Impact assessment indicators of hiv programs

Typically, a program evaluation focuses on an assessment of a single intervention or program and whether or not intended client outcomes were achieved, comparing outcomes of the intervention arm with the outcomes of a planned control or comparison arm, in which a similar population did not receive the intervention.

Funded with non-research i. Instead, the ECHPP project used a new programmatic approach that charged health departments with making local programmatic changes to maximize the impact of their HIV programs, considering all sources of HIV funding CDC and other federal, state, local, and private funding streams.

Additionally, the ECHPP evaluation was designed to use data from existing data sources only, avoiding the need to conduct new, costly, and time-consuming data collection activities. This article describes the overall evaluation approach and specific evaluation activities; some have been completed, and others are in progress. Once completed, this evaluation will provide a better understanding of HIV-related activities supported by health departments in high-prevalence areas and how health departments leveraged local prevention and care resources to increase local impact.

Additionally, the evaluation will provide an opportunity for federal agencies to identify strategies that increase the coordination, collaboration, and integration of HIV-related services and the standardization and streamlining of data collection both within and across agencies.

Each health department was required to develop an enhanced comprehensive HIV program plan to describe how it would improve its HIV prevention and care services using a combination of interventions, intervention targets, and intervention scales to optimize impact on NHAS goals.

CDC provided a list of 24 required or recommended interventions Table 1 , many of which were already being implemented at some level in these sites. Innovative local initiatives, if approved by CDC, could also be included in a health department's plan. The health departments were expected to use the ECHPP cooperative agreement funds primarily for planning and secondarily for some initial implementation; however, most activities during — were supported by other health department funds i.

CDC's evaluation approach for ECHPP comprises several components: 1 a broad assessment of program planning and implementation of HIV prevention and care activities across multiple funding sources, 2 a detailed examination of core HIV prevention activities across multiple years, and 3 an analysis of local environmental and contextual factors that can affect services. This data collection will allow us to describe trends and changes across an eight-year period in these 12 sites.

Data analysis will extend beyond by several years because of time lags in data availability. The evaluation consists of process questions, outcome questions, and impact questions Table 2 , along with various types of data collected and numerous indicators. Preexisting data sources, both internal e. The following general approach was used:. Collect process data associated with program and intervention delivery that can be plausibly linked to client outcomes.

We obtained process data associated with program and intervention delivery from several data sources. Grantees submitted process data through routine progress reports on HIV-related activities funded from all sources.

In these progress reports, grantees described their planning process and implementation for each intervention in their ECHPP plan, including successes and challenges. Grantees also submitted data on their total annual budget allocations for HIV prevention from all funding sources for the following program categories: HIV testing, comprehensive prevention services for PLWH, condom distribution, and behavioral risk-reduction interventions.

When the data were available, grantees also provided data on allocations directed toward target populations. Expenditure data were not available. Such factors include, for example, a local HIV-related clinical trial conducted during the study period, as well as STD prevalence 8 and poverty rate, 9 which are associated with HIV risk and related outcomes and have the potential to affect ECHPP findings.

Funding levels of health department programs are also considered to be a contextual factor, because a decrease in resources for services in general could adversely affect client-level outcomes and community impact.

We obtained additional outcome data related to the HIV care continuum 4 , 12 , 13 from the Medical Monitoring Project. These data included 1 self-reported survey data on the percentage of participants who received professional help with medication adherence and the percentage who received housing services and 2 medical chart abstraction data on the percentage of participants who were prescribed antiretroviral therapy and the percentage who had a suppressed viral load at the most recent viral load test in the previous 12 months.

We also collected data on the percentage of NHBS participants who tested for HIV and the percentage who used antiretroviral therapy postexposure prophylaxis after sex because they believed it would prevent HIV infection. Impact data obtained from the National HIV Surveillance System 14 include the following indicators: estimated number of diagnosed and undiagnosed new HIV infections incidence , number of new HIV diagnoses, number of people living with HIV infection prevalence , percentage of people diagnosed with AIDS within three months of HIV diagnosis, percentage of HIV-positive people linked to medical care as evidenced by CD4 count and viral load test within three months of diagnosis , and percentage of HIV-diagnosed people who have a suppressed viral load.

Table 3 summarizes proposed analytic methods. When evaluation data for all eight years — are available, the first step in data analysis will be to produce descriptive tables and graphs of the quantitative data on process, outcome, impact, and contextual factors by year. Descriptive statistics will summarize annual changes in programs delivered and target populations reached; outcomes for risk behaviors and service access among target populations; and estimated HIV incidence, HIV diagnoses, linkage to HIV medical care, and viral suppression among target populations.

Statistical testing of trends will be conducted to determine whether or not changes in indicators during the eight-year period are significant. For the qualitative analysis, we plan to use thematic coding methods to identify themes of cross-jurisdictional planning and implementation reported through the ECHPP progress reports.

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