integrated hiv/aids project haut katanga

INTEGRATED HIV/AIDS PROJECT HAUT KATANGA FY21 Performance Monitoring and Evaluation Plan

This document was produced by the Integrated HIV/AIDS Project in Haut Katanga consortium through support provided by the United States Agency for International Development. The opinions herein are those of the author(s) and do not necessarily reflect the views of the United States Agency for International Development or the United States government.

IHAP-HK FY21 PMEP ǀ Page iii

Table of Contents

Acronyms and Abbreviations ............................................................................................ iv

Introduction and Project Description ...................................................................................1

Critical Assumptions Necessary for Project Success ......................................................1

IHAP-HK Results Framework .............................................................................................2

IHAP-HK’s Approach to Monitoring and Evaluation .........................................................3

Data Collection and Reporting ........................................................................................4

Data Use and Application ...............................................................................................5

Data use for improved service delivery ......................................................................6

Data use for PEPFAR-specific reporting ...................................................................7

Data Quality Assurance...................................................................................................8

Monitoring and Evaluation Team ...................................................................................8

Specific Monitoring Approaches ....................................................................................8

Specific Evaluative Approaches .....................................................................................9

Collaboration with Partner Agencies and Organizations ................................................9

Appendix 1. Performance Monitoring and Evaluation Matrix ..........................................10

Appendix 2. PEPFAR Targets Provided by USAID .........................................................25

IHAP-HK FY21 PMEP ǀ Page iv

Abbreviations AIDS Acquired Immune Deficiency Syndrome ANC antenatal care ART antiretroviral therapy ARV antiretroviral medication DATIM Data for Accountability, Transparency, and Impact DBS dried blood spot DHIS2 District Health Information System 2 DPS Division Provinciale de la Santé (Provincial Health Division) DRC Democratic Republic of Congo FY Fiscal Year GBV gender-based violence GDRC Government of the Democratic Republic of Congo HCW health care worker HIV human immunodeficiency virus HTS HIV testing services HZ health zone HZMT health zone management team IHAP-HK Integrated HIV/AIDS Project in Haut Katanga iHRIS integrated Human Resource Information System IPC infection prevention and control IPT isoniazid preventive therapy IR Intermediate Result M&E monitoring and evaluation MER Monitoring, Evaluation, and Recording MOH Ministry of Health N/A not applicable NGO nongovernmental organization OPQ Optimizing Performance and Quality PEPFAR United States President’s Emergency Plan for AIDS Relief PITC provider-initiated HIV testing and counseling PLHIV people living with HIV/AIDS PMEP Performance Monitoring and Evaluation Plan PMTCT prevention of mother-to-child transmission of HIV

IHAP-HK FY21 PMEP ǀ Page v

PNLS Programme National de Lutte contre le SIDA (national HIV/AIDS program) POART PEPFAR Oversight Accountability Response Team PrEP pre-exposure prophylaxis ProVIC Projet Intégré de VIH/SIDA au Congo (Integrated HIV/AIDS Project in the

Democratic Republic of Congo) QA quality assurance QI quality improvement SCM supply chain management SIMS Site Improvement Through Monitoring System SNIS System Nationale Information Sanitaire (national health management

information system) SOP standard operating procedure TB tuberculosis TBD to be determined TB/HIV tuberculosis and HIV co-infection USAID United States Agency for International Development VCT voluntary counseling and testing

IHAP-HK FY21 PMEP ǀ Page 1

Introduction and Project Description PATH and its partner IntraHealth International are implementing a program in support of HIV/AIDS efforts of the Government of the Democratic Republic of Congo (GDRC) and the United States Agency for International Development (USAID) in 8 health zones (HZs) in Haut-Katanga Province. The overarching goal of the Integrated HIV/AIDS Project in Haut Katanga (IHAP-HK) is to help the GDRC strengthen the continuum of care for high-quality HIV/AIDS services to achieve sustained epidemic control. IHAP-HK includes interventions at the provincial, HZ, facility, and community levels. It builds on successful work by the ProVIC (Projet Intégré de VIH/SIDA au Congo) and ProVICplus projects, implemented by PATH, to improve comprehensive, integrated HIV/AIDS services in the Democratic Republic of Congo (DRC).

Critical Assumptions Necessary for Project Success IHAP-HK recognizes there are assumptions and risks that could have negative implications on the success of the project. The project has developed risk mitigation strategies, although it is also clear that not all risks can be foreseen. Whenever new threats to the project’s or team’s ability to implement high-quality and successful interventions are identified, the IHAP-HK management team will take measures to mitigate those risks and will inform USAID of steps taken. Some examples of assumptions, risks, and proposed mitigation activities are outlined below:

• Project goals and objectives are aligned with those of the GDRC, and engagement of national and provincial authorities in the planning and implementation process should result in government facilitation of and support for planned project activities. Should the GDRC change its priorities, either due to a change in elected officials or a shift in focus, IHAP-HK will seek dialogue with such officials to find common ground that will allow continued implementation of high-priority activities.

• Political instability and associated violence could result in a worsening security situation, which in turn could seriously impede the team’s ability to implement activities. To mitigate such risks, PATH, as the prime Recipient, will continue its linkage with United States government and United Nations security information networks and will revise security plans accordingly. In cases in which the security of staff cannot be guaranteed in the DRC, PATH will base some project staff members temporarily in a neighboring country to continue support for ongoing project activities. A similar situation may arise as a result of public health emergencies or natural disasters. In case of public health emergencies, PATH will take all reasonable measures to protect its staff while avoiding project disruptions.

• An important assumption underlying the project’s impact on the epidemic concerns the continued availability of antiretroviral medications, test kits, treatment for opportunistic infections, and laboratory and clinic commodities/reagents. Should there be interruptions in essential supplies, this may in turn affect the project’s ability to test people, retain them on treatment, and achieve viral load suppression. While the Early Warning System being implemented by the Global Health Supply Chain project, with IHAP-HK support at the facility level, may mitigate distribution risk at the end of the supply and logistics chain, the project will discuss more upstream risks with USAID and propose risk-mitigation solutions.


IHAP-HK Results Framework Three objectives contribute to the achievement of the overall project goal of improved HIV/AIDS response to ensure sustained epidemic control in targeted HZs in Haut Katanga. Figure 1. IHAP-HK results framework.

IR: Intermediate Result; PLHIV: people living with HIV/AIDS; TB: tuberculosis.

Objective 1 Continuum of care for

HIV/AIDS services ensured

Objective 2 Utilization of integrated

HIV/AIDS services increased at both facility-

and community-based levels

Objective 3 Health systems

strengthened to improve access to services and improve outcomes of

PLHIV

Sub-obj. 1.1: Increased availability of

comprehensive HIV prevention services

Sub-obj. 1.2: Expanded

comprehensive HIV/AIDS care and treatment services

Sub-obj. 1.4: Expanded network and referral

systems for other health and social services

Sub-obj. 2.1: Improved

community environment to support healthy

behaviors

Sub-obj. 3.1: Essential

commodities are available and

effectively managed at all appropriate

levels

Sub-obj. 3.2: Improved use of reliable data to continuously

improve service delivery quality and

effectiveness

Sub-obj. 3.3: Effective,

operational laboratory systems

Sub-obj. 2.2: Optimized service delivery models

Sub-obj. 1.3: Improved integration of TB/HIV

services

Goal: Strengthen the continuum of care for high-quality HIV/AIDS services to achieve sustained

epidemic control

Sub-obj. 1.5: Provision of a comprehensive

package of OVC services.


IHAP-HK’s Approach to Monitoring and Evaluation This Performance Monitoring and Evaluation Plan (PMEP) articulates IHAP-HK’s approach to systematic monitoring and evaluation (M&E) throughout the project lifecycle. It helps organize project reporting against critical indicators and ensures a standardized strategy for collecting, analyzing, applying, and reporting results. The PMEP includes standard United States President’s Emergency Plan for AIDS Relief (PEPFAR) and customized indicators along with established targets and identified reporting frequency. The plan will ensure that data systems are designed to meet PEPFAR and GDRC requirements and that all indicators and disaggregation’s are aligned with the current version of PEPFAR’s Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide and reported under PEPFAR’s Data for Accountability, Transparency, and Impact (DATIM). IHAP-HK will ensure that results and lessons are captured, analyzed, shared regularly, and translated into learning that is immediately applied to the project and documented for use by USAID and other partners. IHAP-HK will track not only results but also output and impact indicators alongside expenditures and other project implementation data, which will provide multidimensional, high-quality data for decision-making. Baseline data are determined by a combination of data aggregated from secondary sources and data collection as needed. As required by PEPFAR, all indicator data will be disaggregated by age, sex, site, and HZ. The IHAP-HK PMEP is built around the following principles:

• Openness, transparency, flexibility, and alignment with PEPFAR. Based on the experience and lessons learned from ProVIC and ProVICplus, PATH, with IntraHealth, builds upon existing relationships with the USAID Mission and PEPFAR in the DRC and at headquarters.

• Linkage of measurement activities to continuous quality improvement (CQI), evidence generation, and accountability. IHAP-HK staff uses M&E data to reflect on and inform decisions related to CQI and service improvement with an emphasis on data for learning. Intermittently, specific data collection and analysis will be used to assess performance and course-correct as needed. IHAP-HK will introduce a culture of curiosity about data and the functions involved in data collection through regular mentoring, capacity-building, and modeling the active use of data for decision-making.

• Alignment with existing GDRC M&E frameworks. Cognizant of the importance of coordinating all HIV/AIDS work in the DRC under the National M&E Framework, IHAP-HK works closely with the Programme National de Lutte contre le SIDA (PNLS) and the Ministry of Health (MOH) to ensure that project indicators are harmonized with national indicators, definitions, and methods of measurement and reporting, and that data collection and reporting systems are coordinated with these institutions’ M&E systems [e.g., PNLS District Health Information System 2 (DHIS2)] as well as the Système National Information Sanitaire (SNIS). This strategy contributes toward the project ensuring that its efforts are strengthening the health system in the DRC and making lasting investments in the data systems being developed. In addition, all data collected are in compliance with family planning and HIV legal and policy requirements.

The IHAP-HK M&E team works to build the capacity of facility and community-based providers in monitoring and recordkeeping by providing onsite mentorship and supportive supervision to effectively use SNIS and its data collection forms (canevas unique) as well as other M&E mechanisms used by the PNLS, HZMTs, and health facilities themselves to collect and report data. IHAP-HK will build on the work of the ProVICplus team to continue capacity-building and one-on-one mentorship for data quality assurance.


Data Collection and Reporting IHAP-HK supports staff in health facilities and HZMTs to collect and report data in the IHAP-HK project database (via the MOH’s DHIS2) and problem-solve any challenges that arise. IHAP-HK’s commitment to capacity-building includes strengthening the GDRC’s capacity to generate and use data and evidence. The IHAP-HK data collection system is synergistic wherever possible with MOH systems to reduce the burden of data entry at facility and HZ levels and support long-term capacity for data collection, reporting, and use (Figure 2). Figure 2. Data systems, synergies, and flow.

DATIM: Data for Accountability, Transparency, and Impact; DHIS2: District Health Information System 2; DPS: Division Provinciale de la Santé; HZMT: health zone management team; MOH: Ministry of Health; NGO: nongovernmental organization; PEPFAR: United States President’s Emergency Plan for AIDS Relief; PNLS: Programme National de Lutte contre le SIDA; SNIS: System Nationale Information Sanitaire; USAID: United States Agency for International Development. IHAP-HK’s data collection and reporting aligns with PEPFAR MER 2.0 version 2.5, and IHAP-HK will make further adaptations as needed to align with any future PEPFAR MER updates. All data possible will be collected from the national canevas unique template,

Aggregated and validated d ata for analysis and decision - making:

Annual microplanning . Monthly 95-95-95

analysis meetings with PEPFAR, partners, and MOH.

DHIS2

Electronic database

(DHIS2: Aggregate, Tracker)

Health Zone

Facility

IHAP - HK Database (DHIS2) DHIS2 and SNIS (DHIS2)

DATIM (DHIS2) SNIS (DHIS2 ) DHIS2

PNLS (National)

Tier.Net

PNLS and DPS (Provincial)

National level IHAP/USAID Health zone Service delivery

Data reporting Feedback loop

LEGEND

MOH

IHAP - HK/L

PEPFAR/USAID

Paper - based tools: (e .g ., canevas unique , patient registers)

NGO activity reports; peer educator outreach forms

Community

Electronic database

-

Monthly review of facility and

community 95 - 95 95 dashboards (DHIS2:

Aggregate, Tracker)

Health zone microplanning

• Collects strategic information (national and HZ data and statistics, program and service data, and key informant interviews with stakeholders).

• Analyzes the HIV micro-epidemic at the HZ level (per 95-95-95 targets).

• Concludes with data-driven planning of targeted and prioritized interventions.


entered into the project DHIS2 database, and disaggregated according to the new guidelines. When required data are not available from the national template, IHAP-HK will actively collect data from health facility registers using an annex to the template. The project team will submit quarterly reports to the IHAP-HK Agreement Officer’s Representative and IHAP-HK Agreement Officer. These reports will summarize activities conducted during the reporting period and provide an update on progress made toward activities outlined in the implementation plan and PMEP; these reports will also include an M&E table with achievements made toward project targets. The project will submit detailed indicator reports on DATIM every quarter to the DRC PEPFAR team to allow them to monitor project progress against targets. IHAP-HK will share monthly site-level data with USAID for the indicators selected by USAID for monthly partner performance reviews, to the greatest extent possible. Furthermore, IHAP-HK will submit weekly and monthly data for key indicators in accordance with the USAID Office of HIV/AIDS High Frequency Reporting (HFR) guidance version 2.2. IHAP-HK will also respond to data requests from USAID for its Annual Portfolio Review process and PEPFAR Oversight Accountability Response Team (POART) processes. The majority of IHAP-HK–supported hub facilities (81 of 105) now enter data into Tier.Net (a database that manages the project’s antiretroviral therapy cohort) and DHIS2 on their own. IHAP-HK provides technical assistance during regular monitoring visits to facilities to ensure that facilities enroll all people living with HIV (PLHIV) in Tier.Net when initiating patients on treatment and regularly update patient records on Tier.Net. IHAP-HK staff also coach facility-based providers to use the Missed Appointment Tracker tool, populated using Tier.Net data and facility registers, and monitor efforts to trace PLHIV who miss appointments. Similarly, project staff support facility-based providers to use Tier.Net records to identify PLHIV eligible for VL counts and ensure timely VL sample collection. IHAP-HK also support facilities to submit Tier.Net dispatches to their respective HZMTs using DropBox, with HZMTs reviewing and submitting zonal dispatches to the national PNLS (using outil de transfert and ONGDIV) In FY21, IHAP-HK, with FHI 360/EpiC, will continue investigating the feasibility of facilitating interoperability between Tier.Net, DHIS2, and FHI 360’s application (DDD app) for gathering out-of-facility antiretroviral treatment dispensing data. If interoperability between these systems are possible and this the addition of the DDD app does not entire additional costs or parallel processes (outside of current project and national reporting systems), IHAP-HK will coordinate with FHI 360 and relevant government bodies to roll out use of the mobile application at community-based points distributing antiretroviral treatment and care services to PLHIV.

Data Use and Application Data are shared appropriately and used to improve programming. IHAP-HK shares data with USAID and PEPFAR through DATIM and M&E tables included in quarterly reports, project-supported health facilities and partners, counterparts at the provincial and HZ levels, community-based partners, and other stakeholders to identify problems and root causes, refine strategies, document best practices, and improve overall project performance. In addition, IHAP-HK holds regular data review meetings to close the reporting loops with HZ staff, which ensures that those who collect data are involved in the analysis and interpretation of data to understand and invest in the approaches moving forward. IHAP-HK will adapt systems and plans as required by any changes in PEPFAR MER indicators throughout the life of the project.


In alignment with these guiding principles, the PMEP and data collection system are part of a learning, data-driven culture, both within the IHAP-HK team and for the collaborating health care workers (HCWs), managers, and other key stakeholders. IHAP-HK’s M&E Advisor will coordinate and collaborate with other USAID- and CDC-funded projects focused on strengthening health information systems in the DRC.

Data-use for improved service delivery IHAP-HK will use the microplanning process developed by PATH to ensure that interventions in each HZ are highly targeted, focus on specific priority populations, and engage all relevant actors. This decentralized and participatory planning based on evidence from each HZ improves ownership and coordination of HIV/AIDS activities. A primary component of the IHAP-HK project is to improve use of reliable data to continuously improve service-delivery quality and effectiveness, as detailed in sub-objective 3.2. There are multiple barriers to the systematic use of data for decision-making at all levels of the health system. IHAP-HK will strengthen and support systematic use of high-quality, timely, and reliable data by nongovernmental organizations (NGOs), facilities, and HZs by employing a bottom-up approach to strengthen information and data processes at the site level and above while ensuring both use of data where data are generated and feedback from higher to lower levels. Strategies/approaches IHAP-HK uses a multifaceted strategy to explore, implement, and adapt interventions to improve use of data on service delivery and human resources:

• Continuing the microplanning process and improving facility-level filing systems to build capacity in data-use among HZMTs and facility staff.

• Streamlining information systems and interoperability to improve timeliness and accuracy in data reporting, minimize provider- and HZ-level staff time spent reporting to multiple databases, and maximize staff time spent analyzing data.

• Improving use of information at the facility and HZ levels through a visualization platform that enables and fosters feedback.

• Generating, evaluating, and disseminating data to promote continuous learning.

Activities Activities to enhance use of data to improve services focus on the following elements. Data quality. The IHAP-HK M&E team will provide regular onsite mentorship in the monthly use of data quality/validation tools. Similar data quality mentoring will be provided to community-based organizations and NGOs, and IHAP-HK will support HZMTs, facilities, and NGOs to conduct regular data-quality audits, focusing on conducting data quality audits in 80 facilities total in FY21.

95-95-95 Dashboard: Visualization for data-driven quality

improvement

• Excel- and Tableau-based visualizations showing monthly and over-time comparative progress against 95-95-95 targets at facility and HZ levels.

• Visual format to enable easier identification of gaps in testing, care, treatment, adherence, and laboratory services.

• Built on IHAP-HK indicator data, including HTS_TST, TX_NEW, TX_CURR, and TX_PVLS.


Data-use for CQI. IHAP-HK aims to create an environment in which near-real-time data are available and used for CQI of ongoing services in both facilities and community service-delivery settings. To achieve this, IHAP-HK will support a transition from paper-based to electronic data collection and reporting systems at the service-delivery level, starting with technical assistance and training to ensure paper-based data are entered into the DHIS2 and Tier.Net databases. The IHAP-HK team will continue to use a paper-based 95-95-95 Dashboard poster that visualizes a facility’s performance against key indicators related to epidemic control. These Dashboards are posted on the wall of each project-supported health facility, and facility-based service providers (with support from IHAP-HK technical officers and site support coordinators) update these on a monthly basis, analyze trends in performance and achievement against targets, and consider strategies to address underperformance. The Dashboards show gaps in performance and indicate areas for CQI (sub-objective 2.2). IHAP-HK will also continue developing Tableau-based visualizations and dashboard tools, which will allow users to assess aggregated or to disaggregate by sex, age, and facility data against key indicators and technical areas for regular performance reviews. This tool will be used by IHAP-HK technical staff and rolled out at the facility levels as part of DHIS2 rollout. Data flows. Figure 2 above shows data flows through IHAP-HK facilities and HZs. Until the DHIS2 database is functional at the facility and community levels, IHAP-HK will support the transfer of paper-based data to the HZ level. Using DHIS2, the majority of facilities and NGOs in Haut Katanga directly upload project data into the project’s DHIS2 instance for transmission to USAID via DATIM. IHAP-HK will support data transfer for facilities in areas with poor access to electricity by transporting either paper copies or USB flash drives to HZMTs for uploading into the DHIS2 database. Data-use for planning. IHAP-HK provides technical support to HZ Data Managers to aggregate, validate, and analyze data received from facilities and NGOs on a monthly basis.

Data-use for PEPFAR-specific reporting IHAP-HK’s M&E reporting activities adhere to PEPFAR processes and support specific PEPFAR initiatives, as outlined below:

• Site Improvement Through Monitoring System (SIMS). IHAP-HK assists USAID as needed with data collection for the SIMS assessment, provides written remediation plans for facilities that score “red” or “yellow,” supports site-level improvements within three to six months, and remains flexible to any adaptations in PEPFAR reporting. IHAP-HK uses SIMS indicators on an ongoing basis to monitor and improve the quality of the sites.

• POART quarterly data reviews. IHAP-HK continues to support USAID in the preparation and debriefing of the quarterly POART reviews. This includes an assessment of all available data, including SIMS, MER, financial and partner-level results along with contextual information about implementation and any existing challenges.

• Expenditure reporting. IHAP-HK reports on expenditures on an annual basis, in alignment with PEPFAR’s Expenditure Reporting procedures. Project achievements and expenditure data will also be used to identify areas in which greater efficiency can be achieved.

Data-quality improvement tools

• PEPFAR’s M&E systems strengthening tool

• PATH’s data quality assurance tool for program-level indicators


• High-frequency reporting. IHAP-HK reports weekly and monthly data on select indicators to the USAID Mission in DRC in alignment with HFR guidance version 2.2. IHAP-HK analyzes this data and uses findings to inform timely course-corrections as needed related to pre-exposure prophylaxis initiation, HIV testing, ART initiation and retention, and multi-month ART dispensing.

Data Quality Assurance IHAP-HK uses a multilayered system to facilitate data collection at the community, facility, and health-system levels. Data collection methods and procedures, along with appropriate capacity-building efforts, are implemented by all IHAP-HK partners and health facilities. IHAP-HK’s M&E team periodically conducts data quality assessments and verification activities to ensure accurate reporting and efficient management of PEPFAR funds. These data quality activities ensure that:

• Data are collected using a consistent collection process (standardized data collection tools).

• Data are collected using methods to minimize sampling and non-sampling errors.

• Data are collected with precision, including required details and disaggregations.

• Data are collected by qualified personnel who are properly supervised.

• Data analysis focuses on reduction of double-counting and duplicated data.

• Safeguards are in place to prevent unauthorized changes to the data and protect individual data.

• Source documents are maintained and readily available. Additionally, data verification requirements are included in scopes of work for IHAP-HK sub-partners, and payments are tied to data-validation processes by the IHAP-HK M&E and technical teams. Through the application of these tools and principles, IHAP-HK assesses data quality according to USAID’s six data-quality standards—validity, integrity, precision, reliability, timeliness, and confidentiality—and works to improve data quality as appropriate.

Monitoring and Evaluation Team IHAP-HK’s M&E team comprises a Senior Strategic Information Advisor, a Data Systems Officer, an M&E—Orphans and Vulnerable Children Officer, a Health Information Systems Developer, and two data clerks. PATH’s M&E team based in the United States and Senegal provides technical assistance, and other IHAP-HK technical staff contribute to the data collection and analysis process and are instrumental in using generated analysis and data to drive decision-making.

Specific Monitoring Approaches The IHAP-HK team collects monitoring data on activities conducted in project-supported facilities and surrounding communities as well as activities in support of health systems strengthening. IHAP-HK uses existing monitoring tools and mechanisms such as facility patient registers and HZMT reporting forms. At minimum, data are collected monthly


through IHAP-HK’s DHIS2 M&E system and Tier.Net. Data are analyzed and reported on a quarterly basis through project reports to USAID and uploaded into the DATIM system, in accordance with PEPFAR reporting guidelines. Further, as part of the project’s weekly monitoring system and in conjunction with HFR 2.2, IHAP-HK collects and reviews select data on a weekly basis against key indicators or technical priority areas to monitor progress against annual indicators and inform potential implementation adaptations to increase impact or address gaps. As part of capacity-building activities for project-supported facilities, IHAP-HK assesses all monitoring reports for timeliness, completeness, and data quality and provides technical assistance as needed to ensure accurate reporting. At site level, IHAP-HK implements a performance-based financing (PBF) model to incentivize facility-based health care providers to adopt and implement key strategies with fidelity (e.g., efficient case-finding, index testing, immediate treatment initiation, patient cohort management using Tier.Net, etc.). Under this model, IHAP-HK measures monthly performance against key indicators including HTS_TST, TX_NEW, and TX_CURR, correct packaging of dried blood spot or plasma-based blood samples, timely complete completion of data entry in Tier.Net by a facility-based data clerk, and completeness of facility-level, monthly CQI plans.

Specific Evaluative Approaches IHAP-HK will work with USAID and other counterparts to explore strategies to evaluate the success and impact of project interventions to inform decision-making by USAID and other stakeholders on current and future programming. Internal routine analysis of programmatic data will be conducted by examining MER and other indicators identified in this PMEP and conducting trend analyses to inform project-management decisions as well as capture lessons learned and disseminate these through success stories, presentations, case studies, and technical briefs. IHAP-HK recognizes that an external evaluation of the project may be planned for and funded by USAID. The project looks forward to collaborating to make this external evaluation a success and plans to apply any learning from this evaluation toward ongoing or future implementation. In addition, IHAP-HK will continue moving forward a learning agenda that presents opportunities to answer questions related to the effectiveness and efficiency of different testing, care, adherence, and treatment interventions, including frequent analyses of sub-sets of IHAP-HK’s treatment cohort to understand factors impacting mortality, loss to follow-up/interruption in care, adherence/retention, and viral suppression.

Collaboration with Partner Agencies and Organizations Implementation of the PMEP depends heavily on developing linkages with national and provincial-level government agencies, donors, local NGOs, and other health projects. IHAP-HK will collaborate with key USAID implementing partners for data- and information-sharing purposes.


Appendix 1. Performance Monitoring and Evaluation Matrix The following matrix outlines key indicators and targets for IHAP-HK for the life of the project, in alignment with USAID and PEPFAR guidance.

Result/indicator Indicator definition

Source of data/ method of collection

Frequency of reporting

Targets

FY17 FY18 FY19 FY20 FY21

Objective 1: Continuum of care for HIV/AIDS services ensured IR 1.1: Increased availability of comprehensive HIV prevention services PrEP_CURR Number of

individuals, inclusive of those newly enrolled, that received oral PrEP to prevent HIV during the reporting period.

PrEP register Twice annually

N/A N/A N/A 80 2,297*****

PrEP_NEW Number of individuals who were newly enrolled on oral PrEP to prevent HIV infection in the reporting period.

PrEP register Twice annually

N/A N/A N/A 60 1,983*****

HTS_TST Number of individuals who received HTS and received their test results.

PITC registers, VCT registers, ANC registers, labor and delivery registers, TB registers, PNLS data reporting template

Quarterly

213,086 318,195 287,348 217,861 301,274





Targets


HTS_TST_POS Number of individuals who received HTS and received positive test results.


Quarterly

6,894 13,933 12,913 12,085 14,726

HTS_INDEX Number of individuals who were identified and tested using index testing services and received their results.

Index case testing register

Quarterly

N/A N/A 18,884 18,221 27,145

HTS_SELF Number of individual HIV self-test kits distributed.


Quarterly

N/A N/A N/A 200 39

PMTCT_STAT (numerator)

Number of pregnant women with known HIV status at first visit (ANC1) (includes those who already knew their HIV status prior to ANC1).

ANC registers, labor and delivery registers, PNLS data-reporting template

Quarterly

74,778 66,604 78,514 54,623 54,599





Targets


PMTCT_STAT_POS Number of pregnant women with known HIV-positive status at ANC1 (includes those who already knew their HIV-positive status).


Quarterly

N/A N/A 1,088 793 1,241

PMTCT_STAT (denominator)

Number of new ANC clients within the reporting period.


Quarterly

76,304 67,913 80,154 54,599 54,599

PMTCT_EID

Number of infants who had a first virologic HIV test (sample collected) by 12 months of age during the reporting period.

Mother-baby pairs registers, laboratory intake forms for DBS samples, registers, PNLS data-reporting template

Quarterly

1,247 1,357 1,452 732 1,262

PMTCT_FO Number of HIV-exposed infants with a documented outcome by 18 months of age disaggregated by outcome type.


Annually

N/A N/A N/A N/A N/A





Targets


PMTCT_HEI_POS Number of HIV-infected infants identified in the reporting period, whose diagnostic sample was collected by 12 months of age.


Quarterly

N/A N/A N/A N/A N/A

PMTCT_ART

Number of HIV-positive pregnant women who received ART to reduce the risk of mother-to-child transmission during pregnancy.

ANC registers, labor and delivery registers, ART registers, PLHIV patient-file registers, PNLS data reporting template

Quarterly

1,182 1,413 1,498 768 1,220

IR 1.2: Expanded comprehensive HIV/AIDS care and treatment services TX_NEW Number of adults

and children newly enrolled on ART.

ART registers, Tier.Net, PNLS data reporting template

Quarterly

6,267 11,732 13,929 12,836 14,318

TX_CURR Number of adults and children currently receiving ART.


Quarterly

27,454 31,501 42,658 38,975 52,221

TX_ML Number of ART patients with no clinical contact or ARV pick-up for greater than 28 days since their last expected clinical contact or ARV pick-up.


Quarterly

N/A N/A N/A N/A N/A





Targets


TX_RTT Number of ART patients with no clinical contact or ARV pick-up for greater than 28 days since their last expected contact who restarted ARVs within the reporting period.


Quarterly

N/A N/A N/A N/A N/A

TX_PVLS (numerator)

Number of ART patients with suppressed VL results (<1,000 copies/ml) documented in the medical or laboratory records/LIS within the past 12 months.

ART registers, Tier.Net, laboratory registers

Quarterly

10,521 14,244 27,242 33,680 46,481

TX_PVLS (denominator)

Number of ART patients with a VL result documented in the medical or laboratory records/LIS within the past 12 months.


Quarterly

14,857 18,038 34,487 35,590 49,013

IR 1.3: Improved integration of TB/HIV services





Targets


TB_STAT (numerator)

Number of new and relapsed TB cases with documented HIV status during the reporting period.

TB registers, PNLS data-reporting template

Quarterly

5,528 5,267 5,788 3,988 3,872

TB_STAT (denominator)

Total number of new and relapsed TB cases during the reporting period.


Quarterly

5,528 5,267 5,793 3,952 3,872

TB_ART Number of TB cases with documented HIV-positive status who start or continue ART during the reporting period.


Quarterly

943 1,127 1,318 440 1,494

TB_PREV (numerator)

Among those who started a course of TPT in the previous reporting period, the number that completed a full course of therapy.


Twice annually

N/A 6,147 6,316 22,064 43,371

TB_PREV (denominator)

Number of ART patients newly started on TB preventive therapy.


Twice annually

N/A 7,228 7,439 31,379 48,187





Targets


TX_TB Number of ART patients who were started on TB treatment during the semiannual reporting period.


Twice annually

N/A 31,485 42,650 41,758 53,293******

Proportion of health care facilities providing PLHIV services that have TB IPC policies

Number of health care facilities with TB IPC policies/total number of health care facilities providing services for PLHIV.

Facility records Annually

30% 30% 65% 80% 90%

IR 1.4: Expanded network and referral systems for other health and social services GEND_GBV Number of people

receiving post-GBV clinical care based on the minimum package.

GBV screening forms and medical records, GBV registers

Twice annually

N/A 86 190 40 40

Number of documented referrals

Number of documented referrals (completed or uncompleted), disaggregated by type of referral.

Referral registers Quarterly

N/A TBD TBD TBD TBD

IR 1.5: Provision of a comprehensive package of OVC services





Targets


OVC_SERV Number of beneficiaries served by PEPFAR OVC programs for children and families affected by HIV.

PEPFAR OVC program registers, project records

Twice annually

N/A N/A N/A N/A 12,654

OVC_HIVSTAT Number of orphans and vulnerable children (<18 years old) with HIV status reported, disaggregated by HIV status.

HIV test results self-reported by OVC or caregivers, results of HIV risk assessments conducted by IPs, registers, referral forms, client records, other confidential case management and program monitoring tools that track those in treatment and care

Twice annually

N/A N/A N/A N/A TBD

OVC_DISCL Percentage of HIV-positive OVC enrolled in IHAP-HK’s OVC program who are aware of their HIV status.

OVC case management records

Quarterly

N/A N/A N/A N/A 80%





Targets


OVC_TX_NEW Percentage of newly-diagnosed HIV-positive orphans and vulnerable children (<18 years old) newly enrolled on ART.


Quarterly

N/A N/A N/A N/A 95%

OVC_TX_CURR Number of orphans and vulnerable children (<18 years old) currently on ART during the reporting period.


Quarterly

N/A N/A N/A N/A TBD

OVC_TX_ADH Percentage of orphans and vulnerable children (under 18 years old) who appeared at their scheduled ART refill appointment during the reporting period.

ART registers, Tier.Net

Quarterly

N/A N/A N/A N/A 90%

OVC_TX_PVLS Percentage of OVC on ART with suppressed viral load result documented in their medical record in the past 12 months


Quarterly

N/A N/A N/A N/A 95%





Targets


OVC_NUT Percentage of OVC (below five years of age) enrolled in IHAP-HK's OVC program assessed as undernourished and referred for nutritional support.

OVC case management records, Project records

Twice annually

N/A N/A N/A N/A 100%

OVC_PREV Number of adolescents and youth in households of enrolled OVC who received a minimum package of HIV prevention services.

OVC case management records, Project records

Twice annually

N/A N/A N/A N/A TBD

OVC_GBV Number of enrolled OVC beneficiaries receiving post-GBV clinical care based on the minimum package.

GBV screening forms and medical records, OVC case management records, GBV registers

Twice annually

N/A N/A N/A N/A TBD





Targets


OVC_EDUC Percentage of enrolled children, adolescent, and caregivers (<18 years) who were enrolled and completed an annual school term.

OVC case management records; project records

Annually

N/A N/A N/A N/A 90%

OVC_EDUC_GIRLS Percentage of enrolled female OVC and caregivers (<18 years) who transitioned from primary to secondary school.


Annually

N/A N/A N/A N/A 80%

OVC_ECON Number of enrolled vulnerable OVC households who received economic support services.


Twice annually

N/A N/A N/A N/A 233

Objective 2: Utilization of integrated HIV/AIDS services increased at both facility- and community-based levels IR 2.1: Improved community environment to support healthy behaviors





Targets


PP_PREV Number of priority populations reached with standardized, evidence-based interventions that are designed to promote the adoption of HIV-prevention behaviors and service uptake.

Project records Twice annually

N/A 1,600 1,770 1,023 671

KP_PREV Number of key populations reached with individual and/or small group–level HIV prevention interventions designed for the target population.

Project records Twice annually

N/A N/A N/A N/A 1,740****

IR 2.2: Optimized service delivery models Number of health zones with contextualized approaches to increase service use

Number of health zones with documented approaches to increase service utilization (e.g., innovative community-based delivery of ARVs, targeted community testing, etc.).

Project records Annually

4 12 14 8 8





Targets


Number of QA/QI teams implementing the IQPM or QA/QI approach in health facilities.

Number of IQPM teams completing requirements regularly.


24 43 162 24 105

Percentage of decisions in project-supported facility quality improvement plans that were fully implemented

Number of decisions within a facility’s monthly QI/remediation plan that are fully implemented within the month.

Project records Quarterly

N/A N/A N/A N/A 100%

Objective 3: Health systems strengthened to improve access to services and improve outcomes of PLHIV HRH_CURR Number of health

care workers at the facility/site level who are working on HIV-related activities (e.g., prevention, treatment) and are receiving any type of support from PEPFAR, as well as total spend on these workers.

Grant agreements Annually

N/A N/A N/A 1,549* --

IR 3.1: Essential commodities are available and effectively managed at all appropriate levels SC_ARVDISP Number of ARV

bottles (units) dispensed within the reporting period by ARV drug category.

Facility dispensing records

Twice annually

N/A N/A N/A N/A N/A





Targets


SC_CURR The number of ARV drug units) at the end of the reporting period by ARV drug category.

Facility dispensing records, stock records

Twice annually

N/A N/A N/A N/A N/A

Percentage of health facilities without stockouts of essential drugs for HIV/AIDS and TB management

Number of health facilities with zero stockouts of essential drugs for HIV/AIDS and TB management/total number of health facilities.

Facility records Quarterly

96% 100% 100% 100% 100%

IR 3.2: Improved use of reliable data to continuously improve service delivery quality and effectiveness EMR_SITE Number of

PEPFAR-supported facilities that have EMR system within the following service delivery points: HTS, care and treatment, antenatal or maternity services, EID or under-5 clinic, or TB/HIV services.


23 38 153 103** 105





Targets


Number of health zones with microplanning completed.

Number of microplans developed by HZMTs with IHAP-HK/L assistance.

Facility records Annually

16 9 18 8*** 8

Percentage of facilities implementing data quality assurance.

Number of facilities implementing a data quality–assurance process.


6% 30% 50% 70% 75%

IR 3.3: Effective, operational laboratory systems ensured LAB_PTCQI Number of

PEPFAR-supported laboratory-based testing and/or PoC testing sites engaged in CQI and proficiency testing activities.

Facility and laboratory records, project records

Annually

N/A N/A N/A N/A N/A

Percentage of laboratories with SOPs and complying with safety and environmental standards

Number of hospital laboratories with SOPs and safety standards implemented/total number of laboratories.

Facility and laboratory records, project records

Annually

60% 70% 90% 100% 100%





Targets


Percentage of laboratories that participated in at least one PNLS HIV proficiency test.

Number of laboratories that completed at least one PNLS proficiency test/total number of laboratories enrolled in the proficiency testing program.

Facility results from PNLS HIV proficiency tests.

Annually

N/A N/A 50% 80% 100%

Indicator and target notes: *IHAP-HK was not assigned a target for FY20; for HRH_CURR in FY20, this was calculated based on number of health care workers budgeted for FY20 per the COP 19 HRH Budget (Annex 1).

**IHAP-HK was not assigned a target for FY20 or FY21; we assume we should target 100% of sites, which will be 102 facilities in FY20 (reduced from 159 in FY19 due to the transition in Lualaba to a local implementing partner) and 105 facilities in FY21.

***The reduction of health zones from 18 in FY19 to 8 in FY20 is due to the reduction in health zones supported by IHAP-HK as a result of the transition of Lualaba province to a local implementing partner.

****As instructed by our Agreement Officer’s Representative via email on May 1, IHAP-HK will not be implementing key population-related activities in FY21, so this indicator needs to be removed from IHAP-HK’s record in DATIM. IHAP-HK will not be reporting against this indicator in FY21.

*****As per verbal guidance provided by the DRC/Mission in Q2 FY20, IHAP-HK is required to report clients newly enrolled and continued on PrEP by EpiC/FHI 360 in DATIM. It is not specified if these targets are inclusive of PrEP clients managed by EpiC/FHI 360.

******The target for this cohort-based indicator is larger than the assigned annual target for TX_CURR, which is illogical. We are assuming that this target should equal our assigned TX_CURR target max.

Note: ANC, antenatal care; ART, antiretroviral therapy; ARV, antiretroviral; DBS, dried blood spot; GBV, gender-based violence; HTS, HIV testing services; HZMT, health zone management team; IHAP-HK/L, Integrated HIV/AIDS Project in Haut Katanga and Lualaba; IPC, infection prevention and control; IPT, isoniazid preventive therapy; PEPFAR, United States President’s Emergency Plan for AIDS Relief; PITC, provider-initiated testing and counseling; PLHIV, people living with HIV/AIDS; PMTCT, prevention of mother-to-child transmission of HIV; PNLS, Programme National de Lutte contre le SIDA (National Program for the Fight against AIDS); PrEP, pre-exposure prophylaxis; QA, quality assurance; QI, quality improvement; SOP, standard operating procedure; TB, tuberculosis; VCT, voluntary testing and counseling.


The below table presents IHAP-HK PEPFAR targets specifically for FY20, by age, as extracted from DATIM on August 6, 2020. Table 3: IHAP-HK/L FY21 targets.

Age <15 years Age 15+ years IHAP-HK Total GEND_GBV N/A N/A 40 HTS_TST 48,630 252,644 301,274 HTS_TST (index) 11,403 15,742 27,145 HTS_TST_POS 1,890 12,836 14,726 HTS_SELF N/A 39 39 PMTCT_ART 34 1,186 1,220 PMTCT_EID 1,262 N/A 1,262 PMTCT_STAT 74 54,525 54,599 PMTCT_STAT_POS 34 1,207 1,241 PP_PREV 226 445 671 PrEP_CURR N/A 2,297 2,297 PrEP_NEW N/A 1,983 1,983 TB_ART 170 1,324 1,494 TB_PREV_N 5,481 37,890 43,371 TB_STAT 240 3,632 3,872 TX_CURR 6,512 45,709 52,221 TX_NEW 1,875 12,443 14,318 TX_PVLS_N 5,792 40,689 46,481 TX_PVLS_D 6,091 42,922 49,013 TX_TB 6,651 46,642 53,293 KP_PREV* N/A N/A 1,740

* Target erroneously assigned to IHAP-HK in DATIM; IHAP-HK will not be providing prevention services to key populations, as directed by our Agreement Officer’s Representative.

integrated hiv/aids project haut katanga

Documents