Strategic Information for HIV/AIDS

Key Priorities  |   Strategic Information Spotlight  |  Technical Resources

	SOURCE: Bob Emrey, GH/HIDN

Health policymakers, international donors, managers, service providers, and other system stakeholders all need reliable HIV/AIDS data and information to make sound programmatic decisions. In fact, fostering evidence-based decisionmaking is one of the most important elements of administering HIV/AIDS programs throughout the developing world. For the most part, these data and information are now widely collected and available; however, actual use of these data to improve programs and policies remains limited. With the right information in hand, practitioners and stakeholders are better able to make decisions based on evidence. Improved use of information also promotes accountability and transparency in the decision-making process.

Key Priorities

The 2008 reauthorization of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has placed an increased emphasis on the use of operations research and evaluation to better guide programs. Specifically, this legislation calls for a strategy to “expand the integration of timely and relevant research within the prevention, care, and treatment of HIV/AIDS” and mandates “carrying out and expanding program monitoring, impact evaluation research and analysis, and operations and disseminating data and findings.” With respect to strategic information, USAID supports PEPFAR programs in three overarching areas: health management information systems, monitoring and evaluation (M&E), and surveys and surveillance.

At the heart of strategic information in support of PEPFAR is the ongoing and critical work of the PEPFAR Next Generation Indicators, in which USAID played a key technical role.  Strategic information is the cornerstone of U.S.-supported HIV/AIDS programs in developing countries, and the collection of data and information serves multiple purposes:

• to assist host country governments to plan, monitor, and manage a coordinated national response to the HIV/AIDS epidemic;
• to assist PEPFAR country teams to plan, monitor, and manage U.S. Government HIV/AIDS activities in support of the national plan;
• to provide information to PEPFAR Headquarters for management of PEPFAR;
• to demonstrate progress of PEPFAR in each annual report to the U.S. Congress; and
• to educate stakeholders about the needs and resources required for HIV/AIDS prevention, care, and treatment programs.

Health Management Information Systems
Community program and health care delivery personnel often face competing demands that make the collection and recording of daily service delivery data a challenge. Many countries lack robust health management information systems, and the related information and communications technology infrastructure needed to access and report high-quality data.  In support of PEPFAR, USAID promotes health management information systems activities that build on existing data and information system standards and infrastructures in program countries.  USAID affirms the concept of implementing the “Three Ones” at the country level: one action framework, one coordinating authority, and one monitoring and evaluation system. In support of this model, USAID provides technical leadership and resources to strengthen national capacity for collecting and compiling HIV/AIDS data at the national level for use by AIDS program managers to improve their programs. Specific achievements include collaborating with the World Health Organization to publish Patient Monitoring Guidelines for HIV Care and Antiretroviral Therapy (ART) and developing software and systems to improve data storage and flow from the sub-national to the national level.

Monitoring and Evaluation
Sustainable capacity for M&E of HIV/AIDS programs at the local, regional, and national levels is a high priority for countries affected by the HIV/AIDS pandemic.  Strong M&E programs provide data to assist countries with making policy decisions; implement planning and reporting for accountability; enable program improvement and strategic planning; and support accessible, targeted program service delivery for high-priority populations.  USAID supports the development of standardized indicators, in consultation with other national governments, multilateral donors, technical experts, and nongovernmental organizations (NGOs). These indicators enable program managers to track similar results over time and across multiple countries. The system includes two basic categories of data:

• HIV Seroprevalence Studies: HIV prevalence provides an estimate of the severity of the epidemic and the national-level impact of HIV/AIDS programs over time. USAID’s objective is to reduce the rate of HIV transmission.  HIV seroprevalence data are collected through national sentinel surveillance systems or population surveys, along with HIV testing. The International Programs Center of the U.S. Census Bureau analyzes and disseminates these data. In collaboration with various partners, such as the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention and international donors, USAID will continue to improve and expand national surveillance systems. Because the HIV status of young people is a good proxy for HIV incidence, or new infections, USAID pays particular attention to tracking HIV prevalence for those 15 to 24 years of age.
  
  
• Surveys: The most important way to slow the epidemic and reduce transmission is to change human sexual behavior. Monitoring changes in behavior also provides a measure of the success of national HIV/AIDS programs and suggests ways to improve prevention and care programs’ efficiency and coverage. USAID supports Demographic and Health Surveys (DHS), AIDS Indicator Surveys, and Behavioral Surveillance Surveys. National surveys on sexual behavior are conducted every three to five years. Indicators include sexual debut and age at first sex (measures of abstinence), extramarital sexual activity, number of sexual partners, and condom use. When the HIV epidemic is concentrated or low level, greater focus is given to sub-populations that are most vulnerable and at risk for transmission. Additionally, USAID supports MEASURE DHS to field national surveys of health facilities in order to track the scale-up of HIV/AIDS-related care and treatment services by taking inventory of existing policies, services, drugs, trained staff, and laboratory and monitoring capacity. Other studies of AIDS-related mortality are also supported through MEASURE Evaluation and the U.S. Census Bureau.

Strategic Information Spotlight
HIV/AIDS Surveillance Database This online database is an international compilation of HIV prevalence and incidence data resources from various sources for countries in Africa, Asia, Europe, Latin America and the Caribbean, and Oceania. Learn more

Increasing Surveillance Capacity
USAID has long recognized the importance of supporting high-quality surveillance data collection to track the HIV/AIDS pandemic and to measure prevalence trends in the epidemic, risk behaviors, and coverage of prevention and care services. USAID surveillance activities include support to the U.S. Census Bureau to collect and analyze HIV surveillance data and support to ORC Macro/MEASURE DHS to develop and maintain a database of key HIV/AIDS indicators on risk behaviors and HIV-related services from population surveys. The resulting databases make these data easily accessible to the Office of the U.S. Global AIDS Coordinator, countries, donors, NGOs, and other stakeholders. USAID is expanding surveillance activities to better capture a diverse and changing pandemic, strengthen national surveillance programs, and increase training for epidemiologists and service providers in developing countries. Through collaborative efforts among USAID and the Joint United Nations Programme on HIV/AIDS (UNAIDS); the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention; and other partners, second-generation surveillance systems are linking behavioral and biological data for strategic planning purposes.

Guiding Principles
USAID HIV/AIDS strategic information is produced in order to manage and improve program strategies and interventions.  Using the following guiding principles, USAID and its partners have developed various approaches to improving the use of health information in a wide variety of contexts – from primary and clinical care to high-level advocacy and policy development.

• Participation:  Data are used more often when information consumers actively participate in designing data collection and analysis.  Stakeholder participation helps ensure that relevant data are collected and analyzed appropriately, fosters ownership of the information, and leads to more information use and better decisions.  It can also improve data quality.
  
  
• Collaboration:  When several stakeholders collaborate, they develop a shared understanding and vision.  This enhances the use of data and information.
  
  
• Capacity Building:  Improving local stakeholders’ capacity to use their own data independently improves information use.  Technical assistance, which can help build capacity, is most effective when it is ongoing.
  
  
• Demand-driven:  Data collection systems should be designed to collect data that respond to demonstrated needs for decisionmaking.  Those needs should be understood from the beginning and should guide the entire cycle of data collection, analysis, and use.