Priscilla Akwara , PhD Senior Advisor, Statistics & Monitoring UNICEF, New York

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

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

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

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

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

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

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

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

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

10. Recommended national HIV indicators for most-at-risk populations * UNGASS INDICATORS

11. MARPS Core Indicators CONT’D… * UNGASS INDICATORS

12. MARPS HIV indicators cont’d… * UNGASS INDICATORS

13. OTHER RESOURCES 13 • UNAIDS - WWW.UNAIDS.ORG • WHO - WWW.WHO.INT • UNICEF - WWW.CHILDINFO.ORG • MACRO DHS - WWW.MEASUREDHS.ORG

14. Website: www.childinfo.org

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

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

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

18. Supply THANK YOU MERCI GRACIAS شكراً 谢谢 СПАСИБО!