This document offers guidance in planning, monitoring, and evaluating programmes in settings where HIV affects men who have sex with men (MSM), sex workers, and transgender people. It represents the result of a large individual and multiple agency collaboration. The objectives of these guidelines are to:
- Support monitoring and evaluation (M&E) systems that are responsive to local HIV epidemics among sex workers, MSM, and transgender people;
- Provide guidance for M&E of prevention programmes at 3 levels: the national, sub-national, and service delivery levels;
- Recommend indicators for monitoring and evaluating HIV prevention programmes at the national, sub-national and service delivery levels;
- Describe methods to estimate indicators and generic forms to collect indicator data;
- Include methods that facilitate meaningful involvement of MSM, sex workers, and transgender people;
- Incorporate experienced-based and qualitative evidence;
- Encourage timely sharing of data between national/sub-national and service delivery levels;
- Promote the use of programme implementation pathways using input-output-coverage models;
- Facilitate use of the guidelines with simple checklists, decision trees, and examples;
- Provide methods that can be used to identify and prioritise questions for operations and effectiveness research; and
- Provide links to relevant tools and resources.
The guidelines are organised using the 8-step "Public Health Questions Model". The 8 steps are adapted to the HIV epidemic, specifically:
- Know your epidemic
- Identify determinants of the epidemic
- Know your response
- Identify inputs required
- Assess quality of the delivered response
- Assess adequacy of coverage
- Monitor programme outcomes and evaluate programme effectiveness
- Monitor HIV impact and whether program has reduced new HIV infections
For each of the 8 steps, the following are presented: rationale (why is this step important?); flowchart of key questions, methods, and data use; how to answer key questions and use data; methods and tools; and summary and additional information.
As outlined in the guidelines, this process has many communication-centred aspects, such as: "Convening a local forum for people from a variety of disciplines, perspectives and experiences to discuss the size and characteristics of the local population of sex workers, men who have sex with men, and transgender people can be very useful. It can identify people who can help in the effort to prevention HIV transmission. Information from the forum can be used to plan mapping venues where sex workers, men who have sex with men, and transgender people can be reached....Here is one strategy for local mapping:
- Ask 50-100 local people where sex workers, men who have sex with men, and transgender people can be reached. Ask people who are likely to know how to reach the population such as street vendors, youth, taxi drivers.
- Visit and map all places named.
- Interview people socializing at these locations about their behaviour and any other locations where sex workers, men who have sex with men, and transgender people can be reached.
- Determine whether the venue would be suitable for outreach activities.
- Map the locations of each place on hand-drawn maps or use global positioning equipment and digital maps or photos. Geographic data from global positioning system (GPS) units can be displayed on free Google Earth images...
- Key populations can be made more vulnerable if the mapping exercises are not managed with appropriate controls and results are presented without full consideration of how maps may be misused or undermine confidentiality. Maps can draw unwanted attention to vulnerable populations. In addition, when combined with other data, location can be a unique identifier of individuals."
Email from MEASURE Evaluation to The Communication Initiative on March 21 2012. Image courtesy of The Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008