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

Export Indicator

Number of key populations reached with individual and/or small group-level HIV prevention interventions designed for the target population
What it measures

This indicator provides information on the total number of unique individuals that have received individual-level and/or small-group level intervention(s). This indicator will help determine the reach of key populations (if no denominator) and may help understand the relative saturation (coverage) of PEPFAR-supported KP prevention programs when reliable population size estimates are included as the denominator.

Small-group intervention is defined as less than or equal to 25 individual attendees in one setting.

HIV testing services (HTS) or referring an individual to HTS is required to be offered (at least once during the reporting period and/or in accordance with WHO/national guidance) unless the individual had previously been tested positive for HIV. If the individual is selfidentified as HIV positive, then HTS provision or referral to HTS will not be a required element of this indicator.

A partner may count an individual (with unknown HIV sero-status or self-identified as HIV negative) as having received a prevention activity if they have provided HTS and/or referral to HTS AND at least one of the other listed prevention activities below during the reporting period. If an individual is already known to be HIV positive at the time of the outreach, s/he should receive at least one of the interventions listed in the table (outside of HTS) to qualify as being counted under this indicator. The table below lists the prevention interventions that a partner may offer in addition to HTS (or HTS referral).

Prevention Interventions for Key Populations

  • Offer or refer to HTS* (Required)
  • Targeted information, education, and communication (IEC)
  • Outreach/Empowerment
  • Condoms
  • Lubricant
  • Offer or refer to STI screening, prevention, and treatment
  • Link or refer to ART
  • Offer or refer to prevention, diagnosis, treatment of TB
  • Offer or refer to screening and vaccination for viral hepatitis
  • Offer or refer to Reproductive Health (Family Planning; PMTCT), if applicable
  • Refer to medication-assisted therapy (MAT), if applicable
  • Offer or refer to needle syringe program (NSP), if applicable

*Partner should also report the number of individuals tested under the indicator “HTS_TST” if HTS was conducted (and results were given) as part of the outreach activity. If it was a documented complete HTS referral to the facility, it can be counted as HTS_TST_TA. Please refer to the HTS_TST indicator definition sheet for details.

Numerator

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

Denominator

Total estimated number of key populations in the catchment area.

Calculation

Sum across both reporting periods; de-duplicating unique individuals already reached and reported in Q1-Q2 of the same fiscal year in Q4 reporting.

Method of measurement

Tracking systems must be able to reduce double-counting of individuals in a reporting period. The numerator can be generated by counting the number of de-duplicated individuals who were reached and had completed the appropriate prevention intervention(s) designed for the intended key population. For example, it means that when a unique individual receives HTS referral plus condoms and lubricant at more than one occasion during the reporting period, the person is counted only once for being reached for this indicator.

Furthermore, double-counting of all returning beneficiaries within the Q3-Q4 reporting period (April 1 – September 30) will also need to take place in Q4 reporting if they had already been counted under KP_PREV in Q1-Q2 of the same fiscal year. For example, if an individual had received prevention interventions under KP_PREV through PEPFAR-supported program in January 2017 and was counted as being reached in FY17 Q2 reporting cycle, and this same individual was later reached with prevention services again by PEPFAR-supported program in June 2017, that individual should NOT be reported again in the FY17 Q4 reporting period. This de-duplication is critical in order to accurately track the ANNUAL number of unique individuals reached by PEPFAR within a given fiscal year. Trend analysis of past performance KP_PREV data will be adversely affected with the change in frequency of KP_PREV reporting from annually to semi-annually if this de-duplication is ignored (i.e. annual number of KP_PREV reported within the same fiscal year would be inflated as the same individual would be counted twice if this de-duplication does not occur at Q4 reporting).

If possible, a unique identifier can be assigned. The use of a unique identifier can help programs monitor the frequency of contact/outreach of a single individual over time (i.e. Beneficiary A with unique identifier AW0901 had four documented outreach visits in FY17 but was only counted once under KP_PREV in FY17).

How to review for data quality

Data should be reviewed regularly for the purposes of program management, to monitor progress towards achieving targets, and to identify and correct any data quality issues. Potential data quality issues with KP_PREV are:

  • Numerator
  1. The Numerator is = the sum of the disaggregation: The number of KP reached with individual and/or small-group level preventive interventions should be equal to the sum of KP disaggregates.
  2. Despite persons potentially falling into more than one KP disaggregate (e.g. FSW who injects drugs), implementing partners should be instructed to report an individual in only one KP category.
  • Denominator ≥ Numerator: The total estimated number of key populations should be greater or equal to the number of key populations provided with individual and/or small group level preventive interventions.

Reporting level

Site level: facility and community.

Measurement frequency

Semi-Annual

Disaggregation

Numerator (Required) : Number of key populations reached with individual and/or small group-level HIV prevention intervention(s) that are based on evidence or are facilitators of evidence-based interventions (e.g., IEC)

KP Type (Required)

MSM who are SW; MSM who are not SW; TG who are SW; TG who are not SW; Female SW; PWID male, PWID female; People in prisons and other enclosed settings

Testing Service

KP known positive; KP was newly tested and/or referred for testing; KP declined testing and/or referral

Description of Disaggregate

MSM: Men who have sex with men TG: Person who identifies as transgender SW: Sex worker PWID: People who inject drugs, People in prisons, and other enclosed settings

Known Positive – Persons within each key population type for whom HIV testing is not indicated because they are known to be HIV-positive. HIV-positive test results should be verified, if possible, for all persons accessing HIV prevention services during the reporting period. Implementing partners should maintain records on whether the HIV-positive client is linked to treatment.

Newly Tested and/or Referred for Testing – Persons within each key population type for whom HIV testing is indicated because they do not know their HIV status or their last HIV-negative test was more than 3-6 months ago (or more/less frequently as indicated by National Guidelines) should either be offered an HIV test on site or given information about where and when they can access an HIV test at another nearby clinic. Every attempt should be made to ensure the client is linked with HIV testing services that are KP-friendly, and where possible the completed referral should be documented (i.e. the client accessed HIV testing).

Note: Persons who access testing and whose results are newly tested HIV-positive in the reporting period should also be counted under “newly tested” even if they return for additional prevention services during that reporting period. Patients tested positive in previous reporting periods should be counted as Known Positives.

Declined Testing and/or Referral – Persons who, after explaining the benefits of HIV testing and the reason for testing every 3-6 months (or more/less frequently as indicated by National Guidelines), decline to be tested on-site or referred to a site where HIV testing is offered. Although every attempt should be made to support key/priority populations with HIV testing as part of the package of HIV prevention services and to provide HIV testing on site or KP-friendly sites, programs should also respect the autonomy of clients to decline this service. Clients who decline testing and/or referral can still receive other prevention services, as long as the benefits of HIV testing were explained and testing or a referral for testing was offered.

Denominator (Optional): Total estimated number of key populations in the catchment area*.

*Estimating the catchment area should be explained in the narratives.

KP Type

MSM who are SW; MSM who are not SW; TG who are SW; TG who are not SW; Female SW; PWID male, PWID female; People in prisons and other enclosed settings

Description of Disaggregate

MSM: Men who have sex with men TG: Person who identifies as transgender SW: Sex worker PWID: People who inject drugs. 

Explanation of the numerator

The numerator can be generated by counting the number of unique individuals from an activity who are reached with prevention interventions designed for the intended key population.

Explanation of the denominator

Catchment area: The denominator is the estimated number of key populations in a defined catchment area. Programs need to define their geographic catchment area from which key population beneficiaries receive HIV prevention services. Country teams should encourage methodological harmonization across their KP partners when estimating KP population size within a catchment area.

Further information

MER 1.0 to 2.0 Change

KP type disaggregations changed, three testing service disaggregations were added, and HIV testing or referral of an individual to HIV testing services (HTS) is required to be offered to those who are not known and/or self-identified as diagnosed HIV positive. The denominator is now optional, but recommended for those with good size estimation metrics (estimating the catchment area should be explained in the narratives).

EA/ SIMS considerations

EA has historically calculated unit expenditures for provider-initiated testing and counseling, voluntary-testing and counseling, and community-based testing and counseling. To do this, MER service-delivery disaggregates are mapped into these categories. Incomplete and inconsistent MER service-delivery disaggregates (e.g. disaggregates do not sum to total) will result in data quality concerns related to the corresponding unit expenditures. More details can be found in Appendix 2 on EA-MER Alignment.

PEPFAR Support definition

Standard definition of DSD and TA-SDI used. Provision of key staff or commodities for KP receiving HIV prevention services include: ongoing procurement of critical commodities such as test-kits, condoms, lubricants, or funding for salaries of personnel providing any of the prevention package components (i.e. peer navigators, outreach workers, program managers). Staff responsible for the completeness and quality of routine patient records (paper or electronic) can be counted here; however, staff who exclusively fulfill MOH and donor reporting requirements cannot be counted.

Ongoing support for HIV prevention among KP improvement includes: mentoring and supportive supervision; training; organizational strengthening; QA/QI; program design like development of training curricula, prevention guidance development, or standard operating procedures (SOPs) and follow-up to ensure fidelity to the program design; regular assistance with monitoring and evaluation functions and data quality assessments; or condom forecasting and supply management.