Annex A: Impact, Outcome and Coverage Indicators (including Glossary of Terms)

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1 IMPACT INDICATORS (INDICATORS PER GOAL) HIV/AIDS TUBERCULOSIS MALARIA Reduced HIV prevalence among sexually active population Reduced HIV prevalence in specific groups (sex workers, clients of sex workers, men who have sex with men, injecting drug users, tuberculosis patients, others: please specify) Reduced number of smear-positive TB cases per 100,000 population per year Reduced number of deaths from TB (all forms) per 100,000 population per year Reduced Annual Parasite Incidence x 1,000 Reduced Annual Malaria Incidence x 1,000 Reduced HIV prevalence among pregnant women Increased case detection rate Reduced Malaria Death Rate x 1,000 Reduced syphilis prevalence among pregnant women Increased treatment success rate Percentage reduction in malaria-related mortality in children under 5 years of age and other age groups Reduced percentage of children under 15 who are orphans due to HIV/AIDS Reduced percentage of HIV-infected infants born to HIV-infected mothers Increased percentage of people still alive 6,12, and 24 months after initiation of antiretroviral treatment Reduced adult HIV prevalence (ages 15-49) Increased percentage of high-risk groups that have adopted behaviors that reduce HIV transmission Reduced HIV seroprevalence in high-risk groups (sex workers, clients of sex workers, men who have sex with men, injecting drug users, TB patients, others: please specify) Reduced number of smear-positive TB cases per 100,000 population per year Reduced number of deaths from tuberculosis per 100,000 population per year Reduced HIV seroprevalence among TB patients 1

2 OUTCOME INDICATORS : HIV/AIDS Reduced percentage of people who had sex before the age of 15 (can be for specific groups) Reduced percentage of people who had sex with more than one partner in the preceding year (can be for specific groups) Increased percentage of people reporting the use of condoms during sexual intercourse with a non-regular sexual partner (can be for specific groups) Increased percentage of people reporting the use of condoms at last sex (can be for specific groups) Increased percentage of people that have adopted behaviors that reduce HIV transmission (can be for specific groups) Increased percentage of people remaining on antiretroviral treatment after 6,12 and 24 months Increased percentage of adults on antiretroviral treatment who gain weight by at least 10% at 6 months after the initiation of treatment Increased percentage of people with accepting attitudes towards those living with HIV (can be for specific groups) Increased number of employers ensuring no discrimination against People Living With HIV/AIDS (PLWHA) Decreased number of injecting drug users sharing equipment at last injection Increased number of injecting drug users never sharing equipment in the last month 2

3 HIV/AIDS Prevention Behavioral Change Communication (BCC) Community Outreach people reached by BCC outreach activities (specify activities and targets groups) Number of targeted areas with BCC services in BCC Community Outreach (can be for specific target groups) people with no incorrect beliefs about AIDS (can be for specific groups) Number of community or peer educators active in BCC Community Outreach people with knowledge of HIV prevention methods (can be for specific groups) Behavioral Change Communication (BCC) Mass Media Estimated number of people reached Number of HIV and HIV/TB radio/tv programs, newspapers, posters, leaflets, etc. produced in BCC Mass Media Blood Safety and Universal Precautions transfused blood units screened for HIV according to national guidelines Number and percentage of service delivery points applying national guidelines for blood safety and universal precautions (including prevention of accidental transmission) 3

4 Number and percentage of districts, regions or areas (to be defined) with donor recruitment and blood transfusion services Youth Education young people exposed to HIV/AIDS education in school settings Number and percentage of schools that have introduced HIV/AIDS education into the school curriculum to deliver youth education young people exposed to HIV/AIDS education in outof-school settings Condom Distribution Number of condoms sold * Number of retail outlets and service delivery points with condoms in stock (public) Number of condoms distributed for free* Number of retail outlets and service delivery points with condoms in stock (private) * Proxy for number of people reached, needs to be supported by behavior change survey. 4

5 Counseling and Testing (CT) people completing the testing and counseling process delivery points providing counseling and testing with minimum conditions to provide quality services Number of counselors trained Prevention of Mother To Child Transmission (PMTCT) Number of pregnant women completing the testing and counseling process Number of PMTCT centers established/supported Number of counselors trained HIV infected women receiving a complete course of antiretroviral prophylaxis to reduce the risk of Mother to Child Transmission Sexually Transmitted Infection (STI) Number of patients receiving diagnosis and treatment for STIs according to national guidelines (including advice on prevention and referral) Number and percentage of service points applying STI guidelines and with drugs available in STI management STI patients referred to counseling and testing centers 5

6 Post-Exposure prophylaxis (PEP) deliverers receiving post-exposure prophylaxis Number and percentage of service points with guidelines for PEP and with drugs available Programs for Specific Groups Number of people exposed to outreach programs (please specify activities and target groups) Number of community or peer educators working with specific groups (please specify) Number of community or peer educators trained to work with specific groups (please specify) HIV/AIDS Treatment Prophylaxis and Treatment for Opportunistic Infections People Living with HIV/AIDS (PLWHA) receiving diagnosis and treatment for opportunistic infections Number and percentage of service delivery points providing diagnosis and treatment of opportunistic infections Antiretroviral Treatment and Monitoring people with advanced HIV infection receiving antiretroviral combination therapy Number and percentage of service delivery points providing antiretroviral combination therapy Number and percentage of laboratories with capacity to monitor antiretroviral combination therapy according to national guidelines 6

7 Number and percentage of service delivery points with no stock out of Antiretrovirals HIV/AIDS Care and Support Care and Support for Orphans and Vulnerable Children (OVC) Number of orphans and vulnerable children receiving care and support (please specify which type) Number of organizations or service points providing care and support for orphans and vulnerable children Number of caretakers trained Number of parents of HIVpositive children counseled orphans and vulnerable children who are attending school Care and Support for the Chronically Ill and Families Affected by HIV/AIDS Number of chronically ill and/or families affected by HIV/AIDS receiving care and support Number of organizations or service points providing care and support for the chronically ill and families affected by HIV/AIDS Number of caretakers trained Number of caretakers providing services 7

8 Home-based Care Number of people reached by home-based care services Number of organizations or service points supported for home-based care deliverers (including community workers) trained in home-based care Number of home-based care workers and volunteers providing services HIV/TB Collaborative Activities Prevention of HIV in TB Patients Number of TB patients who receive HIV counseling and testing delivery points supported Number of registered TB patients who are HIV positive Number of TB facilities where condoms are available Number of TB facilities where harm reduction strategies for injecting drug users (IDU) are implemented Prevention of TB Infection in People Living with HIV/AIDS (PLWHA) Number of people reached by services Number of health-care and/or congregate settings implementing infection control policy for TB 8

9 Prevention of Opportunistic Infections in PLWHA with TB Number of HIV-positive TB patients who receive cotrimoxazole preventive therapy delivery points supported Prevention of TB Disease in PLWHA Number of newly diagnosed HIV-positive clients given treatment for latent TB infection delivery points supported Intensified TB Case Findings in PLWHA Number of PLWHA receiving HIV testing and counseling or HIV treatment and care services who were screened for TB symptoms delivery points supported Number of new cases of TB identified through screening in PLWHA receiving HIV testing and counseling and or HIV treatment and care services Provision of Antiretroviral Treatment for TB patients during TB treatment Number of HIV positive TB patients who have begun or are continuing ART, during or at the end of TB treatment delivery points supported 9

10 HIV Care and Support for HIV- positive TB patients Number of HIV-positive TB patients referred to HIV care and support services during TB treatment delivery points supported HIV and HIV/TB Supportive Environment Stigma Reduction and Respect of Confidentiality Number of PLWHA benefiting from support groups against discrimination Number of PLWHA support groups fighting against discrimination Strengthening of Civil Society Number of people reached Number of NGOs/CBOs providing HIV/AIDS prevention, treatment, care and support services according to national guidelines Workplace Policy Programs Number of employees whose enterprises/companies support interventions for prevention and medical treatment for HIV-infected persons Number of large enterprises/companies capable of providing advanced interventions for prevention and medical treatment for HIV-infected persons (please specify) Number of advocacy materials developed and distributed Advocacy Initiatives Number of policy makers sensitized on HIV/AIDS and HIV/TB 10

11 Coordination and Partnership Development Number of organizations (NGOs, CBO, public, private, others) participating in coordination networks/partnerships for HIV/AIDS activities Number of members from different organizations trained Number of multisectoral commitments formulated and implemented Number of community groups involved in HIV or HIV/TB prevention and treatment activities Number of potential partners in collaborative TB/HIV activities actively involved in planning, implementation and monitoring of TB/HIV activities Health Systems Strengthening Human Resources Number of people who received in-service training during the year Existence of national training programs for malaria, tuberculosis, HIV/AIDS (including link between HIV andtb) 11

12 Number of sites with regular supervision visits according to national training guidelines Monitoring and Evaluation (M&E) Number and percentage of service delivery points submitting complete and timely reports in M&E, statistics and data management Existence of a national M&E plan for malaria, tuberculosis, HIV/AIDS or TB/HIV Number of impact and outcome surveys related to HIV, tuberculosis, HIV/TB or malaria conducted and reported for and disseminated Health Infrastructure Development delivery points supported (please specify) Number of health facilities where both TB and HIV services are available 12

13 Procurement and Supply Management System Number and percentage of sites reporting no stock out of drugs, laboratory equipment and medical supplies (can be regional/district warehouses, offices or service delivery points) in procurement and management supply Number of sites applying national regulations regarding procurement and supply management Operational Research Number of sites implementing operational research according to national plan and guidelines in research methods Existence of a protocol for operational research for malaria, tuberculosis, HIV/AIDS or TB/HIV at the national or regional level Operational research used to feed into policy making and updating of treatment guidelines 13

14 Malaria Prevention Behavioral Change Communication (BCC) Community Outreach people reached by BCC community outreach activities (can be for specific groups) Number of targeted areas with BCC services in BCC Community outreach (can be for specific target groups) Percentage of schools that have introduced malaria prevention and treatmentseeking into the school curriculum Behavioral Change Communication (BCC) Mass Media Number of malaria radio/tv programs, newspapers, posters, leaflets, etc. produced in BCC Mass Media Vector Control Number of areas with vector control activities (IVM: Integrated Vector Management including different measures) in vector control activities (can be specific activities for specific category of personnel) Number of areas sprayed with insecticide Number of homes sprayed with insecticide (only in countries where they do indoor spraying) 14

15 Insecticide-Treated Nets (ITN) Number of LLINs (Long Lasting Insecticide Treated Nets), pre-treated nets, retreatment kits distributed, nets re-treated * Number of sentinel sites established for monitoring insecticide resistance in insecticide-treated nets (can be specific category of personnel) Number of children under the age of five sleeping under ITNs Number of households owning ITNs* Malaria in Pregnancy Number of pregnant women receiving correct Intermittent Presumptive Treatment (IPT) (only countries with national policy for IPT) in prevention of malaria in pregnancy (can be for specific category of personnel ) Number of LLINs, pretreated nets or re-treatment kits distributed to pregnant women* Prediction and Containment of Epidemics delivery points supported (provide details about the type of support) * Proxy for number of people reached, needs to be supported by behavior change survey. 15

16 Malaria Treatment Case Detection patients with lab confirmation of malaria Number of labs with regular quality control in taking blood smears, analyzing blood smears, dipstick testing (can be specific activities for specific category of personnel) Number of blood slides (or dipsticks) examined for malaria parasites Prompt, Effective Antimalarial Treatment patients with uncomplicated malaria receiving correct diagnosis and treatment Percentage of facilities with first- and second-line antimalarial drugs available (can be specific activities for specific category of personnel) patients with severe malaria receiving correct treatment children under the age of five receiving correct diagnosis and treatment within 24 hours patients who are accurately referred 16

17 people with a malaria attack getting appropriate therapy within 24 hours Monitoring of Drug Resistance Number of patients examined for drug resistance per sentinel site Number of sentinel sites established for monitoring antimalarial drug resistance (can be specific activities for specific category of personnel) Home-based Management of Malaria Number of people reached through home-based management Number of communities reached through homebased management (community members in every community) Number of community workers receiving regular supervision visits Malaria Supportive Environment Coordination and Partnership Development (National, Community, Public-Private) Number of networks/partnerships involved Number of members from different organizations trained Number of multisectoral commitments formulated and implemented Number of community groups taking action on malaria 17

18 Health Systems Strengthening Human Resources Number of people who received in-service training during the year Existence of national training programs for malaria, tuberculosis or HIV/AIDS (including link between HIV and TB) Number of sites with regular supervision visits according to national training guidelines Monitoring and Evaluation Number and percentage of service delivery points submitting accurate, complete and timely reports in M&E, statistics and data management Existence of a national M&E plan for malaria, tuberculosis, HIV/AIDS or TB/HIV Number of impact and outcome surveys related to malaria, tuberculosis, HIV/TB or HIV/AIDS conducted and reported for and disseminated 18

19 Health Infrastructure Development delivery points supported (specify) Number of health facilities where both TB and HIV services are available Procurement and Supply Management System Number and percentage of sites reporting no stock out of drugs, laboratory equipment and medical supplies (can be regional/district warehouses offices or service delivery points) in procurement and management supply Number of sites applying national rules and regulations regarding procurement and supply management 19

20 Operational Research Number of sites implementing operational research according to national plan and guidelines in research methods Existence of a protocol for operational research for malaria, tuberculosis, HIV/AIDS or TB/HIV at the national or regional level Operational research used to feed into policy making and updating of treatment guidelines 20

21 Tuberculosis Prevention Behavioral Change Communication Community Outreach people reached with BCC community outreach activities (can be for specific target groups) Number of targeted areas with BCC services in BCC Community Outreach (can be for specific target groups) Behavioral Change Communication Mass Media Number of TB and HIV/TB radio/tv programs, newspapers, posters, leaflets, etc. produced in BCC mass-media Identification of Infectious Cases Number of new smear positive TB cases detected under Directly-Observed Treatment Strategy (DOTS) delivery points supported new smear positive TB cases registered under DOTS who smear convert at the end of initial phase of treatment 21

22 Tuberculosis Treatment Timely Detection and Quality Treatment of Cases Number of new smear positive TB cases registered in a specific period delivery points supported Percentage of population living in the area of basic management units implementing the DOTS strategy re-treatment TB cases registered during a specified time period new smear positive pulmonary TB cases registered in a specified period that were cured plus the number that completed treatment (treatment success rate) Control of Drug Resistance new smear positive pulmonary TB cases registered in a specified period that are smear positive five months or more after initiating treatment (failure rate) 22

23 new smear positive pulmonary TB cases registered in a specified period that interrupted treatment for more than two consecutive months (default rate) new smear positive pulmonary TB cases registered in a specified period that were transferred to another basic management unit and for which there is no treatment outcome information Treatment of Multi-drug resistant Tuberculosis (MDR-TB) suspected cases of MDR-TB tested with drug susceptibility test Number of TB facilities delivering treatment for MDR-TB on management of MDR-TB MDR-TB patients enrolled on treatment Reduced number and percentage of MDR-TB patients who are culture negative by six months of treatment 23

24 MDR-TB patients registered in a specified period that were cured plus the number that completed treatment (treatment success rate) MDR-TB patients registered in a specified period that interrupted treatment for more than two consecutive months (default rate) TB/HIV Prevention of HIV in TB Patients Number of TB patients who receive HIV counseling and testing delivery points supported Number of registered TB patients who are HIVpositive Number of TB facilities where condoms are available Number of TB facilities where harm reduction strategies for intravenous drug users are implemented Prevention of TB Infection in PLWHA Number of people reached by services Number of health-care and/or congregate settings implementing infection control policy for TB 24

25 Prevention of Opportunistic Infections in PLWHA with TB Number of HIV-positive TB patients who receive cotrimoxazole preventive therapy delivery points supported TB/HIV Collaborative activities Prevention of TB Disease in PLWHA Number of newly diagnosed HIV-positive clients given treatment for latent TB infection delivery points supported Intensified TB Case Findings in PLWHA Number of PLWHA receiving HIV testing and counseling or HIV treatment and care services who were screened for TB symptoms delivery points supported Number of new cases of TB identified through screening in PLWHA receiving HIV testing and counseling and or HIV treatment and care services Provision of Antiretroviral Treatment for TB patients during TB treatment Number of HIV-positive TB patients who are started on or continue ART, during or at the end of TB treatment delivery points supported 25

26 HIV Care and Support for HIV-positive TB patients Number of HIV-positive TB patients referred to HIV care and support services during TB treatment delivery points supported TB and TB/HIV Supportive Environment Coordination and Partnership Development (National, Community, Public-Private) Number of community groups involved in TB or HIV/TB prevention and treatment activities Number of members from different organizations trained Number of multisectoral commitments formulated and implemented 26

27 Number of organizations (NGOs, CBO, public, private, others) participating in coordination networks/partnership for TB or HIV/TB prevention and treatment activities Number of potential partners in collaborative TB/HIV activities actively involved in planning, implementation and monitoring of TB/HIV activities Advocacy Initiatives Number of advocacy materials developed and distributed Number of policy makers sensitized on TB and HIV/TB Supporting Patients through Direct Observation Number of new smear positive pulmonary TB patients who report observation of every dose of medication according to National Tuberculosis Program guidelines 27

28 Health Systems Strengthening Human Resources Number of people who received in-service training during the year Existence of national training programs for malaria, tuberculosis or HIV/AIDS (including link between HIV and TB) Number of sites with regulatory supervision visits according to national training guidelines Monitoring and Evaluation (M&E) Number and percentage of service delivery points submitting complete and timely reports in M&E, statistics and data management Existence of a national M&E plan for malaria, tuberculosis, HIV/AIDS or TB/HIV Number of impact and outcome surveys related to HIV, tuberculosis, HIV/TB or malaria conducted and reported for and disseminated 28

29 Health and Infrastructure Development delivery points supported (please specify) Number of health facilities where both TB and HIV services are available Procurement and Supply Management System Number and percentage of sites reporting laboratory equipment, medical supplies (can be regional/ district warehouses offices or service delivery points) and no out-of-stock drugs in procurement and management supply Number of sites applying rules and regulations regarding procurement and supply management 29

30 Operational Research Number of sites implementing operational research according to national plans and guidelines in research methods Existence of a protocol for operational research for malaria, tuberculosis, HIV/AIDS or HIV/TB at the national or regional level Operational research used to feed into policy making and updating of treatment guidelines 30

31 Glossary Goal: There is usually one goal per component. A goal should be broad and overarching and will typically reflect national disease-control program goals. The results achieved will usually be due to collective action undertaken by a range of partners. Examples include Reduced HIV-related mortality, Reduced burden of tuberculosis and Reduced transmission of malaria. Impact s: List national behavioral and disease surveillance s linked to each goal. Annex A contains globally agree-upon s for measuring disease impact. Other s and descriptions can also be included. Baselines: If previous surveys have already been implemented, give details of last survey results for the particular. Targets: List targets to be reached at, or towards, the end of the proposal. If the method of collecting this information (e.g. survey) is only employed every several years, include the target for the year in which the data collection will take place, and specify the year. Technical partners involved in measurement: List the organizations that are involved in monitoring the given. These should include both national and international organizations, and should list organizations even if they are not involved in all aspects of measurement (e.g. if an organization is involved purely in survey design and does not participate in data collection or analysis, it should be included). Data source: Specific information is required about the data source for each and its baseline. For example, if a national demographic and health survey is to be used to measure an, indicate to which survey year the baseline survey relates. For s linked to service delivery areas, the data source will most likely be the implementing agencies at the district and/or provincial levels, so these agencies should be listed as the data sources. Additionally, if these data are to be centralized at the national level, give the source that will provide aggregate, national-level data. Directly Tied: Input Yes if results for this service delivery area are directly tied to Global Fund Financing. Input No if results reflect a broader program to which Global Fund resources contribute. Frequency of data collection: Indicate the frequency of data collection. This will vary considerably, depending on the type of data being collected. Service delivery coverage data (e.g. numbers trained or clients reached) may be collected monthly or quarterly, whereas data relating to impact s may only be collected annually or every two, three or five years. : The Global Fund aims to reach more people with highquality services. A central aim is to increase coverage of prevention, treatment and care of HIV/AIDS, TB and malaria, and to measure this. The service delivery area is a defined service that is being provided for example, antiretroviral therapy, support for orphans, control of TB drug resistance and indoor residual malaria spraying. A standard list of service delivery areas agreed and used by partners is provided (above and in the M&E toolkit). s form the core of performance evaluation; it is in these areas that performance is measured. s at the three levels (,, ): The Global Fund does not create new s but uses those already developed and agreed by technical partners. However, as a Fund, it needs to report on coverage across projects using common metrics not always captured by national-level s. The Fund needs to show that its activities are improving coverage in prevention, treatment and care. includes the number of people reached by services, the number of people trained and the number of service points financially supported. These should be included, where possible, in reporting to the Global Fund, even when they do not always fully fit into a traditional M&E framework. : : Process Indicators levels in providing services 31

32 : : delivery points supported by the funding Number of people reached by the services Main activities: List the key for tracking progress made towards achieving this activity and list the implementing partners involved in it, preferably including the names of the organizations to be involved. If this is not possible, then at least list the categories of implementing partners involved (e.g. academic/educational sector; government; nongovernmental and community-based organizations; people living with HIV/AIDS, tuberculosis and/or malaria; the private sector; religious/faith-based organizations; multi- or bilateral development partners). 32

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