operating procedures) for the screening of every blood unit.

2. Participation of the laboratories in an external quality assessment scheme for HIV screening in which external assessment of the laboratory’s performance is conducted using samples of known, but undisclosed, content to assess its quality system and assist in improving standards of performance.


52

Number of donated blood units screened for HIV in a quality assured manner. For the purposes of data collection screening in a quality assured manner is defined as screening performed in blood centres/blood screening laboratories that:

1. follow documented standard operating procedures and 2. participate in an external quality assurance scheme.

Numerator

Total number of blood units donated.

In this context, donation refers to any blood collected for the purposes of medical use. This includes all possible types of providers of blood, regardless of whether they receive remuneration or not.

Denominator



53

To measure the percentage of schools providing life skills-based HIV education.

Every two years.

School survey or education program review.

Number of schools that provided life skills-based HIV education in the most recent academic year.

Number of schools surveyed.

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

Within the most recent academic year, did your school provide at least 30 hours of life-skills training to each grade?

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Level (primary, secondary).Disaggregation


Indicator 29: Percentage of schools that provided life skills-based HIV education within the most recent academic year

Life skills-based education is an effective methodology that uses participatory exercises to teach behaviours to young people that help them deal with the challenges and demands of everyday life. It can include decision-making and problem-solving skills, creative and critical thinking, self-awareness, communication and interpersonal relations. It can also teach young people how to cope with their emotions and causes of stress.

When adapted specifically for HIV education in schools, a life skills-based approach helps young people understand and assess the individual, social and environmental factors that raise and lower the risk of HIV transmission. When implemented effectively, it can have a positive effect on behaviours, including delay in sexual debut and reduction in the number of sexual partners.


54

To measure the coverage of HIV prevention programs for MARPs.


Behavioural surveillance or other special surveys.

Number of MARP respondents who replied ‘yes’ to both (all three for injecting drug users) questions.

Total number of respondents surveyed.

Respondents are asked the following questions:

1. Do you know where you can go if you want to have an HIV test?2. In the last 12 months, have you been given condoms (for example, through an

outreach service, drop-in centre or sexual health clinic)?Injecting drug users should be asked the following additional question:3. In the last 12 months, have you been given sterile needles and syringes (for example,

by an outreach worker, a peer educator or through a needle exchange program)?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator


Disaggregation


Indicator 30: Percentage of MARPs reached with HIV prevention programs

MARPs are often difficult to reach with HIV prevention programs. However, in order to prevent the spread of HIV among these populations as well as into the general population, it is important that they access these services.

The NHS defines MARPs as groups of people that have a common HIV risk behaviour and often some other defining characteristic, such as selling sex, and that have an existing rate of HIV infection. In PNG, MARPs include: women and men involved in sex work and transactional sex, men who have sex with men, migrant workers, enclave workers, prisoners and mobile men with money (such as public servants, police, politicians, landowners, cash crop buyers and sellers, transport sector workers and business men). MARPs vary over time as the dynamics of an epidemic change. In other countries the term ‘most’ at risk populations is generally used. There is currently insufficient epidemiological data in PNG to determine which populations are ‘most’ at risk so the term ‘more’ at risk has been used.

This indicator should be calculated separately for each population that is considered more-at-risk. Countries with generalised epidemics may also have a concentrated sub-epidemic among one or more MARPs so this is an important indicator.


55

To measure the number of district health care facilities providing ART.

Annual for program records; every 2 to 3 years for facility survey/census.

For health facility surveys or censuses, tools such as SPA or SAM can be used.

Number of health care facilities at district level that offer ART (that is, prescribe and/or provide clinical follow up).

Not applicable.

Number of health care facilities at district level that offer ART (that is, prescribe and/or provide clinical follow up). Health care facilities include public and private facilities, health centres and clinics (including TB centres), as well as health care facilities run by FBOs or NGOs.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Type of health facility (government, FBO, NGO, private). Type of ART service (prescription, clinical follow up).Disaggregation


Indicator 31: Number of district level ART sites

ART is a cornerstone of effective HIV treatment, and measuring the percentage of health care facilities that offer ART provides valuable information about ART availability. One strategy to scale-up ART services is to make ART available in more health care facilities. This may be achieved by decentralising ART services from tertiary facilities (for example, hospitals) to primary- and secondary-level health care facilities.


56

To improve availability of quality paediatric ART services in all ART sites.

Data will be collected routinely through the monthly ART collection forms.

Numerator: This will be collected continuously through the monthly ART data form submitted by sites. This form has variables for age groups that indicate whether the site is providing ART to children

Denominator: This will be collected in the same way as for the numerator.

Number of ART sites providing paediatric ART.

Number of ART sites providing both adult and paediatric ART services.

Routine monthly program reports.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Public and private.Disaggregation


Indicator 32: Percentage of health care facilities that offer paediatric ART (that is, prescribe and provide clinical follow up)

Scale-up of paediatric ART has lagged behind ART scale up for adults. It is important that both adult and paediatric ART services are provided in all facilities that are delivering ART. Where paediatricians are not available, it is important to encourage and support health care workers trained in integrated management of adolescent and adult illness to provide paediatric ART to all eligible children.


57

To measure the coverage of cotrimoxazole CTX prophylaxis for HIV-exposed infants in line with international guidelines.

Annual.

Numerator: facility-based records, such as integrated maternal and child health registers, HIV-exposed infant follow-up registers, or pre-ART registers.

Denominator: ANC surveillance, Spectrum, published estimates (for example, estimates from the UNDP).

Number of infants born to HIV-infected women in the last 12 months started on CTX prophylaxis within two months of birth.

Estimated number of HIV-infected pregnant women giving birth in the last 12 months.

Data for the numerator should be aggregated from the appropriate facility registers, which could include integrated maternal and child health registers, HIV-exposed infant follow-up registers, or pre-ART registers.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Sex (male; female).Disaggregation


Indicator 33: Percentage of infants born to HIV-infected women who are started on Cotrimoxazole prophylaxis within two months of birth

Cotrimoxazole (CTX) prophylaxis is a simple and cost-effective intervention to prevent pneumocystis jiroveci pneumonia (PCP) among HIV-exposed and HIV-infected infants. PCP is the leading cause of serious respiratory disease in young HIV-infected infants in resource-constrained countries, and it often occurs before HIV infection can be diagnosed. Because of the difficulties in diagnosing HIV-infection in young infants, all infants born to HIV-infected women should receive CTX prophylaxis, starting at 4 to 6 weeks after birth and continuing until HIV infection has been excluded and the infant is no longer at risk of acquiring HIV through breastfeeding.


58

To enhance the availability of STI screening and syndromic management.

All patients with STI symptoms and/or risk factors will be screened and data will be recorded and continuously reported to NHIS at NDOH. The data will be aggregated annually.

Numerator: collected routinely by NHIS.

Denominator: collected routinely by NHIS.

Number of all health care facilities providing STI screening and syndromic management.

Total number of health care facilities in the country.

Quarterly program data.

PURPOSE


MEASUREMENT TOOL

Numerator

Denominator

Private/public.Disaggregation


Indicator 34: Percentage of health care facilities that provide STI screening and syndromic management

It is crucial that all health care facilities provide STI screening and syndromic management or refer all individuals with risk factors and/or STI symptoms to appropriate services. Currently, not all facilities are providing these services to patients. Given the link between HIV and STI, it is important that STI services are provided in all healthcare facilities or through referrals.


59

To support the continuum of prevention to care and treatment.

Data should be collected quarterly at the facility level and should be aggregated at least annually.

Numerator: This will be collected through supervisory visits and aggregated annually.

Denominator: This will be collected through quarterly reports.

Program reports.

PURPOSE


MEASUREMENT TOOL

Number of ART sites linked to HBC and family and community services.Numerator

Total number of ART sites.Denominator

Public; private; FBOs.Disaggregation


Indicator 35: Percentage of ART sites that are linked to HBC and other family and community support services

Linking patients on ART to HBC and family and community support is critical to the provision of comprehensive care and support. It also helps to promote HIV treatment adherence, which in turn improves quality of life and limits the development of drug resistance. HBC and family support also help to minimise HIV-related stigma and discrimination and facilitates community access to services.


60

To ensure HIV prevention, care and treatment services are provided directly to HIV-positive individuals in a timely manner or through referrals to other services.

Data will be collected continuously at the facility level and will be aggregated at least annually.

Numerator: The number will be collected from the monthly HCT report form (Survey 1). The numerator is calculated from national program records, aggregated from facility rapid test log books for ANC, labour and delivery and postpartum care; STI, TB, VCT, outpatients/inpatients, blood donors etc. All public, private, FBO and NGO health care facilities and standalone services that are providing testing and counselling should be included.

Denominator: The total number of reporting sites providing HIV counselling and testing.

PURPOSE


MEASUREMENT TOOL

Number of HCT sites implementing POC – HIV confirmation testing.Numerator

Total number of HCT sites.Denominator

Public; private; FBOs.Disaggregation

Program monitoring.


Indicator 36: Percentage of HCT sites using the 2009 national point-of-care algorithm

Provision to clients of their HIV test results on the same day as testing will minimise loss to follow up.


61

To assess progress towards universal knowledge of the essential facts about HIV transmission.


Youth survey, Demographic and Health Survey, other related surveys.

Number of respondents who gave the correct answer to all five questions.

Number of all respondents.

This indicator 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 uninfected partner who has no other partners?

2. Can a person reduce the risk of getting HIV by using a condom every time they have sex?

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 food with someone who is infected?


PURPOSE


MEASUREMENT TOOL

Numerator

Denominator



Indicator 37: Percentage of women and men who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission

HIV epidemics are primarily perpetuated through sexual transmission of infection. Sound knowledge about HIV is an essential prerequisite – albeit, often an insufficient condition – for adoption of behaviours that reduce the risk of HIV transmission.


62

To assess progress in building knowledge of the essential facts about HIV transmission among MARPs.


Special behavioural surveys such as the FHI BSS for MARPs.

Respondents are asked the following five questions:

1. Can having sex with only one faithful, uninfected partner reduce the risk of HIV transmission?

2. Can using condoms reduce the risk of HIV transmission?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?


PURPOSE


MEASUREMENT TOOL

Number of MARP respondents who gave the correct answers to all five questions.Numerator

Number of MARP respondents who gave answers, including ‘don’t know’, to all five questions.Denominator

Sex (male, female). Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59). Gender (men, women, male-to-female transgender, female-to-male transgender).

Disaggregation


Indicator 38: Percentage of MARPs who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission

Sound knowledge about HIV and AIDS is an essential prerequisite if people are going to adopt behaviours that reduce their risk of infection.

The NHS defines MARPs as groups of people that have a common HIV risk behaviour and often some other defining characteristic, such as selling sex, and that have an existing rate of HIV infection. In PNG, MARPs include: women and men involved in sex work and transactional sex, men who have sex with men, migrant workers, enclave workers, prisoners and mobile men with money (such as public servants, police, politicians, landowners, cash crop buyers and sellers, transport sector workers, and business men). The populations who are more-at-risk vary over time as the dynamics of an epidemic change. In other countries the term ‘most’ at risk populations is generally used. There is currently insufficient epidemiological data in PNG to determine which populations are ‘most’ at risk so the term ‘more’ at risk has been used.

This indicator should be calculated separately for each population that is considered more-at-risk. Countries with generalised epidemics may also have a concentrated sub-epidemic among one or more MARPs.


63

To assess progress in increasing the age at which young women and men aged 15–24 first have sex.


Youth survey, Demographic and Health Survey, other related surveys.

Respondents are asked whether or not they have ever had sexual intercourse and, if yes, they are asked: How old were you when you first had sexual intercourse for the first time?


PURPOSE


MEASUREMENT TOOL

Number of respondents (aged 15–24 years) who report the age at which they first had sexual intercourse as under 15 years.Numerator

Number of all respondents aged 15–24 years.Denominator

Sex (male, female). Age (15–19, 20–24).Disaggregation


Indicator 39: Percentage of young women and men who have had sexual intercourse before the age of 15

One HIV prevention strategy is to delay the age at which young people first have sex and discourage premarital sexual activity because it reduces their potential exposure to HIV. There is also evidence to suggest that first having sex at a later age reduces susceptibility to infection per act of sex, at least for women.


64

Strategic information needs not addressed through national indicators

The NHS has an emphasis on generating and using evidence to guide all programs. While a good deal of strategic information will be collected by the national indicators, additional evidence will be needed. Table 2 lists major activity areas from the NHS Implementation Framework where additional strategic information is needed, beyond what will be collected by the national indicators. Research topics related to these major activities will be included in a revised National Research Agenda (NRA) for the NHS 2011–2015. The first 21 activities in Table 2, which are highlighted in light green, are of a higher priority.

In addition, the NHS has placed an emphasis on the importance of operations research. This will be reflected in the NRA, including a focus on developing capacity for operations research.

(Note: in Table 2, in the column ‘NHS Strategic Objective’, I, II and III refers to NHS Priority areas 1, 2 and 3. For example, I–1.1.2 refers to Priority area 1: Prevention, and Strategic objective 1.1.2.)

I – 1.1.2

I – 1.1.4

I – 1.1.9

NHS strategic objective

NHS Implementation Framework major activity areas

Identify and address the barriers (including gender- and age-related barriers) to effective condom promotion, including working with churches, to advocate the importance of condoms as a tool for the prevention of HIV, STIs and for family planning.

Conduct social research on concurrent sexual relationships to guide programming.

Conduct regular reviews of evidence for HIV-related, high-risk behaviours to determine who are the more-at-risk populations in PNG.

I – 1.1.10 Identify and address barriers to PLHIV accessing sexual and reproductive health services.

Table 2: NHS Implementation Framework—major activity areas where additional strategic information is needed

I – 1.4.3 Expand surveillance to establish a clearer understanding of the extent that injecting drug use is practised and undertake socio-behavioural research to understand data on injecting drug use, its contexts of use and meanings, what is being used, why it is being used, and whether this is a significant mode of HIV transmission.


65

I – 2.1.2 Review existing gender-based violence, sexual violence and related intervention programs and identify and disseminate lessons learned, with reference to the Family and Sexual Violence Action Strategy and including a clearing house on resources.

I – 2.4.1 Conduct social research to identify HIV vulnerabilities of more-at-risk populations and use this information to inform interventions.

I – 2.4.4 Develop criteria for ‘mobile men with money’ based on social and behavioural research.

I – 2.5.2 Undertake research to explore the links between sexual risk for males and females in relation to the transportation and sale of buai.

I – 3.2.3 Undertake HIV impact assessments for all current and future economic developments (for example, LNG, mines, plantations, fisheries) and develop and implement appropriate interventions for workforces and surrounding communities.

II – 2.1.1 Review and strengthen existing ART services, including an analysis of gender-linked factors affecting access and adherence.

II – 2 .1.9 Strengthen the capacity for monitoring drug resistance.

II – 2.3.1 Conduct periodic microbial resistance studies for STIs and review and implement recommended changes in national guidelines.

II – 2.3.3 Conduct research on STI health seeking behaviours to increase uptake of STI services.

II – 2.4.7 Identify the requirements of PLHIV support groups for specific populations such as women, young people, men who have sex with men, sex workers, men and sero-discordant partners, and establish groups as needed.

II – 2.4.8 Identify and document the barriers for PLHIV and their families in accessing education, training and vocational skills building.

III – 1.1.2 Undertake a comprehensive review of all ProMEST, starting with higher prevalence provinces, to identify critical gaps and weaknesses and develop appropriate actions to strengthen the effectiveness of each ProMEST.

III – 1.3.2 Revise the priority research areas of the NRA to include research on men and women’s sexuality and sexual beliefs, roles and practices.

III – 2.1.1 Trial, review and share learning from existing or pilot interventions that address gender-related vulnerabilities.



III – 2.4.2 Review and remedy barriers to the effective utilisation of the HAMP Act.

III – 2.5.4 Trial and implement evidence-informed, gender-sensitive interventions which reduce stigma and discrimination within communities, initially in high prevalence or highly stigmatising communities, and particularly focused on addressing higher levels of stigma toward HIV positive women.


66

I – 1.1.9 Conduct periodic size estimations of more-at-risk groups are undertaken.

I – 1.4.1 Conduct targeted social research and surveillance on penile modification practices.

I – 1.4.2 Conduct targeted social research and surveillance on tattooing, piercing and scarification practices and the contexts of their use (ethnicity, identity, as part of initiation).

I – 1.4.2 Develop evidence-informed harm reduction interventions that reduce the risks of HIV transmission for males and females associated with tattooing, piercing and scarification, particularly in cultural groups, work places and institutional environments (for example, prisons, uniformed services, schools).

I – 1.4.4 Conduct targeted social research and surveillance on vaginal drying practices and use of sexual enhancement products.

I – 2.1.6 Review, initiate and disseminate social research that examines the HIV vulnerabilities associated with specific cultural practices.

I – 2.1.6 Establish and share the learning from HIV prevention and care programs that use positive cultural practices to reduce vulnerabilities to HIV.

I – 2.5.1 Implement research-informed pilot programs to reduce drug and alcohol use are established in communities, institutions and workplaces for specific age, gender and more-at-risk groups (MSM, FSW, PLHIV).

II – 1.1.8 Pilot and review initiatives that promote increased access and uptake of HCT of men, women, transgendered and young people.

II – 2.1.10 Develop, trial and implement a range of interventions and tools to improve treatment adherence (for example, counselling services, nutrition support, treatment companions, preventing drug stock outs, use of mobile phones, pill boxes).

II – 2.4.5 Develop and implement a needs assessment tool to determine the scope of psycho-social needs of PLHIV and people affected by HIV.

II – 2.4.5 Develop and implement a needs assessment tool to determine the nutrition needs of PLHIV.

III – 1.3.1 Conduct periodic risk and vulnerability assessment surveys for different geographical as well as specific population groups and develop risk and vulnerability profiles for each of them.

III – 1.3.1 Conduct population size-estimation exercises for the groups found to have higher risks and vulnerabilities.

III – 1.3.3 Conduct periodic assessments of the capacity of research institutions and other possible partners for conducting social, socio-economic and behavioural research based on the NRA priorities and develop and implement a capacity development plan.

III – 1.3.4 Conduct an assessment across major service providers (for example, key government departments, large NGOs and FBOs) regarding their internal operational research capacity and identify TA needs.

III – 2.1.8 Commission research to review the level of participation of men and women on NAC, PACs and DACs.




67

Guidelines for developing program monitoring and evaluation plans based on the National Monitoring and Evaluation Framework

M&E plans for national programs like counselling and testing, care and treatment, and prevention of HIV in target groups such as students, out-of-school children or MARPs should be based on the internal logical framework of inputs, outputs and outcomes. However, to ensure the harmonisation of all M&E activities and alignment of the M&E of specific programs with the National M&E Framework, the following issues need to be considered when developing M&E plans at the program level:

1. Population impact and behavioural-level indicators at the program level should use the national indicators contained in this framework. If the program planners strongly believe they need other population impact and behavioural-level indicators, data collection for those indicators should be aligned with the data collection for the national indicators through the surveys already envisaged in this framework.

2. For output and other indicators developed as part of a program’s logical framework, national indicators and/or the additional indicators in Appendix II should be used. When using national indicators, programs should use the definitions contained in this framework. When designing any additional indicators, programs should keep be guided by the structure of definitions for the national indicators and draw on concepts contained in those definitions, as appropriate.

3. All national programs should use the data flow mechanisms provided in this framework. If there are special needs to add to or change the flow of data, this has to be approved by one of the M&E or STWG.

4. Generally speaking, national programs should not have more than 20 indicators in addition to those that apply from the list of national indicators.

The M&E and surveillance technical working groups will provide technical support to the NACS ICME and NDoH Surveillance Unit in developing M&E for non-health and health sector programs.

Guidelines for developing program monitoring and evaluation plans based on the National Monitoring and Evaluation Framework

68

Appendix I

Inventory of questions to be included in surveys for measuring national indicators

Data for measuring a significant number of the national indicators have to be collected through population or special surveys.

To be able to measure these indicators reliably over time and through different surveys, there is a clear need for a set of standardised questions for each indicator. In addition, questions for age, which is the main demographic attribute, need to be standardised to allow for comparison of results across different surveys. A list of standardised questions for national indicators that will be measured through population or special surveys is provided below. The numbers of those national indicators that will be measured by using these standardised questions have been supplied. Survey designers are encouraged to use these standardised questions in their questionnaires. For many of the indicators, the suggested questions are drawn from international guidelines.

It should be noted that not all of the questions are meant to be included in the one survey. Some of the questions are for general and youth population surveys and others are for special surveys among MARPs. Moreover, using one set of questions might mean others in this standardised list of questions are not needed. It is up to the survey design team, in consultation with the STWG, to choose the indicators they want to measure and determine which standardised questions should be used.

Use these questions for all indicators where disaggregation by age is needed

Age1. Do you know your exact birth month and year? If yes, can you tell me the

month and year of your birth? (if no answer go to the next question)2. Do you know your birth year? If yes, can you tell me your birth year?

(if no answer go to the next question)3. Do you know how old are you? Can you tell me your age?

(if no answer go to the next question)4. Can you tell me which of the following age groups you are in? Less than 15, 15–19, 20–24, 25–29, 30–34, 35–39, 40–45, 45–49, 50–54,

55–59, 60 and above (if no answer go to the next question)5. Can you tell me which of the following age groups you are in? Less than 15, 15–24, 25–59, 60 and above (if no answer leave blank)

Appendix I – Inventory of questions to be included in surveys for measuring national indicators

69

Indicator 1: Multiple concurrent sexual partnerships (in the last three months)

1. Have you ever had sexual intercourse? (If yes go to next question)2. How long ago did you last have sexual intercourse?

(if less than three months continue)3. How long ago did you first have sexual intercourse with that same person?4. Have you had sexual intercourse with any other person in the past three months?

(If yes go to next question)5. How long ago did you last have sexual intercourse with this second person?6. How long ago did you first have sexual intercourse with this second person?7. Have you had sexual intercourse with any other person in the past three months?

(If yes go to next question)8. How long ago did you last have sexual intercourse with this third person?9. How long ago did you first have sexual intercourse with this third person?

Note1: To avoid confusion by respondents in answering these questions the interviewer can use an auxiliary tool such as a graphical representation to depict the answers and check it with the interviewee. This tool will be developed by NACS.

Note 2: The series of questions only cover up to three sexual partners. While some persons might have more than three sexual partners during the previous three months, there is no need to go further than establishing three partners as the respondent has been already identified as having multiple concurrent sexual partners.

Indicator 2: Multiple concurrent sexual partnerships (for the last 12 months)

1. Have you ever had sexual intercourse? (If yes go to next question)2. How long ago did you last have sexual intercourse?

(if less than 12 months continue)3. How long ago did you first have sexual intercourse with that same person?4. Have you had intercourse with any other person in the past 12 months?

(If yes go to next question)5. How long ago did you last have sexual intercourse with this second person?6. How long ago did you first have sexual intercourse with this second person?7. Have you had intercourse with any other person in the past 12 months?

(If yes go to next question)8. How long ago did you last have sexual intercourse with this third person?9. How long ago did you first have sexual intercourse with this third person?

Note1: To avoid confusion by respondents in answering these questions the interviewer can use an auxiliary tool such as a graphical representation to depict the answers and check it with the interviewee. This tool will be developed by NACS.

Note 2: The series of questions only cover up to three sexual partners. While some persons might have more than three sexual partners during the previous three months, there is no need to go further than establishing three partners as the respondent has been already identified as having multiple concurrent sexual partners.


70

Indicator 3: Multiple sexual partnerships (for the past 12 months)

1. Have you ever had sexual intercourse? (If yes go to next question)2. In the last 12 months, how many people have you had sexual intercourse with?

Indicator 4: Condom use in multiple sexual partnerships

1. In the last 12 months, how many people have you had sexual intercourse with? (If more than one, continue)

2. Did you or your partner use a condom the last time you had sexual intercourse?

Indicator 5: Condom use in sex workers1. Have you had sexual intercourse in the past 12 months in exchange for money,

goods or other services? (If yes continue)2. Did you use a condom with your most recent client?

Indicator 6: Condom use in persons engaged in transactional sex

1. Have you had sexual intercourse in the last 12 months with anybody beside your spouse in exchange for money, gifts, food, shelter or any other services? (If yes continue)

2. For the last time you had sexual intercourse in exchange for money, gifts, food, shelter or any other services, did you or your partner use a condom?

Indicator 7: Condom use in men who have sex with men

1. Have you had sex with another man in the past six months? (If yes continue)2. Did you or your male partner use a condom the last time you had anal sex with

another man?

Indicator 8: Condom use in anal sex1. In the last 12 months, have you ever had anal intercourse with another person

(man or woman)? (If yes continue)2. Did you or your partner use a condom the last time you had anal intercourse?3. What was your partner’s sex?


71

Indicators 12 and 13: HIV testing1. I don’t want to know the result, but have you been tested for HIV in the last 12

months? (If yes continue)2. I don’t want to know the result, but did you get the result of that test?

Indicator 30: Reach of HIV prevention programs for MARPs

1. Have you provided sexual services to people in past 12 month in exchange for money, gifts, food, shelter or any other services? (If yes continue)

2. Do you know where you can go if you want to have an HIV test?3. In the last 12 months, have you been given condoms (for example, through an

outreach service, drop-in centre or sexual health clinic)?

OR for males only:

1. Have you had sex with another man in the past six months? (If yes continue)2. Do you know where you can go if you want to have an HIV test?3. In the last 12 months, have you been given condoms (for example, through an

outreach service, drop-in centre or sexual health clinic)?

Indicator 37 and 38: Comprehensive and correct knowledge on sexual transmission of HIV

1. Can the risk of HIV transmission be reduced by having sex with only one uninfected partner who has no other partners?

2. Can a person reduce the risk of getting HIV by using a condom every time they have sex?

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 food with someone who is infected?

Indicator 39: Sexual intercourse before 15 years of age

1. Have you have ever had sexual intercourse? (If yes go to next question)2. How old were you when you had sexual intercourse for the first time?


72

Appendix II

Repository of additional indicators for monitoring and evaluation of programs

A limited number of national indicators, (39), have been developed to collect information on progress in key areas and to collectively give a good overview of PNG’s progress in responding to the HIV epidemic (See List of national indicators). This appendix contains additional indicators, some of which were formulated during the development of this NHS and other indicators already in use at the national and international level for monitoring of particular programs (see Table 3). While the Monitoring and Evaluation Framework only requires reporting against the national indicators, the indicators contained in this appendix can be used, as appropriate, by projects and programs for their internal, more detailed M&E. (Note: in Table 3, in the column ‘Related Strategic Objective’, I, II and III refers to NHS Priority areas 1, 2 and 3. For example, I-1.1.2 refers to Priority Area 1: Prevention, and Strategic objective 1.1.2.)

Appendix II – Repository of additional indicators for monitoring and evaluation of programs

73

Tabl

e 3:

A

dditi

onal

indi

cato

rs fo

r mon

itorin

g an

d ev

alua

tion

of p

rogr

ams

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Inte

rnat

iona

l in

dica

tor l

ist

Dat

a co

llect

ion

tool

Dat

a co

llect

ion

freq

uenc

y

1P

erce

ntag

e of

HIV

pre

vent

ion

prog

ram

s th

at in

clud

e in

terv

entio

ns fo

r gen

der-

base

d an

d se

xual

vio

lenc

e–

I – 2

.1.2

––

Ann

ual

2N

umbe

r of H

IV in

terv

entio

ns th

at a

ddre

ss c

ultu

ral p

ract

ices

w

hich

incr

ease

HIV

risk

dis

aggr

egat

ed b

y se

x, lo

catio

n an

d cu

ltura

l pra

ctic

e–

I – 2

.1.6

––

Ann

ual

3P

erce

ntag

e of

HIV

pre

vent

ion

inte

rven

tions

that

can

de

mon

stra

te m

eani

ngfu

l par

ticip

atio

n of

you

ng p

eopl

eA

ge Sex

Act

ivity

type

I – 2

.2.2

––

Ann

ual

4P

erce

ntag

e of

HIV

pre

vent

ion

prog

ram

s th

at ta

rget

the

vuln

erab

ility

of c

hild

ren

to H

IV w

hich

mea

ning

fully

invo

lve

child

ren

in th

e de

sign

, del

iver

y an

d m

onito

ring

of in

terv

entio

ns–

I – 2

.3.2

––

Ann

ual

5P

erce

ntag

e of

HIV

pre

vent

ion

inte

rven

tions

that

incl

ude

drug

an

d al

coho

l har

m re

duct

ion

activ

ities

–I –

2.5

.1–

–A

nnua

l

6N

umbe

r of c

ultu

ral,

chur

ch a

nd s

ocia

l eve

nts

with

targ

eted

aw

aren

ess

prog

ram

s ad

dres

sing

mul

tiple

con

curr

ent

partn

ersh

ips

–I –

3.1

.1–

–A

nnua

l

7P

erce

ntag

e of

spo

rting

ass

ocia

tions

sig

ned

up to

the

PN

G

Dec

lara

tion

on H

IV a

nd A

IDS

Pre

vent

ion

thro

ugh

Spo

rt–

I – 3

.1.2

––

Ann

ual

8N

umbe

r of d

istri

cts

with

HIV

and

STI

pre

vent

ion

inte

rven

tions

du

ring

elec

tion

perio

ds–

I – 3

1.3

––

Year

s in

whi

ch

elec

tions

are

hel

d

Indi

cato

rs fo

r mon

itorin

g th

e re

spon

se e

nviro

nmen

t and

Inpu

ts

9P

erce

ntag

e of

hot

els,

bar

s an

d ni

ghtc

lubs

that

hav

e m

ade

mal

e an

d fe

mal

e co

ndom

s av

aila

ble

–I –

3.1

.5–

–A

nnua

l

10N

umbe

r of o

rgan

isat

ions

with

app

ropr

iate

HIV

wor

kpla

ce

polic

ies

and

stra

tegi

es–

I – 3

.2.2

––

Ann

ual

11P

erce

ntag

e of

HC

T se

rvic

es th

at e

mpl

oy P

LHIV

Em

ploy

men

t sta

tus

(vol

unte

er; p

aid)

II –

1.1.

4–

–A

nnua

l


74

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Inte

rnat

iona

l in

dica

tor l

ist

Dat

a co

llect

ion

tool

Dat

a co

llect

ion

freq

uenc

y

12P

erce

ntag

e of

trea

tmen

t ser

vice

s th

at e

mpl

oy P

LHIV

Em

ploy

men

t sta

tus

(vol

unte

er; p

aid)

II –

2.1.

7–

–A

nnua

l

13A

nnua

l per

cent

age

chan

ge in

reso

urce

allo

catio

n to

STI

and

se

xual

hea

lth p

rogr

ams

–II

– 2.

3.2

––

Ann

ual

14P

erce

ntag

e of

HB

C a

nd c

omm

unity

sup

port

prog

ram

s th

at

empl

oy P

LHIV

Em

ploy

men

t sta

tus

(vol

unte

er; p

aid)

II –

2.4.

4–

–A

nnua

l

15N

umbe

r of s

uppo

rt gr

oups

run

by p

ositi

ve p

eopl

e–

II –

2.4.

7–

–A

nnua

l

16P

erce

ntag

e of

HB

C a

nd/o

r com

mun

ity s

uppo

rt pr

ogra

ms

whe

re m

en a

nd b

oys

are

activ

ely

invo

lved

–II

– 2.

4.10

––

Ann

ual

17N

umbe

r of u

pdat

ed ri

sk a

nd v

ulne

rabi

lity

profi

les

avai

labl

e–

III –

1.3

.1–

–A

nnua

l

18P

erce

ntag

e of

rese

arch

pro

vide

d by

Gov

ernm

ent o

f PN

G a

nd

deve

lopm

ent p

artn

ers

for r

esea

rch

that

is b

ased

on

the

NR

A–

III –

1.4

.2–

–A

nnua

l

19N

umbe

r of H

IV p

rogr

ams

addr

essi

ng g

ende

r-re

late

d vu

lner

abili

ty, r

epor

ted

in th

e N

HS

ann

ual p

lann

ing

proc

ess

Type

of p

rogr

amIII

– 2

.1.1

––

Ann

ual

20N

umbe

r of m

en’s

gro

ups

invo

lved

in H

IV a

nd A

IDS

pro

gram

sTy

pe o

f or

gani

satio

nA

ctiv

ities

III –

2.1

.3–

–A

nnua

l

21N

umbe

r of w

omen

’s g

roup

s in

volv

ed in

HIV

and

AID

S

prog

ram

sTy

pe o

f or

gani

satio

nA

ctiv

ities

III –

2.1

.4–

–A

nnua

l

22P

erce

ntag

e of

men

and

wom

en o

n H

IV-r

elat

ed c

oord

inat

ion

and

deci

sion

-mak

ing

com

mitt

ees

at n

atio

nal a

nd s

ub-n

atio

nal

leve

lsS

exIII

– 2

.1.8

––

Ann

ual

23P

erce

ntag

e of

HIV

pro

gram

s th

at d

emon

stra

te m

eani

ngfu

l in

volv

emen

t PLH

IV–

III –

2.2

.1–

–A

nnua

l


75

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Inte

rnat

iona

l in

dica

tor l

ist

Dat

a co

llect

ion

tool

Dat

a co

llect

ion

freq

uenc

y

24P

erce

ntag

e of

PLH

IV g

roup

s th

at a

re p

art o

f a n

atio

nal

netw

ork

–III

– 2

.2.2

––

Ann

ual

25P

erce

ntag

e of

PLH

IV g

roup

s th

at m

onito

r and

repo

rt on

st

igm

a an

d di

scrim

inat

ion

and

grea

ter i

nvol

vem

ent o

f peo

ple

livin

g w

ith H

IV (G

IPA

), us

ing

the

stan

dard

inde

x–

III –

2.2

.3–

–A

nnua

l

26N

atio

nal J

oint

Coo

rdin

atin

g C

omm

ittee

(NJC

C) m

eetin

gs

occu

r on

a re

gula

r bas

is b

etw

een

key

serv

ice

deliv

ery

depa

rtmen

ts–

III –

2.3

.3

III –

3.2

.1–

–A

nnua

l

27N

umbe

r of a

rres

ts a

nd p

rose

cutio

ns fo

r sex

wor

k–

III –

2.4

.2–

–A

nnua

l

28N

umbe

r of c

ases

and

suc

cess

ful p

rose

cutio

ns u

nder

the

HA

MP

Act

–III

– 2

.5.1

––

Ann

ual

29N

HS

ann

ual p

lan

and

budg

et s

ubm

issi

ons

and

annu

al

parli

amen

tary

repo

rt co

mpl

eted

on

time

–III

– 3

.1.1

––

Ann

ual

30P

erce

ntag

e of

PA

CS

and

DA

CS

that

rece

ive

thei

r qua

rterly

di

sbur

sem

ents

and

sen

d in

qua

rterly

and

ann

ual r

epor

ts

on ti

me

–III

– 3

.12

––

Ann

ual

31N

umbe

r of N

GO

s an

d FB

Os

that

hav

e pa

rtici

pate

d in

a

colla

bora

tive

proj

ect w

ith a

noth

er N

GO

or F

BO

in th

e

last

yea

r–

III–3

.1.5

––

Ann

ual

32N

umbe

r of g

over

nmen

t dep

artm

ents

repo

rting

to N

AC

S

thro

ugh

the

NH

S p

lann

ing

and

repo

rting

cyc

le–

III –

3.1

.6–

–A

nnua

l

33N

umbe

r of m

eetin

gs b

etw

een

NA

CS

and

PA

CS

–III

– 3

.2.2

––

Ann

ual

34N

umbe

r of c

omm

uniti

es u

sing

gen

der-

sens

itive

com

mun

ity

mob

ilisa

tion

tool

s in

HIV

pla

nnin

g, im

plem

enta

tion

and

mon

itorin

g–

III –

3.3

.1–

–A

nnua

l

35P

erce

ntag

e of

HIV

com

mun

ity m

obili

satio

n pr

ogra

ms

that

can

de

mon

stra

te m

eani

ngfu

l par

ticip

atio

n of

PLH

IV–

III –

3.3

.2–

––


76

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Inte

rnat

iona

l in

dica

tor l

ist

Dat

a co

llect

ion

tool

Dat

a co

llect

ion

freq

uenc

y

36N

umbe

r of f

acili

ties

prov

idin

g A

NC

ser

vice

s th

at a

lso

prov

ide

HIV

cou

nsel

ling

and

test

ing

for p

regn

ant w

omen

–I –

1.2

.1U

AH

ealth

faci

litie

s su

rvey

Ann

ual

37P

erce

ntag

e of

hea

lth c

are

faci

litie

s de

liver

ing

PP

TCT

serv

ices

th

at re

port

stoc

k ou

t of t

est k

its in

the

last

12

mon

ths

–I –

1.2

.4–

Hea

lth fa

cilit

ies

surv

eyA

nnua

l

38P

erce

ntag

e of

hea

lth c

are

faci

litie

s th

at m

eet m

inim

um

stan

dard

s in

uni

vers

al p

reca

utio

ns u

sing

an

infe

ctio

n co

ntro

l au

dit t

ool

–I –

1.3

.1–

Hea

lth fa

cilit

ies

surv

eyA

nnua

l

39P

erce

ntag

e of

you

ng p

eopl

e ag

ed 1

5–24

in fu

ll tim

e ed

ucat

ion

or in

com

e ge

nera

ting

Age Sex

I – 2

.2.8

–Yo

uth

surv

eyE

very

thre

e to

fiv

e ye

ars

40P

erce

ntag

e of

pro

vinc

es w

ith c

hild

pro

tect

ion

syst

em b

ased

on

the

Luka

utim

Pik

inin

i Act

–I –

2.3

.1–

–A

nnua

l

41P

erce

ntag

e of

cus

todi

al fa

cilit

ies

that

mak

e co

ndom

s an

d ot

her h

arm

redu

ctio

n re

sour

ces

acce

ssib

le to

pris

oner

s as

pa

rt of

a c

ompr

ehen

sive

har

m re

duct

ion

prog

ram

–I –

2.4

.3–

Cus

todi

al fa

cilit

ies

revi

ewE

very

two

year

s

Indi

cato

rs fo

r mon

itorin

g th

e na

tiona

l res

pons

e ou

tput

s

42P

erce

ntag

e of

eco

nom

ic e

ncla

ve s

ites

and

reso

urce

de

velo

pmen

t pro

ject

s th

at h

ave

HIV

pre

vent

ion

and

prim

ary

heal

thca

re in

terv

entio

ns–

I – 3

.2.3

––

Ann

ual

43N

umbe

r of p

ublic

-priv

ate

partn

ersh

ips

for H

IV d

isag

greg

ated

by

pro

vinc

e, s

cope

and

type

of s

ervi

ce–

I – 3

.2.4

––

Ann

ual

44P

erce

ntag

e of

HC

T se

rvic

es th

at a

re m

aint

aini

ng m

inim

um

stan

dard

s–

II –

1.1.

5–

–A

nnua

l

45P

erce

ntag

e of

HC

T se

rvic

es th

at a

re a

ccre

dite

d to

pro

vide

H

CT

for c

hild

ren

–II

– 1.

1.6

––

Ann

ual

46P

erce

ntag

e of

HC

T cl

ient

s w

ho a

re s

atis

fied

with

the

serv

ice

prov

ided

Sex

Age

II –

1.1.

8–

–A

nnua

l


77

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Inte

rnat

iona

l in

dica

tor l

ist

Dat

a co

llect

ion

tool

Dat

a co

llect

ion

freq

uenc

y

47P

erce

ntag

e of

HC

T se

rvic

es d

istri

butin

g co

ndom

s to

all

clie

nts

–II

– 1.

1.9

––

Ann

ual

48P

erce

ntag

e of

AR

T se

rvic

es th

at h

ave

unde

rgon

e re

gula

r qu

ality

ass

uran

ce a

uditi

ng–

II –

2.1.

4–

–A

nnua

l

49P

erce

ntag

e of

AR

T se

rvic

es w

ith in

tegr

ated

/link

ed T

B, S

TI

and

gend

er-b

ased

vio

lenc

e se

rvic

es–

II –

2.1.

5–

–A

nnua

l

50N

umbe

r of A

RT

site

s pr

ovid

ing

the

min

imum

pac

kage

of

com

preh

ensi

ve c

are

–II

– 2.

1.6

––

Ann

ual

51P

erce

ntag

e of

AR

T cl

ient

s w

ho a

re s

atis

fied

with

the

serv

ice

prov

ided

Sex

Age

II –

2.1.

8–

–A

nnua

l

52P

erce

ntag

e of

hea

lth c

are

faci

litie

s pr

ovid

ing

AR

T us

ing

CD

4 m

onito

ring

in li

ne w

ith n

atio

nal g

uide

lines

or p

olic

ies,

eith

er o

n si

te o

r thr

ough

refe

rral

–II

– 2.

1.9

UN

GA

SS

+U

A–

Ann

ual

53P

erce

ntag

e of

hea

lthca

re fa

cilit

ies

that

offe

r Pae

diat

ric A

IDS

se

rvic

es w

ith s

taff

train

ed in

del

iver

ing

thes

e se

rvic

es–

II –

2.2.

3–

–A

nnua

l

54P

erce

ntag

e of

hea

lth c

are

faci

litie

s th

at p

rovi

de v

irolo

gica

l te

stin

g se

rvic

es (f

or e

xam

ple,

PC

R) f

or in

fant

dia

gnos

is o

n si

te o

r thr

ough

drie

d bl

ood

spot

s)–

II –

2.2.

4U

A–

Ann

ual

55P

erce

ntag

e of

HIV

infe

cted

chi

ldre

n ag

ed 0

to 1

4 ye

ars

who

ar

e cu

rren

tly re

ceiv

ing

AR

TS

ex

Age

II –

2.2.

5–

–A

nnua

l

56P

erce

ntag

e of

STI

clie

nts

who

are

sat

isfie

d w

ith th

e se

rvic

e pr

ovid

edS

exA

geII

– 2.

3.3

––

Ann

ual

57P

erce

ntag

e of

hea

lth c

are

faci

litie

s re

porti

ng a

dequ

ate

and

unin

terr

upte

d su

pplie

s of

STI

dru

gs–

II –

2.3.

4–

–A

nnua

l

58N

umbe

r of m

ales

and

fem

ales

trai

ned

in n

atio

nal s

tand

ards

fo

r HB

CS

exII

– 2.

4.3

––

Ann

ual


78

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Inte

rnat

iona

l in

dica

tor l

ist

Dat

a co

llect

ion

tool

Dat

a co

llect

ion

freq

uenc

y

60C

urre

nt s

choo

l atte

ndan

ce a

mon

g or

phan

s an

d am

ong

non-

orph

ans

aged

10

to14

Sex

II –

2.4.

6U

NG

AS

S–

Eve

ry th

ree

to

five

year

61N

umbe

r of P

LHIV

acc

essi

ng in

com

e su

ppor

t ini

tiativ

esS

exA

geII

– 2.

4.8

––

Ann

ual

62P

erce

ntag

e of

PLH

IV o

rgan

isat

ions

util

isin

g in

itiat

ives

that

pr

omot

e he

alth

, dig

nity

and

pre

vent

ion

–II

– 2.

4.9

––

Ann

ual

63N

umbe

r of s

uppo

rt pr

ogra

ms

that

spe

cific

ally

targ

et th

e ne

eds

of m

ale

and

fem

ale

yout

h liv

ing

with

HIV

–II

– 2.

4.12

––

Ann

ual

64N

umbe

r of s

uppo

rt pr

ogra

ms

that

spe

cific

ally

targ

et th

e ne

eds

of P

LHIV

who

hav

e ad

ditio

nal v

ulne

rabi

litie

s (fo

r exa

mpl

e,

men

who

hav

e se

x w

ith m

en a

nd s

ex w

orke

rs)

–II

– 2.

4.13

––

Ann

ual

65N

umbe

r of b

io, b

ehav

iour

al, a

nd b

io-b

ehav

iour

al s

urve

illan

ce

stud

ies

cond

ucte

d an

nual

lyS

iteTa

rget

gro

upIII

– 1

.2.1

–S

urve

illan

ce a

nd

rese

arch

repo

rtA

nnua

l

66N

atio

nal C

ounc

il of

Wom

en a

nnua

l act

ivity

pla

n, b

udge

t al

loca

tion

and

repo

rts d

emon

stra

te a

ctiv

e en

gage

men

t with

th

e H

IV a

nd A

IDS

resp

onse

–III

– 2

.1.5

––

Ann

ual

67P

erce

ntag

e of

org

anis

atio

ns w

ith a

ppro

pria

te H

IV w

orkp

lace

po

licie

s an

d st

rate

gies

Type

of

orga

nisa

tion

III –

2.2

.4–

–A

nnua

l

68N

umbe

r of l

eade

rs w

ho p

artic

ipat

e in

HIV

and

AID

S

lead

ersh

ip s

treng

then

ing

prog

ram

sS

exS

ecto

rIII

– 2

.3.1

––

Ann

ual

69P

erce

ntag

e of

HIV

trai

ners

who

can

dem

onst

rate

com

pete

ncy

in H

IV tr

aini

ng to

nat

iona

l sta

ndar

ds–

III –

3.1

.7–

–A

nnua

l

59P

erce

ntag

e of

AR

T si

tes

that

offe

r psy

chos

ocia

l sup

port

and

nutri

tion

inte

rven

tions

–II

– 2.

4.5

––

Ann

ual


79

Dis

aggr

egat

ion(

s)R

elat

ed

stra

tegi

c ob

ject

ive(

s)In

dica

tor

Inte

rnat

iona

l in

dica

tor l

ist

Dat

a co

llect

ion

tool

Dat

a co

llect

ion

freq

uenc

y

71P

erce

ntag

e of

men

and

wom

en w

ho c

an id

entif

y th

e ris

ks

of H

IV tr

ansm

issi

on a

ssoc

iate

d w

ith p

enile

mod

ifica

tion

disa

ggre

gate

d by

the

type

of p

enile

mod

ifica

tion

Sex

Age

I – 1

.4.1

–Yo

uth

and

gene

ral

popu

latio

n su

rvey

Eve

ry th

ree

to

five

year

s

72P

erce

ntag

e of

men

and

wom

en w

ho c

an id

entif

y th

e ris

k of

HIV

tran

smis

sion

ass

ocia

ted

with

tatto

os, p

ierc

ing

and

scar

ifica

tion

prac

tices

, dis

aggr

egat

ed b

y pr

actic

e an

d ag

e

Sex

Age

I – 1

.4.2

–Yo

uth

and

Gen

eral

P

opul

atio

n S

urve

yE

very

thre

e to

fiv

e ye

ars

73P

erce

ntag

e of

inje

ctin

g dr

ug u

sers

who

repo

rted

usin

g st

erile

in

ject

ing

equi

pmen

t the

last

tim

e th

ey in

ject

edS

exA

geI –

1.4

.3U

NG

AS

SS

peci

al p

opul

atio

n B

SS

Eve

ry tw

o to

th

ree

year

s

74P

erce

ntag

e of

wom

en w

ho k

now

that

vag

inal

dry

ing

can

incr

ease

risk

of H

IV tr

ansm

issi

onA

geI –

1.4

.4–

Yout

h an

d G

ener

al

Pop

ulat

ion

Sur

vey

Eve

ry th

ree

to

five

year

s

75P

erce

ntag

e of

you

ng w

omen

and

men

age

d 15

to 2

4 w

ho

repo

rt th

ey c

ould

get

con

dom

s on

thei

r ow

nS

exA

ge (1

5–19

; 20–

24; 2

5–34

; 35–

49;

50–5

9)Fe

mal

e an

d m

ale

cond

oms

I – 2

.2.3

UN

GA

SS

+Yo

uth

and

Gen

eral

P

opul

atio

n S

urve

yE

very

thre

e to

fiv

e ye

ars

70P

erce

ntag

e of

wom

en a

nd m

en li

ving

with

HIV

usi

ng a

co

ndom

at l

ast s

exS

exA

geK

now

n se

ro-

disc

orda

nce

stat

us

of th

e co

uple

I – 1

.1.1

0–

Spe

cial

pop

ulat

ion

BS

SE

very

two

to

thre

e ye

ars

Indi

cato

rs fo

r mon

itorin

g th

e kn

owle

dge

and

beha

viou

rs


80

Appendix III

Glossary

Appraisal: An assessment of the relevance, feasibility and sustainability of a development intervention prior to a decision on funding. Note: In development banks and agencies, the purpose of appraisal is to enable decision makers to decide whether the activity represents an appropriate use of resources.

Assessment: A process (which may or may not be systematic) of gathering information, analysing it and making a judgement on the basis of the information.

Baseline: Data on current status before commencement of an intervention which provides a base for measuring and comparing the effect of the intervention. The baseline may be the status of services (for example, coverage or utilisation data) or outcome-related measures such as knowledge, attitudes and behaviours.

Demographic and Health Survey (DHS): A nationally-representative household survey with a large sample size (usually between 5,000 and 30,000 households). A DHS provides data for a wide range of monitoring and impact evaluation indicators in the areas of population, health and nutrition.

Disease surveillance: The ongoing systematic collection, analysis and interpretation of data to describe diseases and their transmission in populations. These data can help predict future trends and target needed prevention and treatment programs. When data are collected from certain sites – for example, antenatal clinics – that are believed to be representative of the population as a whole or key population groups of interest, surveillance has the potential to provide early warning signs. This is called sentinel surveillance.

Evaluation: The systematic and objective assessment of the design, implementation and results of an ongoing or completed project, program or policy. The aims may include determining relevance, fulfilment of objectives, development efficiency, effectiveness, impact and sustainability. An evaluation should provide information that is credible and useful, enabling the incorporation of lessons learned into the decision-making process of both implementers and donors. Evaluation also refers to the process of determining the worth or significance of an activity, policy or program. Note: Evaluation in some instances involves the definition of appropriate standards, the examination of performance against those standards, an assessment of actual and expected results and the identification of relevant lessons.

Appendix III – Glossary

81

Facility survey: A site inventory of all elements required to deliver services, such as basic infrastructure, drugs, equipment, test kits, registers and trained staff. The units of observation are facilities of various types and levels in the health system and normally include both public and private facilities in the sample frame of sites. This type of survey may also be referred to as a service provision assessment. When a survey covers only facilities providing health services, it is usually called a ’health facility survey’.

Formative evaluation: A type of process evaluation undertaken during program implementation to furnish information that will guide program improvement. A formative evaluation focuses on collecting data on program operations so that needed changes or modifications can be made. Formative evaluations are used to provide feedback to program managers and other personnel about aspects of the program that are working and those that need to be changed.

Impact evaluation: The systematic identification of the broad, long-term effects (positive or negative, intended or unintended) that can at least in part be attributed to a particular project or program. Impact evaluation helps answer key questions for evidence-based policy and program development such as what works, what does not work and why.

Impact monitoring: In the field of public health, impact is usually monitored by measuring disease prevalence or incidence (see ‘disease surveillance’ above). With this type of monitoring, data are collected at provincial, regional and national levels.

Indicator: A quantitative or qualitative variable, or combination of variables, that provides a simple and reliable means to measure achievement in relation to a strategic objective, to reflect the changes connected to an intervention, or to help assess performance (for example, the percentage of female and male sex workers reporting the use of a condom with their most recent client). In order for indicators to be useful for monitoring and evaluating program results, it is important that they be objective, time-sensitive, and that regular data collection in relation to the indicator is practical.

Input and output monitoring: Involves the tracking of information about program inputs (that is, the different types of resources that go into a program) and program outputs (for example, program activities). Data sources for monitoring inputs and outputs usually exist in program documentation, such as activity reports, logs and client records, which offer details about the time, place and the quantity of services delivered, as well as the types of clients receiving services.

Integrated biological and behavioural surveillance measures HIV prevalence, and often STI prevalence, in a defined population at a point in time, as well as behaviours and demographic information, to provide a better understanding of the dynamics of the epidemic. When these surveys are repeated over time, trends in the epidemic can be measured.

Logical framework (Logframe): A management tool used to improve the design of interventions, most often at the project level. It involves identifying strategic elements (inputs, outputs, outcomes, impact) and their causal relationships, indicators, and assumptions or risks that may influence success and failure. It thus facilitates planning, execution and evaluation of an intervention. Related term: results-based management.


82

Monitoring: The routine tracking and reporting of priority information about a program and its intended outputs and outcomes. Monitoring asks: What have we achieved?

Monitoring and evaluation: Symbiotic processes that are used to measure results. These processes include collecting, managing, analysing and interpreting data produced from a variety of sources such as regular program monitoring data, surveillance and research.

Monitoring and evaluation plan: A comprehensive planning document for all M&E activities which documents the key M&E questions to be addressed. It includes baselines, targets, assumptions, what indicators are collected, how, how often, from where and why they will be collected. The plan specifies how all data will be analysed or interpreted, and how or how often reports will be developed and distributed.

Monitoring and evaluation system: The set of planning, information gathering, synthesis, reflection and reporting processes, along with the necessary supporting conditions and capacities required for the M&E outputs, to make a valuable contribution to project decision making and learning.

Monitoring and Evaluation Framework: A matrix describing the performance questions, information gathering requirements (including indicators), reflection and review events with stakeholders, and resources and activities required to implement a functional M&E system. This matrix lists how data will be collected, when, by whom and where.

Operations research: Applies systematic research techniques to improve service delivery. This type of research and evaluation analyses only factors that are under the control of program managers, such as improving the quality of services, increasing training and supervision of staff, and adding new service components. Operations research is usually undertaken to assess the accessibility, availability, quality and sustainability of programs.

Outcome evaluation: A type of evaluation that is concerned with determining if, and to what extent, program activities or services achieved their intended outcomes. Whereas outcome monitoring is helpful and necessary in knowing whether outcomes were attained, outcome evaluation attempts to attribute observed change to the intervention tested, describe the extent or scope of program outcomes and indicate what might happen in the absence of the program. Outcome evaluation is methodologically rigorous and generally requires a comparative element in design, such as a control or comparison group.

Outcome monitoring: The tracking of indicators of desired program outcomes. Changes in outcome could be attributable to multiple factors, not just the program, so outcome monitoring does not infer causality. With national AIDS programs, outcome monitoring is typically conducted through population-based surveys to track whether desired outcomes have been reached. It may also track information directly related to program clients, such as change in knowledge, attitudes, beliefs, skills, behaviours, access to services, policies and environmental conditions.

Output indicator: An indicator that measures the quantity of products and services resulting from program activities within a given timeframe. For example, the number of individual and group client counselling sessions in the past 12 months.


83

Process evaluation: A type of evaluation that focuses on program implementation, adding a dimension to information tracked in input and output monitoring. Areas commonly examined include how services are delivered, access to services and management practices. Process evaluation usually focuses on a single program and uses largely qualitative methods to describe program activities and perceptions, especially during the developmental or early implementation stage of a program. It may also include some quantitative approaches, such as surveys about client satisfaction and perceptions about needs and services. In addition, process evaluation might provide understandings about a program’s cultural, socio-political, legal, and economic contexts that affect implementation.

Process monitoring: The routine gathering of information on all aspects of project or program implementation to check on how project activities are progressing. It provides information for planning and feedback on the progress of the project to the development partners, implementers, and beneficiaries.

Program evaluation: Program evaluation is a systematic method for collecting, analysing, and using information to determine the value of and to improve programs.

Program monitoring: The process of documenting the activities of program implementation. This implies tracking HIV-related activities and services through a monitoring system where all partners submit regular, structured program reports that are externally verified.

Routine data: Are those data generated as part of the implementation of a program, activity or service. For example, every time a patient visits a hospital, the patient’s name is recorded in the hospital register. Such a register therefore contains routine data.

Second-generation surveillance: HIV surveillance that is tailored to meet the specific pattern of the epidemic in a country. It not only tracks HIV prevalence but also uses additional sources of data to increase understanding of trends of the epidemic over time. It includes biological surveillance of HIV and other STIs as well as systematic surveillance of risk behaviours.


papua new guinea national hiv and aids strategy...to the national hiv and aids strategy 2011–2015...

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