Monitoring 3 by 5 Action Plan 20042005

1
Monitoring 3 by 5Action Plan 2004-2005

• WHO Task Force

December 7 2004
2
Overall goal and main functionsTask Force on 3
by 5 monitoring

• To provide accurate and timely information to
  inform and support the scale up of ART and
  related HIV/AIDS programs in developing countries
• Main functions
• Ensure effective coordination between the WHO
  departments and UNAIDS
• Take responsibility for the implementation of the
  strategic monitoring plan with a focus on major
  publications on progress towards the 3 by 5 goals
• Provide the basis for reporting progress to 3 by
  5 funding agencies

3
Principles

• Regular progress updates with wide dissemination
  (semi-)annual updates of progress towards the
  goals in a report end of 2004, mid 2005
  (intermediate), end of 2005
• Alignment close collaboration with WHO regional
  offices and UNAIDS inter country teams in data
  collection and analyses, and with major
  international partners, such as the PEPFAR, MSF,
  etc.
• Minimize country and health staff burden build
  upon existing efforts and work towards a
  sustainable system of ART monitoring that also
  has spill over effects into the general health
  information system
• Transparency use of transparent and
  understandable methods of data collection,
  analysis and estimation

4
Indicators to monitor progressExpanded set of
indicators proposed in 2003

• Core set of input and process indicators are to
  monitor WHO/UNAIDS performance
• Core set of input, process, output, outcome,
  impact indicators to monitor progress towards 35
• Special attention for key issues
• Equity
• Prevention
• Health systems

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WHO/UNAIDS performance indicators
InputProcess OutputOutcomeImpact
Additional financial resources allocated to
3by5 Staff deployed to countries by
WHO Training packages and guidance
documents Involvement partner organizations in
3by5
Countries asking for WHO support Countries
establishing 3by5 level ARV targets Countries
using AMDS
6
Funds received and pledged to WHO to support "3
by 5" by donor, December 2004
7
WHO/UNAIDS performance indicators
Additional financial resources allocated to
3by5 Staff deployed to countries by WHO 73
(32 new, 41 existing staff deployed /
realigned) Training packages and guidance
documents (well over 30 packages
available) Involvement partner organizations in
3by5
InputProcess OutputOutcomeImpact
Countries asking for WHO support Countries
establishing 3by5 level ARV targets Countries
using AMDS
8
108 partners involved in 3 by 5by the end of 2004

• Nature of partnership
• Technical 74
• Collaborative 39
• Networking 24
• Financial 13
• Political 8

• Focus of partnership
• Advocacy 45
• ART 38
• Prevention 20
• VCT 16
• Donors 16
• PMTCT 15
• Procurement 8
• Tuberculosis 1

Multiple answers possible for a single partner
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Core indicators to monitor progress towards 35
goal
InputProcess OutputOutcomeImpact
General tracking of resources for AIDS treatment
/prevention

10
Core indicators to monitor progress towards 35
goal
InputProcess OutputOutcomeImpact
Average price for ARVs per person per year
HIV/AMDS target 100-350, mid 2004
484 Production / Distribution of first line
ARVs HIV/AMDS - Industry figures from leading
producers generic and non-generic
producers Numbers trained to deliver ART
services HIV/SIR Countries that have in place
HIVDR surveillance in naïve patients (number)
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Core indicators to monitor progress towards 35
goal
InputProcess OutputOutcomeImpact
Number of outlets to deliver ART services Number
of antenatal clinics delivering PMTCT
services Number of outlets providing testing and
counseling services Proportion of ART sites
with prevention for positives activities in place
(new)
12
HIV/AIDS Care Units BRAZIL, 2004
1
1
1
1
6
1
1
4
1
7
2
1
1
5
1
4
3
1
2
1
3
1
5
2
4
7
2
2
1
12
2
2
1
1
1
1
1
1
3
TOTAL 950
1
1
2
6
4
4
12
5
2
7
Accredited hospitals 388
6
5
1
40
1
4
9
1
36
Day-care units 79
8
1
9
7
4
26
6
Outpatient units 420
55
159
18
18
91
105
3
1
12
Homecare units 63
17
16
5
26
3
10
49
29
11
Source UDAT/PN-DST/AIDS 2004
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(No Transcript)
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(No Transcript)
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Demand for knowledge of ART scale up Service
Availability Mapping
Database of health facilities that provide ART
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(No Transcript)
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2,800 districts with population 100,000-750,000
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of districts with ART, PMTCT or HIV testing
counselling services, SAM Uganda, 2004
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HIV entry point formonitoring health systems

• Health infrastructure
• Human resources
• Child and maternal health services
• TB and malaria
• Service Availability Mapping (SAM) rapid
  assessment of districts facilities .. using
  Health Mapper

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• On average, 21 registered nurses per 100,000
  population
• 5 districts have less than 10 per 100,000
  population
• 5 districts have more than 40 nurses per 100,000
  population

21
At no additional cost map other key health
services
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(No Transcript)
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Core indicators to monitor progress towards 35
goal
InputProcess OutputOutcomeImpact
Children, women, men with advanced HIV infection
receiving ART (number and percent) Containment
of ARV drug resistance of countries with ARV
drug resistance below 5, 5-15, over 15
(threshold surveys)
24
Number of public ART sites and people on
treatment,Botswana, 2002-2004
People on ART
25
Cumulative number of patients enrolled in
Abidjan, Cote d'Ivoire, ACONDA-ISPED, Jun-Oct
2004
Children 23
Women 55
Men 22
966 people on ART
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Clinical tracking-based system
Monitoring tools
Level of data collection
Status/needs
Global / regional NationalDistrictFacil
ityPatient
Global / regionalsummary-indicators
Summary indicators selectedDrugs distribution
only limited data
Nationalsummary-indicators
Summary indicators selectedDrug monitoring
systemAnalysis tools
Districtsummary-indicators
Summary indicators selectedDrugs monitoring
system in some countries analysis tools
Register manuals pilot testAIDS case
definitionDraft analysis tools
Facility registers patients, drugs
IMAI based card field test various other cards
electronic / paper-based
Patient card
27
Malawi ART monitoring system
28
Malawi ART monitoring system
29
Malawi ART monitoring system
30
Cumulative analysis of all patients started on
ART in 11 sites up to June 30, 2004 regional TB
officer, quarterly
31
Trend in number of people on ART by region, low
and middle income countries, 2002-2004
Latin America Caribbean
Sub-Saharan Africa
Asia
Eastern Mediterranean
Eastern Europe Central Asia
32
Core indicators to monitor progress towards 35
goal
InputProcess OutputOutcomeImpact
Survival among HIV infected people on treatment
(6, 12, 24 months) Age and sex-specific AIDS
mortality rates among adult population HIV
prevalence among young people and among risk
populations
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Operations research

• Real time operations research linked to program
  development while scaling up
• Many program relevant questions that cannot be
  answered by monitoring community attitudes and
  practices, stigma, adherence issues, risk
  behaviour, differential uptake of treatment,
  quality of life and productivity etc.

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Conclusion

• Comprehensive monitoring 3 by 5 plan with UNAIDS
  and WHO at core, in close collaboration with
  partners
• Real-time monitoring system regular reporting on
  3 by 5 progress while working with countries to
  build systems and providing the basis for
  WHO/UNAIDS reporting of progress to civil
  society, donors etc.
• Special attention for critical issues equity,
  health systems, prevention