Strategic InformationFor HIV/AIDS Prevention,

Treatment, Care and Support

Overview of Presentation

Overall Program Evaluation Vision & Design

Strategies for Data Utilisation

Overview of Methods

Emergency Plan goals and corresponding summary

indicators

Estimated from program data and program impact models

Total number of clients served by ART and PMTCT+

Total number of clients receiving HIV care and support and total number of OVC receiving care and support

Treat 2 million with ART

Prevent 7 million new infections

Care and support for 10 million PLWHA and

AIDS orphans

2008

2010

2008

USG/Namibian Emergency Plan goals and corresponding summary indicators

Estimated from program data and program impact models

Total number of clients served by ART and PMTCT+

Total number of clients receiving HIV Care and support and total number of OVC receiving care and support

Treat 23,000 with ART

Prevent 72,000 new infections

Care and support for 118,000 PLWHA and

AIDS orphans

2008

2010

2008

Emergency Plan IndicatorsProgram Level Indicators

# of programs/services# of people served/reached# of people trained, etc.

Program Evaluation IndicatorsIndividual-Level (Perceptions, Knowledge, Behaviors)Community-Level (Information/Access Equity, Community

Cohesion, Social Norms, Collective Efficacy)Social/Political Level (Leadership, Policies, Agendas)

Outcome IndicatorsDHSAISFacility Survey, etc.

PURPOSE of PROGRAM EVALUATION RESEARCH

To Provide Input into Development of Integrated HIV/AIDS Program (including VCT, PMTCT+ and HAART)

To Monitor and Provide Feedback on Implementation To Assess Effects of Integrated HIV/AIDS Program on:

Risk BehaviorsCapacity of Communities to mobilize support for OVC, VCT,

PMTCT+ and HAARTCapacity of Communities to address the issue of stigma and

discrimination

Conceptual Framework Pathways to a Health-Competent Conceptual Framework Pathways to a Health-Competent SocietySociety

Domains forInterventions

Behavioral /IntermediateOutcomes(targets)

SupportiveEnvironment

Service Performance

Client Behaviors:

Community

Individual

Social Political

Environment

Service DeliverySystem

Community/Individual

SustainableHealth Outcomes

By 2008: 23,000

receiving ART

By 2008: 118,000

receiving care and support

By 2010: 72,000

infections averted

Source: Namibia

Emergency Plan COP,

2004

Conceptual Framework Pathways to a Health-Competent Conceptual Framework Pathways to a Health-Competent SocietySociety

Domains forInterventions

Behavioral /IntermediateOutcomes(targets)

SupportiveEnvironment

Service Performance

Client Behaviors:

Community

Individual

Social Political

Environment

Service DeliverySystem

Community/Individual

UNDERLYING CAUSES

Environment

Service Systems

Community Beliefs & Norms

Individual Beliefs, Needs, Habits

SustainableHealth Outcomes

By 2008: 23,000

receiving ART

By 2008: 118,000

receiving care and support

By 2010: 72,000

infections averted

Source: Namibia

Emergency Plan COP,

2004

Program Evaluation Research PlanLEVEL OF ANALYSIS ACTIVITY FREQUENCY Participants

INDIVIDUAL LEVEL Catchment Survey Years 1, 3, 5

Representative Surveyof catchment area

COMMUNITY LEVEL Network Analysis Years 1, 3, 5

Bounded Community for Community Changes

Community Mobilisation Formative (at beginning) Selected Communities

SERVICE DELIVERY/ CLINICAL LEVEL Health Literacy Ongoing Clients/Providers

Health Care Provider Training evaluations Ongoing Health care providers, counselors, etc.

SOCIAL/ POLITICAL LEVEL Parliamentarians Survey Baseline Members of Parliament & Staffers

TARGETED Trusted Partner Baseline/follow-up YouthEVALUATION Suzie & Shafa Show Baseline/process/follow-up Youth

Other tbd Emergency Plan programs Baseline/follow-up Designated communities

Audience profile(fact sheets)

Set TargetsBEHAVIORAL LEVELCOMMUNITY LEVEL

ENVIRONMENT/POLITICAL

Using Data – Set Targets & Work Backwards

Treat 23,000 with ART

Prevent 72,000 new infections

Care and support for

118,000 PLWHA and AIDS orphans

ULTIMATE GOALS

EXAMPLES OFTARGETS

(to achieve goals)

# of Clients Enrolling& Completing ART

Increase Abstinence, Faithfulness, Condoms

# of households

caring PLWHA and AIDS orphans

ADDRESSUNDERLYING

CAUSES

Perceptions of HCWsLack Knowledge

Lack SusceptibilityLack EfficacyAlcohol Use

StigmaDenial of Disease

Lack Knowledge

Profiling your AudienceUsing the data, determine who is NOT doing the

behaviors you desireProfile them

Demographically – who should you target?Psychographically – what are their habits, tendencies?Theory-based variables – what is motivating their behavior,

according to theory?Community – what is happening around them?Prior experiences/practices – what is their experience with HIV?

Create Chart of Beliefs to targetDevelop Programs that specifically address the

Underlying Causes of your Targets (in order to achieve goals)

BELIEFS / PRACTICES TO CHANGE

BELIEFS / PRACTICES TO REINFORCE

BELIEFS / PRACTICES TO INTRODUCE

AUDIENCE PROFILE(specific group(s) to target)

Category Results of Research

From Research, Create Table of Beliefs / Practices

Birth control pill preventsHIV infection…

HIV is a real threat in Namibia & affects many…

Something can be done toImprove PLWA quality of life (not a death sentence).

Single women, aged 15-24,who are students

METHODS

SURVEY METHODSHOUSEHOLD SURVEY – Complete Random

Sample of Households in 10 km catchment area around HIV/AIDS focus hospitalexceptions Katutura, Windhoek – standard EAs usedOshakati, 5km catchment because of overlap Sample N= 3100, n=300 per site (9 sites, n=200 at two

supplemental sites)

NETWORK SURVEY – Complete Census of the households adjacent to the HIV/AIDS focus hospital PLUS health care workers in the focus hospital Sample N=3763, n=400 per site (10 sites)

Fresh Maps drawn in HIV/AIDS focus hospital area

SURVEY METHODScontinued

Sample size determination – effect sizes extracted, power calculated, conventional standard = .80, =.05

Persons 15 years and older eligible for participation in studyAt selected households, Inventory of all eligible participants,

Participant selected by random drawCall-backs on evenings/weekends (up to three times).Non-responses replaced by next eligible household

(occurred only 5 times). One person per household interviewed (privately).

Data Collection

Sept/Oct 2003 Oshikuku Oniipa (Onandjokwe) Rehoboth

May/June 2004 Andara Nyangana Rundu

Aug-Oct 2004 Katutura Keetmanshoop Oshakati Walvis Bay Windhoek (supplemental, household only)

Walvis Bay

Keetmanshoop

KatuturaRehobothWindhoek

OnandjokweOshikukuOshakati

Andara Nyangana

Rundu

FRESH MAP EXAMPLE

Instrument Development

Complete literature search, data base search, solicitation from partners, conducted.

All items developed according to theory, based on validated and reliable items used in previous studies

Both surveys reviewed and vetted by partners twice.Translated and backtranslated until connotative

(“meaning”) equivalence occurred.Piloted and refined to fit Namibian culture

Instrument Development continued

Quantitative Surveys– Open and close-ended items– 4 or 5-point Likert-type scales used

1 2 3 4 5

Strongly Strongly

Disagree Agree

– Respondents adapted easily to response format– Item analysis indicated valid and reliable scales

Making a difference in people’s lives . . .