(GEND_GBV) Number of people receiving postgender based violence (GBV) clinical care based on the minimum package

Export Indicator

Number of people receiving postgender based violence (GBV) clinical care based on the minimum package
What it measures

NOTE: The indicator DOES NOT measure delivery of GBV prevention activities.

This indicator uses the number of people receiving post-GBV clinical services to measure service uptake. An increase in the number of people receiving postGBV care will indicate that more patients are disclosing violence to providers and using the available services.

GBV is defined as any form of violence that is directed at an individual based on his or her biological sex, gender identity or expression, or his or her perceived adherence to socially-defined expectations of what it means to be a man or woman, boy or girl. It includes physical, sexual, and psychological abuse; threats; coercion; arbitrary deprivation of liberty; and economic deprivation, whether occurring in public or private life.

This indicator measures delivery of a basic package of post-GBV clinical services (including PEP and EC). NOTE: This indicator DOES NOT include GBV Prevention activities or nonclinical community-based GBV response (e.g., shelter programs, case management).

This indicator will enable PEPFAR to:

  • To determine the number of individuals that are suffering from GBV and reporting to clinical partners
  • To assess whether post-GBV clinical services are being used.
  • Gain an understanding of the uptake of post-GBV clinical services offered across PEPFAR countries.
  • Provide important information to key stakeholders about PEPFAR programs that mitigate women and girls’ and other marginalized populations’ vulnerability to HIV/AIDS.
  • Support efforts to assess the impact of post-GBV clinical services by correlating the reach (i.e., number of people served) of these services over time with outcomes related to GBV (and HIV/AIDS), as described through other data collection efforts such as survey data (DHS/PHIA/VACS).
  • Identify programmatic gaps by analyzing the number and ages of people receiving services, as well as the reach of services in particular geographic areas.
Numerator

Number of people receiving postgender based violence (GBV) clinical care based on the minimum package

Denominator

N/A

Calculation

Use annual result reported at Q4

Method of measurement

Data sources are standard program monitoring tools, such as forms, log books, spreadsheets and databases that national programs and /or partners develop or already use.

Data should be collected continuously at the point of service delivery (i.e., ANC, PMTCT, ART, etc.) and aggregated in time for PEPFAR reporting cycles.

The indicator can be generated by counting the number of persons receiving post-GBV clinical care, disaggregated by the age group and sex of the client receiving the service, as well as the type of service (sexual violence or emotional/physical violence) and PEP provision (see below for disaggregation information).

To adequately capture the provision of these services, logs and monitoring forms will need to be used wherever the services are offered. These forms will need to track both the outcome of the initial assessment and the provision of referrals or services. For PEP specifically, registries should collect both the administration of the PEP as well as its completion and the patient’s adherence.

Special considerations:

- As outlined in the Program Guide for Integrating GBV Prevention and Response in PEPFAR Programs all programs seeking to address GBV must first and foremost protect the dignity, rights, and well-being of those at risk for, and survivors of, GBV. There are four fundamental principles for integrating a GBV response into existing programs and specific actions for putting these principles into practice. These principles are as follows:

  • Do no harm
  • Privacy, confidentiality, and informed consent
  • Meaningful engagement of people living with HIV (PLHIV) and GBV survivors
  • Accountability and M&E

How to review for data quality

Numerator ≥ subtotal of each of the disaggregation: The number of people receiving postGBV clinical care should be greater or equal to the sum of each individual disaggregate group.

Reporting level

Site level: facility and community

Measurement frequency

Annual

Disaggregation

Numerator: Number of people receiving post-GBV clinical care based on the minimum package

Violence Service Type (Required)

SEXUAL Violence; PHYSICAL and/or EMOTIONAL Violence

[Disaggregat e of Violence Service Type by Age/Sex (Required)

<10 F, 10-14 F, 15-19F, 20-24 F, 25-49 F, 50+ F; <10 M, 10- 14M, 15-19M, 20-24 M, 25- 49 M, 50+ M;

[Disaggregat e of Violence Service Type SEXUAL] PEP (Required)

Number of people who completed PEP services (related to sexual violence services provided)

Description of Disaggregate

Sexual violence (post-rape care): Although guidelines for post-rape care will vary from country to country, in addition to treatment of serious or life-threatening medical issues (e.g., lacerations, broken bones) and the necessary forensic interviews and examinations, the minimum package of post-rape care services should always begin with an assessment of the client’s specific needs.

The following represents the Minimum Package for post-rape care services that must be in place to count under this indicator:

- Provision of Clinical Services: (all of the following must be in place, including relevant commodities, and ability to count individuals— independent of whether individuals use the specific service)

- Rapid HIV testing with referral to care and treatment as appropriate

- Post exposure prophylaxis (PEP) for HIV -- if person reached within the first 72 hours

- STI screening/testing and treatment

- Emergency contraception, if person is reached in the first 120 hours

NOTES: 1) PEPFAR funds cannot be used to procure EC, 2) EC is legal in all PEPFAR countries except Honduras, so should be available in all countries except for Honduras

- Counseling (other than counseling for testing, PEP, STI and EC)

- Physical and/or emotional violence (other Post-GBV care): GBV can take many forms, and includes physical and emotional violence. The following services should be available for persons who have experienced GBV that is not sexual. Services should always begin with an assessment of the client’s specific needs and include, as appropriate. The following represents the Minimum Package for other post-GBV care services that must be in place to count under this indicator:

- Provision of Clinical Services: (all of the following must be in place and available to count persons— independent of whether people use the specific service)

  • Rapid HIV testing with referral to care and treatment as appropriate (Please note that individuals should also be counted under the MER HIV testing and counseling indicator (i.e., # of individuals who received HIV testing and counseling services and received their results).
  • STI screening/testing and treatment
  • Counseling (other than for HIV counseling and testing)

For both Sexual violence and Physical and/or emotional violence: These cannot be counted for the indicator alone, however where applicable should be offered:

- Longer-term psycho-social support (e.g., peer support groups)

- Legal counsel

- Police

- Child protection services

  • Economic empowerment

Sexual violence by <10 F, 10-14 F, 15- 19F, 20-24 F, 25-49 F, 50+ F; <10 M, 10- 14M, 15-19M, 20-24 M, 25-49 M, 50+ M;

Physical and/or emotional violence by <10 F, 10-14 F, 15-19F, 20-24 F, 25-49 F, 50+ F; <10 M, 10-14M, 15-19M, 20-24 M, 25-49 M, 50+ M;

Post-exposure prophylaxis (PEP): PEP service provision should only be counted under this indicator if the individual receives PEP treatment (i.e., drugs) in accordance with international and/or national protocols, guidelines, etc., and if the individual completes the full course of treatment. If an individual is provided with PEP, completes the full course of treatment (and meets the other criteria detailed within this indicator reference sheet) the individual should be counted under this GBV care indicator. The individual should not be additionally counted under other MER treatment indicators (e.g., # of individuals new on ART; # of individuals ever on ART, etc.) PEP is intended to prevent HIV infection, while other MER treatment indicators monitor ARV provision to those who are HIV positive.

Explanation of the numerator
  • GBV: For PEPFAR, GBV is defined as any form of violence that is directed at an individual based on his or her biological sex, gender identity or expression, or his or her perceived adherence to socially-defined expectations of what it means to be a man or woman, boy or girl. It includes physical, sexual, and psychological abuse; threats; coercion; arbitrary deprivation of liberty; and economic deprivation, whether occurring in public or private life. It can affect women and girls, men and boys, and other gender identities. PEPFAR is most likely to address physical and sexual intimate partner violence, including marital rape; sexual assault or rape; female genital cutting/mutilation; sexual violence against children and adolescents; and child marriage.
  • Because of the challenges associated with ascertaining whether a person who experienced sexual violence did so because of their biological sex, gender identity, or his or her perceived adherence to socially defined norms of masculinity and femininity, ALL persons who experience sexual violence and present for care, independent of the cause, or of age and sex, should be counted under this indicator. Note: DO NOT report other who has accompanied the individual seeking services (including perpetrators who receive GBV prevention activities).
Further information

MER 1.0 to 2.0 Change

Age/sex disaggregates modified to align across clinical cascade. Increased focus on the clinical services for gender GBV.

PEPFAR Support definition

Standard definition of DSD and TA-SDI used.

Provision of key staff or commodities for GEND_GBV includes: ongoing procurement of commodities (e.g., ARVs, rapid HIV test kits, STI testing or treatment commodities) or funding of salaries (partial or full) for HCW actively delivering the components of GBV care in accordance with international or national protocols or guidelines [i.e., physicians, nurses, and other health care workers who can assess GBV and provide treatment and appropriate referrals.

Ongoing support for GEND_GBV service delivery improvement includes: mentoring and supportive supervision, training, guidance development, site level QA/QI, regular assistance with monitoring and evaluation functions and data quality assessments, or commodity consumption forecasting and supply management.

DREAMS SNU Specific Guidance

Females: 10-14, 15-17, 18-19, 20-24; Type of Service: sexual violence (post-rape care), physical and/or emotional violence (other GBV care), PEP service provision