A Brief Guide to Identify Information Needs and Use Data for PEPFAR Country and Regional Planning

Author(s): MEASURE Evaluation

Year: 2016

Abstract:

The 2015 strategy for the United States President’s Emergency Plan For AIDS Relief (PEPFAR) involves the use of all available data, “down to the most granular site level,” to inform decisions about priority locations, populations, interventions, and partnerships within a target country in order to achieve epidemic control (Birx, 2014a; Birx, 2014b; DOS–OGAC, 2014, p. 7). A combination of program performance, service quality, and expenditure data is used to ensure that PEPFAR investments align with a country’s epidemic profile as well as health facilities with a high patient volume for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy (ART) (PEPFAR, 2015a). Epidemic control is defined as “the point at which new HIV infections fall below the numbers of AIDS-related deaths” (DOS–OGAC, 2014, p.8). In order to achieve epidemic control, PEPFAR adopted the UNAIDS 90-90-90 target: 90 percent of people living with HIV know their status, 90 percent of those with known status are receiving ART, and 90 percent of those on ART achieve viral suppression (PEPFAR, 2015a).

In January 2015, PEPFAR published extensive guidance for teams working in targeted areas to develop country and regional operational plans that follow this global strategic approach. Additional draft guidance for 2016 was circulated in November 2015 for stakeholder comments (PEPFAR, 2015b). The 2016 PEPFAR guidance documents outline eight modular planning steps, including: (1) understand current context, (2) assess alignment of current investments and program focus, (3) determine priority locations/populations and set targets for country-wide epidemic control, (4) determine support to system-level interventions, (5) determine a package to sustain services and expected volume, (6) project resources required and reconcile that figure with the funding level, (7) set PEPFAR targets, and (8) develop a monitoring strategy (PEPFAR, 2015b). Country PEPFAR planning is expected to be an iterative process, with teams most likely having to look back at previous steps to reassess their decisions about where and why to focus their programs as well as seek collaboration from stakeholders to reach shared targets.

MEASURE Evaluation developed a simplified framework to facilitate the process of developing Country Operational Plans for PEPFAR teams. This framework links potential data sources to key programmatic questions. It starts with a systematic assessment of context, then guides PEPFAR teams on how to link this context with assessments of evidence-based interventions, partnerships, geographic targeting, and when to involve stakeholders to achieve epidemic control targets while also investing in health systems strengthening. Investments in health systems will ensure gains are sustained by partner countries.

The framework focuses the research approach and helps to build an evidence-based epidemic control strategy by linking information needs and potential data sources. This systematic approach will assist PEPFAR teams to analyze and interpret their data with other key stakeholders to develop collective support and ownership for a Country Operation Plan that will have a significant impact on the HIV/AIDS epidemic.