Annex

Indicator Definitions
Annex III
Monitoring and
Evaluation Guidelines
For HIV and AIDS in
Nepal
Government of Nepal
Ministry of Health and Population
National Centre for AIDS and STD Control (NCASC)
Monitoring and Evaluation, NCASC, Kathmandu, Nepal
These indicator definitions draw on standard and recognised definitions1 while adapting them to the context
of the HIV epidemic(s) in Nepal. The primary aim is to ensure that the epidemic and the response are tracked
at national level by all partners. The selection of standardised and tested indicators will also allow regional
comparisons within the country and with others in the region. Ultimately the selection of a core set of standardised
UNGASS indicators will allow Nepal to report more easily on the global commitments towards reducing the
spread of HIV.
This document has been developed with technical contributions and inputs from a range of partners and we are
grateful for their continued support. To ensure comparability in data over time, changes should be minimised.
However, this is a living document and revisions should be considered if required, as the context of the epidemic
and of the response evolve (i.e. every two years).
1
Sources: UNGASS, GFATM, WHO, PEPFAR, USAID etc.
Table of contents
GOAL: Optimise prevention and reduce the social impact of HIV and AIDS
Number of people infected with HIV ................................................................................................ 3
I-1
Percent of [Most At Risk Populations] infected with HIV ..................................................................... 4
I-2
Number of new cases of AIDS reported ............................................................................................ 5
I-3
Percent (& Number) of adults & children still alive at 6 & 12 months after initiation of AR .................... 6
TO-4
Percentage of infants born to HIV-infected mothers, who are infected ................................................... 7
TO-5
PURPOSE: Change behaviour to reduce the transmission of HIV among MARP and vulnerable groups
Behaviour
Percent of female sex workers reporting the use of a condom with their most recent client ................ 8
PO-6
Percent of men reporting the use of a condom the last time they had sex with a male partner ............. 9
PO-7
Percentage of injecting drug users who have adopted behaviours that reduce transmission of HIV, i.e.
PO-8
who both avoid sharing non-sterile injecting equipment and use condoms, in the last month ..........
10
Knowledge
PO-9
Percent of MARPs who both correctly identify ways of preventing the sexual transmission of HIV
and who reject major misconceptions about HIV transmission ..................................................................... 11
Percentage of young people who both correctly identify ways of preventing the sexual
PO-10
transmission of HIV and who reject major misconceptions about HIV ....................................................... 13
Comp1 Objective: Improve access to services to prevent the transmission of HIV among MARP & vulnerable groups
Prevention (targeted)
OP11
Number (& Percent) of Most At Risk Population (SW, IDU, MSM, etc.) reached with targeted HIV
OP12
OP13
prevention ..................................................................................................................................................... 14
Number of condoms distributed or sold (sales & free distribution to target groups) ............................... 15
Number (& Percentage) of blood units transfused in the last 12 months that have been
adequately screened for HIV according to national/WHO guidelines ....................................................... 16
STI treatment
OP14
OP15
Number of people [MAR] diagnosed and treated for STIs ......................................................................... 17

Percentage (& Number) of women and men with STIs appropriately diagnosed, treated
and counselled .............................................................................................................................................. 18
Counselling and Testing

OP16
Number and location of Service Delivery Points providing counselling and testing ................................. 19
Number (& Percent) of individuals (MAR) who receive HIV testing in the last 12 months and who
OP17
received the results ........................................................................................................................................ 20
Percentage of public & private laboratories performing HIV testing according to national guidelines .... 21
OP18
Comp2 Objective: Improve availability & access to care, treatment and support for People living with HIV and AIDS
Prevention of MTCT
OT19
OT20
OT21
Number of health facilities providing the minimum package of PMTCT .................................................. 23

Percentage of [pregnant women] receiving HIV counselling and testing (for PMTCT) and received
their test results ............................................................................................................................................. 24
Percentage (& Number) of HIV+ve mothers/pairs receiving a complete course of ARV prophylaxis
in accordance with nationally approved treatment protocol ........................................................................ 25
HIV and AIDS Treatment/ARV Services

Number of health facilities with capacity & conditions to provide advanced HIV and AIDS clinical
OT22
care & psychosocial support, including providing & monitoring ARV combination therapy .................................. 27
Percentage (& Number) of people with advanced HIV infection receiving antiretroviral combination
OT23
therapy ............................................................................................................................................................. 28
Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

National-level Core Indicator Definitions
Annex III
Comp2 Objective: Improve availability & access to care, treatment and support for People living with HIV and AIDS
Palliative Care
Number of PLWHs receiving Cotrimoxazole Prophylaxis for Opportunistic Infections .............................. 30
OT24
Number of PLWHs diagnosed and treated for tuberculosis ........................................................................ 31
OT25
Number of PLWHs receiving Palliative Care (medical, psycho-social or economic support) .................... 32
OT26
Cross-cutting component objectives: Enhance the institutional, organizational and individual capacity to contribute
to the scale-up of the national response
PT27
PT28
PT29
PT30
PT31
PT32
Percentage (& Number) of schools with at least one teacher who has been trained in participatory
life-skills based HIV and AIDS education and who taught it during the last academic year. ........................... 33
Number of health care providers trained or retrained in the provision of STI according to national
guidelines ...................................................................................................................................................... 35
Number of individuals trained in counselling and testing ............................................................................ 36
Number of health care providers trained or retrained in the provision of PMTCT according to
national guidelines ....................................................................................................................................... 37
Total number of health providers trained to deliver ART, according to national/international
standards (including PMTCT+) ....................................................................................................................... 39
Total number of individuals trained to provide Palliative Care for PLWHs .................................................. 41
Cross-cutting component objectives:

* Strengthen policy, legal reform and advocacy
* Increase finance and resource mobilisation
NCA33
NCA34
NCA35
OP36
Amount of national funds disbursed by the government of Nepal for HIV and AIDS ................................. 42
National Composite Policy Index (Prevention, care & support, human rights, civil society
involvement, monitoring and evaluation) ..................................................................................................... 45
Amount of bilateral and multilateral financial flows (commitments and disbursements) for the
response to HIV and AIDS in Nepal ............................................................................................................ 46
Percent (& Number) of large enterprises/companies which have workplace policies and
programmes .................................................................................................................................................. 47
References

Annex III
People infected with HIV
I-1
HIV case reporting is used to improve HIV-related surveillance, to better track the incidence, prevalence and
treatment burden of HIV infection and to plan appropriate public health responses.
Number of people infected with HIV (by age and sex)

PURPOSE
The scale-up of services for ART, preventing mother-to-child transmission of HIV (PMTCT) and HIV counselling
and testing has led to an increase in the numbers of adults and children being tested and diagnosed with HIV
infection. Accurate data are needed on adults and children diagnosed with HIV infection to facilitate estimation
of the treatment and care burden, to plan for effective prevention and care interventions and assess care
interventions. WHO therefore recommends that countries consider conducting reporting of newly diagnosed
cases of HIV infection in adults and children.
HIV case reporting also provides routine HIV data which can be used to monitor trends, for advocacy purposes
and to provide an early warning on emerging epidemics.2
FREQUENCY: Monthly reporting to the National Centre
MEASUREMENT TOOL: Routine programme monitoring and HMIS
METHOD OF MEASUREMENT
HIV cases diagnosed and not previously reported in a given country should be reported according to a standard
case definition. A case of HIV infection is defined as an individual with HIV infection irrespective of clinical stage
(including severe or stage 4 disease) confirmed by laboratory criteria according to national definition and
requirements (WHO,2006). For this indicator data will be collected primarily from different reporting sites. e.g.
VCT services, Sentinel surveillance sites, ART clinics, STI services, PMTCT clinics.
Data collected from different reporting sites. e.g. VCT services, Sentinel surveillance sites, ART clinics, STI
services, PMTCT clinics. This indicator is calculated using data from pregnant women attending ANC in HIV
sentinel surveillance sites in the capital city, other urban areas, and rural areas. Aggregated national estimates
of age-specific trends in HIV prevalence are obtained through HMIS data.
INTERPRETATION
This indicator definition was adapted from The Presidents Emergency Plan for AIDS Relief, Guidance for
FY2006 (Reporting Percent of young people aged 15-24 that are HIV-infected) WHO sources. VCT provides
large amounts of data at little or no additional cost, though this is counterbalanced by likely selection biases
(New Strategies for surveillance in resource-constrained countries, 2004).
Reference: WHO (2006). Revised Clinical Staging and Immunological Classification of HIV/AIDS and Case Definitions of
HIV-Related Definitions.
WHO (1999). Regional Consultation on HIV, AIDS and STI.
WHO, 2006, Revised Clinical Staging and Immunological Classification of HIV/AIDS and Case Definitions of HIV-Related
Definitions
WHO Regional Consultation on HIV, AIDS and STI (June1999).

Annex III
Most-at-risk populations: reduction in HIV prevalence
I-2
Most-at-risk populations typically have the highest HIV prevalence in countries with either concentrated or generalized
epidemics. In many cases prevalence among these populations can be more than double the prevalence among
the general population. Reducing prevalence among most-at-risk populations is a critical measure of a national level response to HIV. This indicator should be calculated separately for each population that is considered
most-at-risk in a given country, e.g., sex workers, injecting drug users, men who have sex with men.
Note: Countries with generalized epidemics may also have a concentrated sub-epidemic among one or more
most-at-risk population. If so, it would be valuable for them to calculate and report on this indicator for those
populations.
Percentage of [most-at-risk population(s)] who are HIV-infected

PURPOSE
To assess progress on reducing HIV prevalence among most-at-risk populations
APPLICABILITY: Countries with concentrated or low-prevalence epidemics, where routine surveillance among
pregnant women is not recommended; also includes countries with concentrated sub-epidemics within a
generalized epidemic
FREQUENCY: Annual (* to be finalised)
MEASUREMENT TOOL: UNAIDS/WHO Guidelines for Second Generation HIV Surveillance; FHI guidelines
on sampling in population groups
This indicator is calculated using data from HIV tests conducted among SW, IDU and MSM in Kathmandu and
Pokhara. Some of these MAR groups and clients of sex workers (incl. migrant workers and truck drivers) will
also be surveyed in 22 districts along the major highway route.
Numerator: Number of members of [most-at-risk population] who test positive for HIV.
Denominator: Number of members of [most-at-risk population] tested for HIV.
To avoid biases in trends over time and to ensure comparability over time, reporting on this indicator will be
consistently drawn from the same sites. [In recent years, many countries have expanded the number of sentinel
sites to include more rural ones, leading to biased trends resulting from aggregation of data from these sites].
INTERPRETATION
Due to difficulties in accessing most-at-risk populations, biases in serosurveillance data are likely to be
far more significant than in data from a more generalized population, such as women attending antenatal
clinics. If there are concerns about the data, these concerns should be reflected in its interpretation.
An understanding of how the sampled population(s) relate to any larger population(s) sharing similar risk
behaviours is critical to the interpretation of this indicator.
The period during which people belong to a most-at-risk population is more closely associated with the
risk of acquiring HIV than age. Therefore, it is desirable not to restrict analysis to young people but to
report on other age groups as well.
Trends in HIV prevalence among most-at-risk populations in the capital city will provide a useful indication
of HIV-prevention programme performance in that city. However, it will not be representative of the situation
in the country as a whole.
Reference: UNAIDS (2005). UNGASS: Monitoring the Declaration of Commitment on HIV/AIDS:

Guidelines on Construction of Core Indicators, 2006 Reporting, Geneva, Switzerland, May 2005.
Annex III
Cases of advanced HIV infection
I-3
HIV case reporting is used to improve HIV-related surveillance, to better track the incidence, prevalence and
treatment burden of HIV infection and to plan appropriate public health responses. In most countries, reporting
of acquired immunodeficiency syndrome (AIDS) cases has been incomplete and children are rarely included.
Number of new cases of advanced HIV Infection reported

PURPOSE
Data on adults and children diagnosed with HIV infection are useful to determine populations needing prevention
and treatment services. Further, timely and appropriate use of antiretroviral therapy delays and may prevent
the development of AIDS as previously defined. The advances in antiretroviral therapy (ART) therefore mean
that public health surveillance of AIDS alone does not provide reliable population-based information on the scale
and magnitude of the HIV epidemic.
FREQUENCY: Monthly to the National Centre for AIDS and STD Control
MEASUREMENT TOOL: Routine programme monitoring and HMIS
Will be generated from routine data collected through the Health Management Information System and data
from VCT services, ART clinics, STI services, PMTCT clinics.
When it first occurs in any child, adolescent or adult with confirmed HIV infection, cases of advanced HIV infection
not previously reported in the country, should be reported according to the standard case definition. The diagnosis
can be based upon clinical or laboratory criteria. AIDS reporting for surveillance is not required if reporting of
advanced HIV infection is undertaken.
WHO has not previously defined HIV infection for reporting or for clinical purposes or recommended the universal
reporting of HIV. The revised clinical staging and immunological classification of HIV are designed to assist in
clinically managing HIV, especially where there is limited laboratory capacity.
INTERPRETATION
Simplified HIV case definitions are provided based on laboratory criteria combined with clinical or immunological
criteria. The clinical staging of HIV-related disease for adults and children and the simplified immunological
classification are harmonized to a universal four-stage system that includes simplified standardized descriptors
of clinical staging events. The revised HIV case definitions and the clinical and immunological classification
system proposed are intended for conducting public health surveillance and for use in clinical care services.

Annex III
HIV treatment: survival after 12 months on anti-retroviral therapy
TO-4
One of the goals of any antiretroviral therapy programme is to increase survival among infected individuals. As
antiretroviral therapy is scaled up in countries around the world, it is also important to understand why and how
many people drop out of treatment programmes. This data can be used to demonstrate the effectiveness of
those programmes and highlight obstacles to expanding and improving them.
Percentage of adults and children with HIV still alive and known to be on treatment 12 months
after initiation of antiretroviral therapy
PURPOSE
To assess progress in increasing survival among infected adults and children by maintaining them on antiretroviral
therapy
APPLICABILITY: All countries
FREQUENCY: Annual Biennial
MEASUREMENT TOOL: Programme monitoring (routine data)
Information on survival can be obtained from patient registers (HMIS) by tallying results for several monthly
cohorts, each tabulated when on antiretroviral therapy for 12 months. For a comprehensive understanding of
survival, the following data must be collected.
Number of adults and children initiating antiretroviral therapy and the start date.
Number of adults and children continuously on antiretroviral therapy at 12 months after initiating treatment.
Number of people who have stopped antiretroviral therapy, including those who have transferred
out, those lost to follow-up and those who have died.
A proportion of people who have stopped treatment or were lost to follow-up may still be alive. However, since
they are not continuously on treatment, they should not be included in the numerator. People who transfer
between antiretroviral therapy programmes and for whom a start date of treatment exists should be counted as
continuously on treatment.
Numerator: Number of adults and children continuously on antiretroviral therapy at 12 months after initiating
treatment.
Denominator: (a) Minimum survival: Total number of adults and children who initiated antiretroviral therapy in
the therapy start-up group 12 months earlier, including those who have stopped antiretroviral therapy, those who
have transferred out, and people lost to follow-up. (b) Maximum survival: Total number of adults and children
who initiated antiretroviral therapy in the therapy start-up group 12 months earlier, excluding those who have
stopped antiretroviral therapy, those who have transferred out, and people lost to follow-up.
INTERPRETATION
In Nepal, data for this indicator will primarily be obtained from a limited number of care/referral facilities
and/or designated cohort studies while national health-information systems are scaled up. However, all
sites providing antiretroviral therapy (public, NGOs and private) are expected to report on this indicator
as systems become fully operational and data should be more accessible and comprehensive.
Patient records may not include mobile populations or the status of the duration of their therapy.
6

Annex III
Reduction in mother-to-child transmission
TO-5
In high-income countries, strategies such as antiretroviral treatment during pregnancy and following birth, and
the use of breastfeeding substitutes have greatly reduced the rate of mother-to-child HIV transmission. In
developing countries, significant difficulties exist in implementing these strategies due to constraints in accessing,
affording and using voluntary counselling and testing services, reproductive health and maternal and child health
services, which have integrated prevention of mother-to-child transmission interventions including breast milk
substitute (where this is part of the countrys policy on prevention of mother-to-child transmission). Nevertheless,
substantial reductions in mother-to-child transmission can be achieved through approaches such as short-course
antiretroviral prophylaxis.
Percentage of infants born to HIV infected mothers, who are infected

(or Percentage of infants born to HIV positive mothers who have not become infected and remain HIV negative)
PURPOSE
To assess progress towards eliminating mother-to-child HIV transmission
TARGETS: 2005 20% reduction 2010 50% reduction
FREQUENCY: Biennial/ Annual?
MEASUREMENT TOOL: Estimates based on programme coverage
The indicator can be calculated by taking the weighted average of the probabilities of mother-to-child transmission
for pregnant women receiving and not receiving antiretroviral; the weights being the proportions of women
receiving and not receiving antiretroviral, respectively. Expressed as a simple mathematical formula:
Indicator score = { T*(1-e) + (1-T) } * v where:
T = proportion of HIV positive pregnant women provided with antiretroviral treatment
v = mother-to-child transmission rate in the absence of any treatment
e = efficacy of treatment provided
T is simply national indicator #21. Default values of 25% and 50%, respectively, can be used for v and e. However,
where scientific estimates of the efficacy of the specific forms of antiretroviral treatment (e.g., nevirapine) used
in the country are available, these can be used in applying the formula. When this is done, the values of these
estimates should be recorded.
The most common forms of treatment provided during the last 12 months should be noted.
INTERPRETATION
This indicator focuses on prevention of mother-to-child transmission of HIV through increased provision
of antiretroviral drugs. Thus, the effect of breastfeeding on mother-to-child transmission of HIV is ignored
and the indicator may yield underestimates of true rates of mother-to-child transmission in countries
where long periods of breastfeeding are common. Similarly, in countries where other forms of prevention
of mother-to-child transmission of HIV (e.g., caesarean section) are widely practised, the indicator will
typicallyprovide overestimates of mother-to-child transmission. For these reasons, trends in this indicator
may not reflect overall trends in mother-to-child transmission of HIV. National Indicator # 21 may provide
a poor estimate for T in circumstances where usage of antenatal clinic services is low.

Annex III
Sex workers: condom use
PO-6
Various factors increase the risk of exposure to HIV among sex workers, including multiple, non-regular partners
and more frequent sexual intercourse. However, sex workers can substantially reduce the risk of HIV transmission,
both from clients and to clients, through consistent and correct condom use.
Note: Countries with generalized epidemics may also have a concentrated sub-epidemic among sex workers.
If so, it would be valuable for them to calculate and report on this indicator for this population.
Percentage of female and male sex workers reporting the use of a condom with their most
recent client
PURPOSE
To assess progress in preventing exposure to HIV among sex workers through unprotected sex with clients
APPLICABILITY: Countries with concentrated or low prevalence epidemics, including countries with concentrated
sub-epidemics within a generalized epidemic
FREQUENCY: Biennial (under proviso that SGS Review will recommend frequency)
MEASUREMENT TOOL: Special surveys including the [FHI] BSS or IBSS for sex workers
Respondents are asked the following question:
Did you use a condom with your most recent client in the last 12 months?
Numerator: Number of respondents who reported that a condom was used with their last client in the last 12
months
Denominator: Number of respondents who reported having commercial sex in the last 12 months. In the context
of Nepal, sex work in rural areas is of limited relevance and data for this indicator will be disaggregated by gender
and location of residence (urban/highway route). Whenever possible, data for sex workers will be collected
through civil society organizations that have worked closely with this population in the field. Access to survey
respondents as well as the data collected from them must remain confidential.
INTERPRETATION
Condoms are most effective when their use is consistent, rather than occasional. The current Indicator
will provide an overestimate of the level of consistent condom use. However, the alternative method of
asking whether condoms are always/sometimes/never used in sexual encounters with clients in a
specified period is subject to recall bias. Furthermore, the trend in condom use in the most recent
sexual act will generally reflect the trend in consistent condom use.
Surveying sex workers can be challenging. Consequently, data obtained may not be based on a
representative sample of the national sex worker population being surveyed. If there are concerns that
the data is not based on a representative sample, these concerns should be reflected in the interpretation
of the survey data. Where different sources of data exist, the best available estimate should be used.
Information on the sample size, the quality/reliability of the data and any related issues should be included
in the report submitted with this indicator.

Annex III
Men who have sex with men: condom use
PO-7
Condoms can substantially reduce the risk of the sexual transmission of HIV. Consequently, consistent and
correct condom use is important for men who have sex with men because of the high risk of HIV transmission
during unprotected anal sex. In addition, men who have anal sex with other men may also have female partners,
who could become infected as well. Condom use with their most recent male partner is considered a reliable
indicator of longer-term behaviour.
Note: Countries with generalized epidemics may also have a concentrated sub-epidemic among men who have
sex with men. If so, it would be valuable for them to calculate and report on this indicator for this population.
Percentage of men reporting the use of a condom the last time they had anal sex with a male
partner
PURPOSE
To assess progress in preventing exposure to HIV among men who have unprotected anal sex with a male
partner
APPLICABILITY: Countries with concentrated or low-prevalence epidemics, including countries with concentrated
FREQUENCY: Biennial
MEASUREMENT TOOL: Special surveys including the FHI BSS or BSS for men who have sex with men
In a behavioural survey in a sample of men who have sex with men, respondents are asked about sexual
partnerships in the preceding six months, about anal sex within those partnerships, and about condom use at
last anal sex.
Numerator: Number of respondents who reported that a condom was used the last time they had anal sex.
Denominator: Number of respondents who reported having had anal sex with a male partner in the last 6
months. Data for this indicator should be disaggregated by age (<25/25+) and location of residence (urban/rural).
Whenever possible, data for men who have sex with men should be collected through civil society organizations
that have worked closely with this population in the field. Access to survey respondents as well as the data
collected from them must remain confidential.
INTERPRETATION
Condom use at last anal sex with any partner gives a good indication of overall levels and trends of
protected and unprotected sex in populations surveyed.
This indicator does not give any idea of risk behaviour in sex with women, among men who have sex
with both men and women. In countries where men in the sub-population surveyed are likely to have
partners of both sexes, condom use with female as well as male partners should be investigated. In
these cases, data on condom use should always be presented separately for male and female partners.
Surveying men who have sex with men can be challenging. Consequently, data obtained may not be
based on a representative sample of the national population of men who have sex with men. If there
are concerns that the data is not based on a representative sample, these concerns should be reflected
in the interpretation of the survey data. Where different sources of data exist, the best available estimate
should be used. Information on the sample size, the quality/reliability of the data and any related issues
should be included in the report submitted with this indicator.
Annex III
Injecting drug users: safe injecting and sexual practices
PO-8
Safer injecting and sexual practices among injecting drug users are essential, even in countries where other
modes of HIV transmission predominate, because: (i) the risk of HIV transmission from contaminated injecting
equipment is extremely high; and (ii) injecting drug users can spread HIV (e.g., through sexual transmission)
to the wider population.
Note: Countries with generalized epidemics may also have a concentrated sub-epidemic among injecting drug
users. If so, it would be valuable for them to calculate and report on this indicator for this population.
Percentage of injecting drug users who have adopted behaviours that reduce transmission of HIV,
i.e., who both avoided using non-sterile injecting equipment and used condoms in the last month
PURPOSE
To assess progress in preventing injecting drug use-associated HIV Transmission
APPLICABILITY: Countries where injecting drug use is an established mode of HIV transmission
FREQUENCY: Every two years
MEASUREMENT TOOL: Special surveys including the [FHI] BSS or IBSS for injecting drug users
Respondents are asked the following sequence of questions:
1.
Have you injected drugs at any time in the last month?
2.
If the answer to question 1 is yes: Have you shared non-sterile injecting equipment at any time in the
last month?
3.
Have you had sexual intercourse in the last month?
4.
If the answers to questions 1 and 3 are both yes: Did you or your partner use a condom when you
last had sex?
Numerator: Number of respondents who report having never used non-sterile injecting equipment during the
last month and who also reported that a condom was used the last time they had sex.
Denominator: Number of respondents who report injecting drugs and having had sexual intercourse in the last
month. Indicator scores are required for all respondents and will be disaggregated by age (<25/25+) (and gender
as much as sample size allows it-IDU among women very low in Nepal). Whenever possible, data for injecting
rug users should be collected through civil society organizations that have worked closely with this population
in the field. Access to survey respondents as well as the data collected from them must remain confidential.
INTERPRETATION
Surveying injecting drug users can be challenging. Consequently, data obtained may not be based on
a representative sample of the national injecting drug user population being surveyed. If there are
concerns that the data is not based on a representative sample, these concerns should be reflected in
the interpretation of the survey data. Where different sources of data exist, the best available estimate
should be used. Information on the sample size, the quality/reliability of the data and any related issues
should be included in the report submitted with this indicator.
The extent of injecting drug use-associated HIV transmission within a country depends on four factors:
(i) the size, stage and pattern of dissemination of the national AIDS epidemic; (ii) the extent of injecting
drug use; (iii) the degree to which injecting drug users use contaminated injecting equipment; and (iv)
the patterns of sexual mixing and condom use among injecting drug users and between injecting drug
users and the wider population. This indicator provides information on the third factor and partial
information on the fourth factor.
10

Annex III
Most-at-risk populations: knowledge about HIV prevention
PO-9
Concentrated epidemics are generally driven by sexual transmission or use of contaminated injecting equipment.
Sound knowledge about HIV and AIDS is an essential prerequisite if people are going to adopt behaviours that
reduce their risk of infection. This indicator should be calculated separately for each population that is considered
most-at-risk in a given country e.g., sex workers, injecting drug users, men who have sex with men.
most-at-risk populations. If so, it would be valuable for them to calculate and report on this indicator for those
populations.
Percentage of [most-at-risk population(s)] who both correctly identify ways of preventing

the sexual transmission of HIV and who reject major misconceptions about HIV transmission
PURPOSE
To assess progress in building knowledge of the essential facts about HIV transmission among most-at-risk
populations
FREQUENCY: Biennial
MEASUREMENT TOOL: Special surveys such as the [FHI] BSS or IBBS
Respondents are asked the following five questions.
1.
Can having sex with only one faithful, uninfected partner reduce the risk of HIV transmission?
2.
Can using condoms reduce the risk of HIV transmission?
3.
Can a healthy-looking person have HIV?
4.
Can a person get HIV from mosquito bites?
5.
Can a person get HIV by sharing a meal with someone who is infected?
Numerator: Number of [most-at-risk population] respondents who gave the correct answers to all five questions.
Denominator: Number of [most-at-risk population] respondents who gave answers, including dont know, to
all five questions.
Respondents who have never heard of HIV and AIDS should be excluded from the numerator but included in the
denominator. Scores for each of the individual questions-based on the same denominator-are required in addition
to the score for the composite indicator. Indicator scores are required for all respondents and should be disaggregated
by gender and location of residence (urban/semi-urban highway route). Whenever possible, data for SW, MSM,
IDUs and clients of SW will be collected through civil-society organizations that work closely with this population
in the field. Access to survey respondents as well as the data collected from them must remain confidential.

Annex III
11
INTERPRETATION
The belief that a healthy-looking person cannot be infected with HIV is a common misconception that
can result in unprotected sexual intercourse with infected partners.
Correct knowledge about false beliefs of possible modes of HIV transmission is as important as correct
knowledge of true modes of transmission. For example, the belief that HIV is transmitted through
mosquito bites can weaken motivation to adopt safer sexual behaviour, while the belief that HIV can
be transmitted through sharing food reinforces the stigma faced by people living with AIDS.
This indicator is particularly useful in countries where knowledge about HIV and AIDS is poor because
it allows for easy measurement of incremental improvements over time. However, it is also important
in other countries because it can be used to ensure that pre-existing high levels of knowledge are
maintained.
Surveying most-at-risk populations can be challenging. Consequently, data obtained may not be based
on a representative sample of the national [most-at-risk population] being surveyed. If there are concerns
that the data is not based on a representative sample, these concerns should be reflected in the
interpretation of the survey data. Where different sources of data exist, the best available estimate should
be used. Information on the sample size, the quality/reliability of the data and any related issues should
be included in the report submitted with this indicator.
12

Annex III
Young people: knowledge about HIV prevention
PO-10
HIV epidemics are perpetuated through primarily sexual transmission of infection to successive generations of
young people. Sound knowledge about HIV and AIDS is an essential pre-requisite-albeit, often an insufficient
condition-for adoption of behaviours that reduce the risk of HIV transmission.
Percentage of young people aged 1524 who both correctly identify ways of preventing
the sexual transmission of HIV and who reject major misconceptions
PURPOSE
To assess progress towards universal knowledge of the essential facts about HIV transmission
FREQUENCY: Every 35 years (and any ad-hoc studies)
MEASUREMENT TOOL: Population-based survey such as DHS, MICS, Behavioural surveys. Ensure that any
ad-hoc surveys targeting young people include this indicator.
This indicator is constructed from responses to the following set of prompted questions.
1.
Can the risk of HIV transmission be reduced by having sex with only one faithful, uninfected partner?
2.
Can the risk of HIV transmission be reduced by using condoms?
3.
Can a healthy-looking person have HIV?
4.
Can a person get HIV from mosquito bites?
5.
Can a person get HIV by sharing a meal with someone who is infected?
Numerator: Number of respondents (aged 1524 years) who gave the correct answers to all five questions.
Denominator: Number of respondents (1524) who gave answers (i.e., including dont know) to all five
questions. Those who have never heard of HIV and AIDS should be excluded from the numerator but included
in the denominator. Indicator scores are required for all respondents aged 1524 years and for males and
females, separately, each by urban/rural residence. Scores for each of the individual questions (based on the
same denominator) are required as well as the score for the composite indicator.
INTERPRETATION
The belief that a healthy-looking person cannot be infected with HIV is a common misconception that
can result in unprotected sexual intercourse with infected partners.
Rejecting major misconceptions about modes of HIV transmission is as important as correct knowledge
of true modes of transmission. For example, belief that HIV is transmitted through mosquito bites can
weaken motivation to adopt safer sexual behaviour, while belief that HIV can be transmitted through
sharing food reinforces the stigma faced by people living with AIDS.
This indicator is particularly useful in countries where knowledge about HIV and AIDS is poor because
it permits easy measurement of incremental improvements over time. However, it is also important in
other countries as it can be used to ensure that pre-existing high levels of knowledge are maintained.

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13
Most-at-risk populations: prevention programmes
OP-11
Most-at-risk populations are often difficult to reach with HIV-prevention programmes. However, in order to prevent
the spread of HIV among these populations as well as into the general population, it is important that they access
these services. This indicator should be calculated separately for each population that is considered most-at
risk in a given country, e.g., sex workers, injecting drug users, men who have sex with men.
populations.
Percentage of [most-at-risk population(s)] reached with HIV-prevention programmes

PURPOSE
To assess progress in implementing HIV prevention programmes for most-at-risk populations
FREQUENCY: Biennial
MEASUREMENT TOOL: A) Special surveys such as the FHI BSS or IBBS; B) Programme monitoring (routine
data)
A) Surveys: Respondents are asked a series of questions about the exposure/use of key HIV-prevention services.
In the context of Nepal, key prevention services include: (1) outreach and peer education; (2) exposure to targeted
mass media; (3) sexually transmitted infection screening and/or treatment; (4) HIV counselling and testing; (5)
safer injection practices for injecting drug users and/or drug treatment and/or rehabilitation.
B) Programme monitoring: records of programmes providing the above-mentioned services are compiled and
aggregated to obtain an overall measure of the reach of prevention programmes.
Numerator: Number of [most-at-risk population] respondents who have been reached by at least one
HIV-prevention programme during the last 12 months.
Denominator: Number of [most-at-risk population] included in the sample (A) or prevalence estimation methods
for the size of the most-at-risk population for the denominator (B) Data collected for this indicator should be
disaggregated by gender and age (<25/25+). Whenever possible, data for [most-at-risk population] should be
collected through civil-society organizations that have worked closely with this population in the field. Access
to survey respondents as well as the data collected from them must remain confidential.
INTERPRETATION
Accessing and/or surveying most-at-risk populations can be challenging. Consequently, data obtained
may not be based on a representative sample of the national [most-at-risk population] being surveyed.
If there are concerns that the data is not based on a representative sample, these concerns should be
reflected in the interpretation of the survey data. Where different sources of data exist, the best available
estimate should be used. Information on the sample size, the quality/reliability of the data and any related
issues should be included in the report submitted with this indicator.
Different types of services will all count the same in estimating overall service coverage.
In case the indicator is based on programme data, an attempt to address the issue of double counting
during the reference period should be made. There is a need to ensure that clients served (as opposed
to clients-visits) for the same service or across services are counted.
14

Annex III
Condom distribution
OP-12
This indicator reflects the success of attempts to broaden the distribution of condoms so that they are more
widely available to people at locations and times when people are likely to need them. It measures actual
distribution of condoms for HIV prevention activities at the national level.
Increasing condom use, especially among groups at higher risk of HIV transmission has been a central
intervention strategy for many AIDS programmes.
Number of condoms distributed and sold (sales and free distribution) to target groups
PURPOSE
To assess progress in the distribution and availability of condoms in the framework of HIV prevention programmes,
either through targeted promotion and distribution or social marketing. Condom use is measured through
behavioural surveys among different groups. The availability, easy access to condom and good quality are also
prerequisites for their use.
FREQUENCY: Annual
On-going programme monitoring records provides the data on the numbers of condoms distributed in the
framework of targeted HIV prevention among different groups at risk or through social marketing, These records
are collected by different partners, compiled and aggregated to obtain an overall measure of the reach of condom
distribution and prevention in the country.

Annex III
15
Blood safety
OP-13
Blood-safety programmes aim to ensure that the overwhelming majority (ideally 100%) of blood units are screened
for HIV and those units that are included in the national blood supply are uninfected. In many countries, blood
units are not screened at all; often, if they are screened, the testing is done by poorly-trained personnel or with
outdated equipment or insufficient inputs, which could lead to blood units being classified as safe even when
they are infected.
Percentage of transfused blood units screened for HIV

PURPOSE
To assess progress in screening transfused blood units for HIV
FREQUENCY: Biennial
MEASUREMENT TOOL: MEASURE Evaluation blood safety protocol
Three pieces of information are needed for this indicator: the number of blood units transfused in the previous
12 months, the number of blood units screened for HIV in the previous 12 months, and among the units screened,
the number screened up to WHO or national standards.
The number of blood units transfused and the number screened for HIV should be available from National Health
Information Systems (Nepal Red Cross Society). Quality of screening may be determined from a special study
that retests a sample of blood previously screened. In situations where this approach is not feasible, data on
the percentage of facilities with good screening and transfusion records and no stock-outs of test kits may be
used to estimate adequately screened blood for this indictor.
Numerator: Number of blood units screened for HIV in the last 12 months up to WHO or national standards.
Denominator: Number of blood units transfused in the last 12 months.
INTERPRETATION
In Nepal, the Nepal Red Cross Society is mandated by the government as the sole authority to conduct
blood programmes. In addition to the Kathmandu-based Central blood centre, there are 21 District-level
blood banks, emergency units in 26 districts and 15 hospital units in the country for which a blood
screening system is in place which reports to the central level NRCS (and to NCASC).
Where health systems are decentralized, or where the private sector, including hospitals and clinics, is
involved in blood screening and blood banking, it may be difficult to obtain enough accurate information
to construct a robust indicator on a national scale. In this case, it will probably be necessary to select
sentinel hospitals and laboratories in both the public and private sector for facility-based surveys of
blood transfusion and screening quality.
Countries may have different national standards for blood screening. If the standards are below those
published by WHO, it is essential that details of the national standards be included in the report on this
indicator.
16

Annex III
Number of new cases diagnosed and treated for STIs

(by age, sex, MARP)
OP-14
The risk of HIV transmission is substantially increased when one or both partners in a sexual relationship have
another sexually transmitted infection. Thus, the availability and utilization of services to treat and contain the
spread of sexually transmitted infections (STI) can reduce the rate of HIV transmission within a population.
Number of new cases diagnosed and treated for STIs (by age, sex, MARP)
PURPOSE
One of the corner stones of HIV prevention is the control of sexually transmitted infection through comprehensive
case management of patients with symptomatic sexually transmitted infections. Effective HIV prevention
programmes will aim to improve availability and expand the treatment of STIs, especially among those groups
most at risk.
FREQUENCY: Annual
MEASUREMENT TOOL: Programme monitoring (routine) and HMIS data
This indicator should include aggregated routine data on new cases of STI provided by all facilities providing
STI treatment in the public, non-governmental, civil society and private sectors. It provides information on the
numbers and distribution of new cases in the population and can contribute to surveillance data and serve as
an early warning system. Dis-aggregation by risk group could provide basic data and estimates of coverage for
STI treatment.
Number of patients treated for STIs should include all new cases of STIs treated according to national guidelines
and/or using syndromic management.
This indicator also reflects investments in resources and training for STI care within the context of HIV prevention
combined with efforts to ensure adequate supplies of drugs and other necessary materials to care provision
sites. This is a common indicator used for programme and annual reports.
INTERPRETATION
Appropriate treatment of STIs has been measured in a variety of ways in Nepal, including interviews and
observations of provider behaviour. This indicator reflects number of people, especially among individuals at
higher risk who received treatment for STIs and also investments in resources and training for STI care within
the context of HIV prevention combined with efforts to ensure adequate supplies of drugs and other necessary
materials to care provision sites.
Reference: USAID/Nepal (2005-2006). HIV/AIDS Performance Monitoring Plan.

Annex III
17
Sexually transmitted infections: comprehensive case management
OP-15
The risk of HIV transmission is substantially increased when one or both partners in a sexual relationship have
another sexually transmitted infection. Thus, the availability and utilization of services to treat and contain the
spread of sexually transmitted infections can reduce the rate of HIV transmission within a population. One of
the corner stones of sexually transmitted infection control is comprehensive case management of patients with
symptomatic sexually transmitted infections.
Percentage of women and men with Sexually Transmitted Infections at health care facilities,
who are appropriately diagnosed, treated and counselled
PURPOSE
To assess progress in implementing universally effective sexually transmitted infection diagnosis, treatment and
counselling
FREQUENCY: Biennial
MEASUREMENT TOOL: Health facility survey-based on the UNAIDS/MEASURE (2000) National AIDS
Programme: A guide to monitoring and evaluation
Data are collected in observations of provider-client interaction at a sample of health care facilities offering
sexually transmitted infection services. See reference on: Evaluation of a national AIDS programme: A methods
package UNAIDS/WHO (1994) for details on how to select this sample. Providers are assessed on history taking,
examination, proper diagnosis and treatment of patients, and effective counselling including counselling on
partner notification, condom use and HIV testing. Appropriate diagnosis and treatment and counselling
procedures in any given country, are those specified in national sexually transmitted infection service guidelines.
A health-care facility is defined as any setting (i.e., including public, private, and church sectors) where healthcare services are provided by one or more medically qualified personnel.
Numerator: Number of sexually transmitted infection patients for whom the correct procedures were followed
on: (a) history-taking; (b) examination; (c) diagnosis and treatment; and (d) effective counselling on partner
notification, condom use and HIV testing.
Denominator: Number of sexually transmitted infection patients for whom provider-client interactions were
observed. Disaggregated indicator scores should be reported for men and women and for patients under and
over 20 years of age. Scores for each component of the indicator (i.e., history-taking, examination, diagnosis
and treatment, and counselling) must be reported as well as the overall indicator score. Generalized Epidemics
Indicators: Number 5
INTERPRETATION
This composite indicator reflects the competence of health-service providers to correctly identify and
treat sexually transmitted infections, the availability of the necessary equipment, drugs and materials,
and the provision of appropriate counselling to patients.
The indicator reflects the quality of services provided but not the cost or accessibility of these services.
The standard for appropriate care upon which the measurement of the indicator is based may vary
between countries (or over time). Currently, syndromic management is seen as the most practical
approach in high-prevalence, low-income countries since there are fewer bottlenecks in diagnosis.
18

Annex III
Number and location of service delivery points providing

counselling and testing
OP-16
Voluntary Confidential Counselling and Testing (VCCT) allows infected individuals to receive appropriate
counselling and referral to other services. VCT services can also be a factor in reducing stigma and encouraging
community support and care for those affected. This indicator provides critical information on the national
availability of voluntary counselling and testing. It is useful to programme planners in determining where services
are providing the full spectrum of testing and counselling services or where facilities may be needed.
Number and location of Service Delivery Points providing counselling and testing
PURPOSE
This indicator provides data on the expansion, coverage and location of VCT services in the country. It also
reflects investments in resources and training for routine counselling and testing and VCT services.
FREQUENCY: Annual
MEASUREMENT TOOL: Programme monitoring (routine data). Number of service delivery points and other
facilities (and their location) providing counselling and testing established either in a stand alone site or an
existing clinic or health facility that meet established national standards.
Number of VCT and routine counselling and testing sites dis-aggregated by district.
The number of Service Delivery Points will be counted through routine data obtained from programme reports
of different partners.
Reference: OGAC (2005). The Presidents Emergency Plan for AIDS Relief:
Indicators, Reporting Requirements, and Guidelines for Focus Countries, Revised for FY2006 Reporting.

Annex III
19
Most-at-risk populations: HIV testing
OP-17
In order to protect themselves and to prevent infecting others, it is important for members of most-at-risk
populations to know their HIV status. Knowledge of ones status is also a critical factor in the decision to seek
treatment. This indicator should be calculated separately for each population that is considered most-at-risk in
a given country e.g., sex workers, injecting drug users, men who have sex with men.
populations.
Percentage of [most-at-risk population(s)] who received HIV testing in the last 12 months and
who know the results
PURPOSE
To assess progress in implementing HIV testing and counselling among most-at-risk populations
FREQUENCY: Annual
MEASUREMENT TOOL: A) Special surveys such as the FHI BSS or IBBS, B) Programme monitoring
A.
Surveys: respondents are asked the following questions.
1.
Have you been tested for HIV in the last 12 months?
2.
If the answer to question 1 is yes: Do you know the results of that test?
B.
Programme monitoring: the proportion of the population accessing HIV testing and counselling services
is calculated from data collected by service providers.
Numerator: Number of [most-at-risk population] respondents who have been tested for HIV during the last 12
months and who know the results of their test.
Denominator: Number of [most-at-risk population] included in the sample (A) or prevalence estimation methods
for the size of the most-at-risk population for the denominator (B). Data for this indicator should be disaggregated
by gender and age (<25/25+). Whenever possible, data for [most-at-risk population] should be collected through
civil society organizations that have worked closely with this population in the field. Access to survey respondents
as well as the data collected from them must remain confidential.
INTERPRETATION
Accessing and/or surveying most-at-risk populations can be challenging. Consequently, data obtained
may not be based on a representative sample of the national [most-at-risk population] being surveyed.
If there are concerns that the data is not based on a representative sample, these concerns should be
reflected in the interpretation of the survey data. Where different sources of data exist, the best available
estimate should be used. Information on the sample size, the quality/reliability of the data and any related
issues should be included in the report submitted with this indicator.
Tracking most-at-risk populations over time to measure progress may be difficult due to mobility.
20

Annex III
Public and private laboratories performing HIV testing
OP-18
Laboratory sites that have at minimum the capacity to perform HIV testing according to national guidelines.
Percentage of public and private laboratories performing HIV testing according to the national
guidelines
PURPOSE
This indicator examines the percentage of facilities that have the capacity to provide an HIV test, pre-test and
post-test counselling for HIV and AIDS according to national guidelines and protocols.
FREQUENCY: Annual
MEASUREMENT TOOL: Special health facility surveys
Capacity to provide HIV testing includes: policies or guidelines for informed consent and confidentiality, adequate
supplies, a client register and documentation for recording whether the results were given to the client. Capacity
for testing also includes a protocol and guidelines for pre-and post-test counselling, trained staff, a register for
pre- and post-test counselling and visual and auditory privacy.
The staff responsible for compiling the annual reporting data should use the laboratory sites list submitted by
each national agency and national programme-funded partner reporting on this indicator in order to count the
total number of laboratory sites that have the stated capacity, avoiding any double-counting of the same laboratory
site supported by more than one national agency/national-funded partner.
This includes facilities that refer clients for the test through a formal or informal agreement with an external
network laboratory or testing unit if they are responsible for follow-up on the results of those clients. If the facility
refers to a site with no expected follow-up, then the facility is not included.
Numerator: Number of facilities that have all items (see definition under Data collection and analysis) for HIV
testing capacity.
Denominator: Total number of health facilities that report that they provide HIV testing or refer clients for an
HIV test through a formal agreement.
Data collection Each point-of-service area for HIV testing in a facility must have all the individual items in the
checklist and analysis below for it to meet all the requirements for this item.
Items
(a) An observed, written policy or guideline on informed consent, routine pre- and post-test counselling
or with guidelines or protocols related to the pre- and post-test counselling content outlining the content
of an informed consent message and clarifying that the facilitys policy is to inform the client prior to
conducting the HIV test (this should be available in each service area where a provider orders HIV tests).
(b) At least one trained counsellor. Training that qualifies a counsellor will be country-specific and may
be reported by the person in charge if the staff member is not present the day of the survey. This refers
to specific training for counselling and not general education for HIV and AIDS diagnosis or prevention.
(c) All necessary supplies to conduct any one test for diagnosis of HIV infection on the day of the survey.
e acceptable tests will be defined locally.

Annex III
21
(d)
A register or other record that provides information on HIV tests conducted and the results and
that has some means for identifying the client (such as a client number). A register or other records that
document pre- and post-test counselling as well as test results. If the client did not return, there should
be some documentation that a pre-test client did not receive post-test counselling. The register should
be up to date, with an entry for a client identifier and column for a test result within the prior 30 days.
The register must be observed and up to date (a test is recorded within the prior 30 days).
(e) Counselling is conducted in an area providing visual and auditory privacy. Visual and auditory privacy
can be provided in a private room or in a screened area of a larger room if people are evidently not
routinely standing or seated immediately adjacent to the screened area.
(f) Documentation that indicates whether the results have been provided to the client or referring
provider. This may be: i) writing the results on a referral form for the client (the laboratory should have
referral forms that are waiting for results available; ii) a register that indicates that the results were
provided or not provided; and iii) any other system that achieves the objective.
or
Evidence that the facility uses written referral for laboratory tests external to the facility and has an
observed register or record indicating whether the client returned or not with results and meeting the
informed consent conditions and confidentiality outlined above.
INTERPRETATION
Data collection. This indicator assesses whether clients receive pre- and post-test counselling, regardless of
which and analysis service in the facility refers them for HIV testing. Data are collected from all service areas
where service providers directly order HIV tests. If a variety of service areas provide pre-test counselling but
post-test counselling is provided in only one service area, the pre-test items and the post-test items are assessed
in the areas where relevant.
Each point-of-service area for HIV testing in a facility must have all the individual items in the checklist below
to meet the requirements for this area.
Reference: National AIDS programmes: a guide to monitoring and evaluating HIV/AIDS care and support. World Health
Organization, 2004.
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Annex III
Number of Service Delivery Points providing the minimum

package of PMTCT
OT-19
This indicator provides critical information on the national availability of prevention and care efforts for women
and infants. It is useful to program planners in determining where services may be needed, or where facilities
are providing the full spectrum of services to prevent HIV infection in women and infants.
The number of public, civil society and workplace venues (family planning and primary health
care clinics, ANC/MCH, and maternity hospitals) offering the minimum package of services
to prevent HIV infection in infants and young children in the past 12 months.
PURPOSE
This indicator provides data on the location, coverage and expansion of PMTCT services in the country. It also
reflects investments in resources and training for PMTCT services.
FREQUENCY: Annual
3
MEASUREMENT TOOL: Routine Programme monitoring data

The information required for this indicator can be collected through a variety of different methods, and depends
on resource availability as well as the amount of detail sought. It focuses on the minimum package of services
which is defined by the type of clinical setting (see reference below). One option is to send a questionnaire to
all public, civil society and workplace health facilities offering family planning and primary health care clinics,
ANC/MCH, and maternity services. Another way to collect the relevant information is by adapting other instruments
that already exist.
A service outlet refers to the lowest level of service. For example, a hospital, clinic, or mobile unit. This could
be public, civil society, and workplace venues (family planning and primary health care clinics, ANC/MCH, and
maternity hospitals) offering the minimum package of services to prevent HIV infection in infants and young
children. The minimum package of services for preventing mother-to-child transmission (MTCT) of HIV includes
at least all four of the following services:
1.
Counselling and testing for pregnant women
2.
ARV prophylaxis to prevent MTCT
3.
Counselling and support for safe infant feeding practices
4.
Family planning counselling or referral
Reference: UNICEF (2004). National Guide to Monitoring and Evaluating Programmes for the Prevention of HIV in Infants
and Young Children (http://www.who.int/hiv/en).
The definition has been adapted to take into account the relatively recent initiation of PMTCT in the country and thereby
counts the number of facilities providing PMTCT. The full definition should be reviewed in 2008 to adapt standards to evolving
levels of care.

Annex III
23
Women completing the testing and counselling process
OT-20
For PMTCT to be effective, it is necessary to know a womans sero-status in order to tailor prevention and care
to her needs. A successful PMTCT program will reach as many pregnant women as possible to ensure knowledge
of sero-status.
Percentage of pregnant women receiving HIV counselling and testing (for PMTCT) and receive
their test results
PURPOSE
The indicator provides a broad measure of programme coverage in the country concerned. However, issues of
poor access to services and poor uptake result in only a small percentage of women knowing their status.
FREQUENCY: Annual
The indicator requires that programme records be reviewed in order to count how many women have
completed the testing and counselling process, i.e. have received their test results and post-test counselling.
The number of women who have made at least one ANC visit is estimated by multiplying the number of births
in the preceding 12 months, as given in a census or the best available source, by the rate of ANC attendance
(Demographic and Health Surveys-type sample survey).
In some cases the numerator may be obtainable by examining national records. If this is not possible the required
data are likely to be available at the district level, where they can be collected directly from facilities providing
the services in question.
In some cases the denominator may be obtainable by examining national ANC registries. This is the preferable
denominator and should be used if possible. If this number is not available or reliable the estimate of the number
of pregnant women described above can be substituted but this approach involves an increased possibility of
misinterpretation. The indicator should be measured annually.
Numerator: The number of pregnant women who have received an HIV test result and post-test counselling
in existing PMTCT sites the preceding 12 months.
Denominator: The estimated number of pregnant women giving birth in the preceding 12 months who have
made at least one ANC visit, in districts where PMTCT is being implemented.
INTEPRETATION
As stated in National AIDS programmes: A guide to monitoring and evaluation, this indicator provides a broad
measure of service provision and gives an idea of coverage in ANC settings where PMTCT interventions are
available. It does not attempt to inform service providers about the points in the counselling and testing cycle
at which women drop out.
It is important that programme managers employ a series of lower-level indicators for determining losses to
follow-up. Because the quality of services is not being measured, information on drop-outs and the points at
which they occur is of limited use if not followed up with operations research aimed at discovering why women
are failing to complete the cycle.
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Annex III
Prevention of mother-to-child transmission: antiretroviral

prophylaxis
OT-21
In the absence of any preventive interventions, infants born to and breastfed by HIV-infected women have roughly
a one-in-three chance of acquiring infection themselves. This can happen during pregnancy, during labour and
delivery or after delivery through breastfeeding. The risk of mother-to-child transmission can be reduced through
the complementary approaches of antiretroviral prophylaxis for the mother with or without prophylaxis to the
infant, implementation of safe delivery practices and use of safe alternatives to breastfeeding. Antiretroviral
prophylaxis followed by exclusive breastfeeding may also reduce the risk of vertical transmission when breastfeeding
is limited to the first six months.
Percentage of HIV positive pregnant women/baby pairs receiving a complete course of ARV
prophylaxis to reduce MTCT in accordance with nationally approved treatmen protocol (or
WHO/UNAIDS standards) in last 12 months
PURPOSE
To assess progress in preventing vertical transmission of HIV
FREQUENCY: Annual
MEASUREMENT TOOL: Programme monitoring and estimates
The number of HIV-infected pregnant women and their newborn provided with antiretroviral prophylaxis to reduce
the risk of mother-to-child transmission in the last 12 months is obtained from programme monitoring records.
Only those pairs who completed the course should be included. The number of HIV-infected pregnant women
to whom antiretroviral prophylaxis to reduce the risk of mother-to-child transmission could potentially have been
given is estimated by multiplying the total number of women who gave birth in the last 12 months (Central
Statistics Office estimates of births) by the most recent national estimate of HIV prevalence in pregnant women
(HIV sentinel surveillance antenatal clinic estimates).
Numerator: Number of HIV-infected pregnant women and their newborns provided with antiretroviral prophylaxis
to reduce mother-to-child transmission according to the nationally approved treatment protocol (or WHO
/UNICEFstandards) in the last 12 months.
Denominator: Estimated number of HIV-infected pregnant women. The decision as to whether or not to include
women who receive treatment from private sector and nongovernmental organization clinics in the calculation
of the indicator is left to the discretion of the country concerned. However, the decision taken should be noted
and applied consistently in calculating both the numerator and the denominator. However, the decision taken
should be noted and applied consistently in calculating both the numerator and the denominator. Private sector
and nongovernmental organization clinics that provide prescriptions for anti-retroviral medication, but assume
that the drugs will be acquired by the individuals elsewhere are not included in this indicator, even though such
clinics may be major providers of prevention of mother-to-child transmission services.

Annex III
25
INTERPRETATION
In many countries, the estimate of HIV prevalence among pregnant women used in the calculation of
this indicator will be based on antenatal clinic-based HIV surveillance data. In some of these countries,
large numbers of pregnant women do not have access to antenatal clinic services or choose not to
make use of them. Pregnant women with HIV may be more or less likely to use antenatal clinic services
(or public rather than private antenatal clinic services) than those who are not infected, particularly where
antiretroviral prophylaxis can be accessed via such services. In such circumstances, this indicator should
be interpreted with reference to recent estimates of utilization of national antenatal clinic services.
Voluntary testing and counselling for HIV and antiretroviral prophylaxis to reduce mother-to-child
transmission can be made available but, ultimately, it is up to individual women to decide whether or
not to make use of these services. Thus, a countrys score on this indicator will reflect the degree of
interest in these services (partly a function of the way in which they are promoted) as well as the extent
to which they are available.
Countries will apply different definitions as to what constitutes a full course of antiretroviral prophylaxis.
Thus, inter-country comparisons may not be entirely valid and should be interpreted with reference to
details of the different definitions used in each case.
This indicator does not measure compliance with the antiretroviral treatment regime because it is not
possible to monitor drug compliance, unless direct supervision is undertaken.

26

Annex III
Health facilities providing advanced HIV and AIDS clinical

care (including ART)
OT-22
This indicator provides critical information on the availability of care for PLWHAs. It is useful to programme
planners in determining where facilities have the capacity & conditions to provide advanced HIV and AIDS clinical
care & psychosocial support, including providing & monitoring ARV combination therapy or where services may
be needed.
Number4 of health facilities that have the capacity and conditions to provide advanced HIV
and AIDS clinical care and psychosocial support services, including providing and monitoring
antiretroviral combination therapy.
PURPOSE
This indicator measures the availability of advanced services specific to people living with HIV and AIDS. It is
assumed that the services and items measured in this indicator require substantial input and personnel training
beyond what is routine for most health systems.
FREQUENCY: Annual
DEFINITION OF INDICATOR
Number of facilities at which a minimum of individual items for each service or item (a) and (c) below exist +
Number of facilities at which all components for all individual services and items (a, b, c, d, e and f) exist.
(a) Systems and items to support the management of opportunistic infections and the provision of palliative
care and symptomatic treatment) for the advanced care of people living with HIV and AIDS;
(b) Systems and items to support advanced services for the care of people living with HIV and AIDS;
(c) Systems and items to support antiretroviral combination therapy;
(d) Conditions to provide advanced inpatient care for people living with HIV and AIDS;
(e) Conditions to support home care services; and
(f) Post exposure prophylaxis.
This information can be collected through a health facility survey with observation in all relevant service areas
or routine programme monitoring. Interviews of HIV and AIDS service providers would also be needed. The
specific items for each service should be presented individually and at a first level of aggregation (all components
of each service or item). When a reasonable proportion of facilities begin to have all first-level aggregated
components, a second-level aggregation can be presented when appropriate.
INTERPRETATION
This indicator does not consider the quality of service provision, which would require more in-depth evaluation
efforts like facility surveys. This is not a complete measure of coverage, as there is no denominator of total
facilities.
Reference: GFATM (2006). Monitoring and Evaluation Toolkit:
HIV/AIDS, Tuberculosis, and Malaria. (http://www.theglobalfund.org/pdf/4_pp_me_toolkit_4_en.pdf),
UNAIDS/WHO/MEASURE (2005), National AIDS Programmes:
A Guide to Monitoring and Evaluating HIV/AIDS care and support.
4
The definition has been adapted to take into account the relatively recent initiation of ART in the country and thereby counts
the number of facilities providing ART. The full definition should be reviewed in 2008 to adapt standards to evolving levels of
care.
Annex III
27
HIV treatment: antiretroviral combination therapy
OT-23
As the HIV pandemic matures, increasing numbers of people are reaching advanced stages of HIV infection.
Antiretroviral combination therapy has been shown to reduce mortality amongst those infected and efforts are
being made to make it more affordable even within less-developed countries. Antiretroviral combination therapy
should be provided in conjunction with broader care and support services including counselling for family
caregivers.
Percentage of people with advanced HIV infection receiving antiretroviral combination therapy
PURPOSE
To assess progress towards providing antiretroviral combination therapy to all people with advanced HIV infection
FREQUENCY: Annual
MEASUREMENT TOOL: Programme monitoring
The number of people with advanced HIV infection who are currently receiving antiretroviral combination therapy
is obtained from programme monitoring records, based on standardised ART clinical monitoring tools.
Numerator: Number of people with advanced HIV infection who receive antiretroviral combination therapy in
accordance with the nationally approved treatment protocol (or WHO/UNAIDS standards); it is calculated as
follows: number of people receiving treatment at the start of the year, plus number of people who commenced
treatment in the preceding 12 months, minus number of people for whom treatment was terminated in the
preceding 12 months (including those who died).
Denominator: Number of people with known advanced HIV infection (i.e. those in need of antiretroviral combination
therapy) The number of adults in need of antiretroviral combination therapy is calculated by adding the number
of adults newly in need of therapy to the number who were on treatment in the previous year and survived to
the current year. The number of adults newly in need of antiretroviral combination therapy is estimated as the
number developing advanced HIV disease who are not yet on treatment. Since some of the adults projected
to develop advanced HIV disease may already have started treatment in the previous year, the number newly
in need of antiretroviral combination therapy is adjusted by subtracting people in this category. It is currently
assumed that between 80% and 90% of adults on treatment will survive to the following year, depending on
patients adherence to treatment, resistance patterns, the quality of clinical management and other factors.
The denominator is generated by estimating the number of people with advanced HIV infection requiring
antiretroviral combination therapy, most frequently on the basis of the latest sentinel surveillance data. The
provision of antiretroviral drugs in the private sector should be included in the calculation of the indicator wherever
possible and the extent of such provision should be recorded separately. The start and end dates of the period
for which antiretroviral combination therapy is given should be stated. Overlaps between reporting periods should
be avoided if possible.
28

Annex III
INTERPRETATION
The indicator permits monitoring of trends in coverage, but does not attempt to distinguish between
different forms of antiretroviral therapy, or to measure the cost, quality, or effectiveness of treatment
provided. These will each vary within and between countries and are liable to change over time.
The proportion of people with advanced stages of HIV infection varies with the stage of the HIV epidemic
and the cumulative coverage and effectiveness of antiretroviral combination therapy among adults and
children.
Dynamic prevalence affects the accuracy of the estimate of the eligible population. Changing
estimates of prevalence are not reflected in current prevalence. This specifically affects the denominator.
The degree of utilization of antiretroviral therapy will depend on cost relative to local incomes,
service delivery infrastructure and quality, availability and uptake of voluntary counselling and
testing services, perceptions of effectiveness and possible side effects of treatment etc.
Preventative antiretroviral therapy for the purpose of prevention of mother-to-child transmission and
post-exposure prophylaxis are not included in this indicator.

Annex III
29
PLWHA receiving Cotrimoxazole Prophylaxis
OT-24
Co-trimoxazole prophylaxis is a simple, well-tolerated and cost-effective intervention for people living with HIV.
It should be implemented as an integral component of the HIV chronic care package and as a key element of
preantiretroviral therapy care. This indicator reflects the provision of support services to HIV infected and
affected individuals.
Number of men, women and children receiving Cotrimoxazole Prophylaxis

PURPOSE
Co-trimoxazole prophylaxis is a critical intervention for HIV positive adults, adolescents and children. It greatly
reduces the incidence of major opportunistic infections and postpones the time at which antiretroviral therapy
(ART) needs to be initiated, thus delaying the onset of AIDS symptoms and prolonging life.
FREQUENCY: Programme monitoring (routine) data, HMIS and established care and support services
MEASUREMENT TOOL: Information will be aggregated through the routine programme monitoring reports from
sites established for care & support services. Data should be collected disaggregated by age and sex.
This indicator counts the numbers of men, women and children (both new and continuing) who are receiving
Co-trimoxazole Prophylaxis for opportunistic infections at care & support sites. Co-trimoxazole, a fixed-dose
combination of sulfamethoxazole and trimethoprim, is a broad-spectrum antimicrobial agent that targets a range
of aerobic gram positive and gram-negative organisms, fungi and protozoa. The drug is widely available in both
syrup and solid formulations at low cost in most places, including resource-limited settings. Co-trimoxazole is
on the essential medicines list (6) of most countries.
INTERPRETATION
The results will be interpreted in term of the efficacy of co-trimoxazole prophylaxis in reducing morbidity and
mortality among adults, adolescents, infants, children and pregnant women living with HIV.
Reference: World Health Organization. HIV/AIDS Programme, New WHO guidelines on Co-trimoxazole prophylaxis for HIV
related infections among children, adolescent and adult in resources limited setting, August, 2006.
The Presidents Emergency Plan for AIDS Relief, Guidance for FY2006 Reporting, Palliative Care (including TB/HIV care).
30

Annex III
PLWHAs diagnosed and treated for tuberculosis
OT-25
The extent of the joint epidemics of HIV and TB, and their impact requires effective, coordinated and wellmanaged interventions. The risk of developing TB is significantly increased in People Living with HIV. Treatment
of TB infection will reduce the incidence of TB disease in PLWHA who are infected with TB. This indicator
measures the number of newly diagnosed HIV positive clients who are given treatment for TB infection, expressed
as a proportion of the total number of newly diagnosed HIV positive people who are found to have TB.
Percentage of PLWHAs diagnosed and treated for tuberculosis

PURPOSE
To ensure that eligible HIV positive individuals are given treatment for TB infection and thus to reduce the
incidence of TB in PLWHA
FREQUENCY: Collected continuously and reported and analysed quarterly
MEASUREMENT TOOL: Programme monitoring (routine data), modified HIV testing register or HIV care register
The data needed for this indicator can be collected in all situations where counselling and testing for HIV are
carried out, e.g. VCT centres, PMTCT sites, inpatient medical services, or at HIV care services, depending on
where TB treatment is to be administered. In all these situations, HIV positive clients should be screened for
TB. Those clients found to have evidence of active TB will be offered TB treatment according to nationally
determined guidelines. All those accepting treatment and receiving at least the first dose of treatment should
be recorded. This information could be recorded in an extra column in the HIV care register. Accurately predicting
drug requirements for supply management requires the collection of more detailed information. From this, facilities
would be able to report the number of new cases, continuing cases and completed cases on a quarterly basis.
If such information is collected routinely, the indicator of choice would be 'the number of HIV positive clients
completing treatment of TB infection, as a proportion of the total number of HIV positive clients started on such
treatment.
Numerator: Total number of newly diagnosed HIV positive clients who have been diagnosed with TB and who
start treatment for TB infection
Denominator: Total number of newly diagnosed HIV positive clients who are positive for TB
INTERPRETATION
To include clients who are given at least one dose is relatively easy, even in resource-limited settings. This
information is the minimum necessary to ensure that TB treatment is being offered to HIV positive clients who
require it. However, unless further data are collected as detailed above, this indicator provides no information
about how many clients adhere to or complete the course and thus no information about the likely effectiveness
of the intervention. Much greater resources are required to collect more complete data on adherence or completion,
but programmes may wish to undertake periodic studies to establish, for example, adherence rates, and the
accuracy of the screening questionnaire.
Reference: WHO (2004). A guide to monitoring and evaluation for collaborative TB/HIV activities.

Annex III
31
PLWHAs receiving palliative care
OT-26
HIV-related palliative care is patient and family-centred care that optimizes the quality of life of adults and children
living with HIV through the active anticipation, prevention, and treatment of pain, symptoms and suffering from
the onset of HIV diagnosis through death. Palliative care includes and goes beyond the medical management
of infectious, neurological or oncological complications of HIV and AIDS to comprehensively address symptoms
and suffering throughout the continuum of illness. The means by which this is achieved will vary according to
stage of illness but always with the understanding that quality of life involves clinical, psychological, spiritual,
and supportive care.
Number of PLWHAs provided with HIV-related palliative care including those HIV-infected
individuals who received clinical prophylaxis and/or treatment for TB (medical, psycho-social
and economic support), by age and sex
PURPOSE
This indicator is the total number of unduplicated individuals receiving palliative care from facilities and/or
community/home based organizations.
FREQUENCY: Annual
Palliative care is a patient and family-centred service, therefore clients provided with general HIV-related palliative
care/basic health care and support during the reporting period may include patients and family members. How
much care is needed in order to count within the indicator is currently left to national standardsall persons
served during the reporting period will be counted once by a unique program regardless of frequency. HIVinfected individuals and families have varying needs for services depending on the stage of illness, type of
service, and available resources of HIV-infected persons.
Quality assurance and supervision are expected by programme managers to ensure that persons are receiving
proper care.
This indicator is not simply the sum of the individuals served by facility-based palliative care (including TB) and
community/home-based palliative care partners, as adjustment for the overlapping service to the same individuals
should be accounted for in this total. Partners should not double count individuals within a program or service
outlet. An individual will count in separate program areas, such as an OVC who may be served separately by
an OVC program, ART facility, and prevention program. However, double counting of individuals within a
programme area is to be avoided among funded partners to the extent possible. While programmes should be
reporting to managers on the number of individuals served, the agency is responsible to the extent possible for
adjusting for the overlap between multiple programs serving the same individuals within a programme area.,
i.e. for those treated for HIV+ or receiving prophylaxis for TB who also receive other palliative care services.
Countries will need to monitor their activities by partner, programmatic area, and geographic area. A matrix is
an excellent programme management tool as well as helping to avoid double counting by a partner and among
partners.
INTERPRETATION
Adjusting for overlap between programs is very difficult, especially when programs are not well linked and patient
confidentiality concerns must be respected.
32

Annex III
Life-skills-based HIV education in schools
PT-27
Life skills is an effective, education methodology, which uses participatory exercises to teach behaviours to
young people that help them deal with the challenges and demands of everyday life. It can include decisionmaking and problem-solving skills, creative and critical thinking, self-awareness, communication and interpersonal
relations. It can also teach young people how to cope with their emotions and causes of stress. When adapted
specifically for HIV education in schools, a life-skills approach helps young people understand and assess the
individual, social and environmental factors that raise and lower the risk of HIV transmission. When properly
implemented, it can have a positive impact on behaviours, including delay in sexual debut and reduction in
number of sexual partners.
Percentage of schools with at least one teacher who has been trained in participatory
life-skills-based HIV and AIDS education and who taught it during the last academic year
PURPOSE
To assess progress towards implementation of life-skills based HIV education in all schools
FREQUENCY: Annual
MEASUREMENT TOOL: Routine programme monitoring data, School survey or education programme review
Principals/heads of a nationally-representative sample of schools (to include both private and public schools)
are briefed on the meaning of life-skills based HIV education and then are asked the following questions.
1.
Does your school have at least one qualified teacher who has received training in participatory life-skills
based HIV education in the last 5 years?
2.
If the answer to question 1. is yes: Did this person teach life skills based HIV education on a regular
basis to each grade in your school throughout the last academic year?
The teacher training must have included time dedicated to mastering facilitation of participatory learning
experiences that aim to develop knowledge, positive attitudes, and skills (e.g., inter-personal communication,
negotiation, decision-making, critical thinking and coping strategies) that assist young people in maintaining safe
lifestyles. Wherever possible, the teacher training should have been done in accordance with the latest UNICEF
guidelines, which can be found at http://www.unicef.org/lifeskills/index_documents.html. For the purposes of
calculating this indicator, at least 30 hours of tuition per year per grade of pupil is recommended if life-skillsbased HIV education is to qualify as standard tuition. However, countries may adjust this number according to
local contexts. Generalized Epidemics Indicators: Number 3
Numerator: Number of schools with staff members trained in and regularly teaching life-skills-based HIV
education.
Denominator: Number of schools surveyed.
Indicator scores are required for all schools combined and for primary and secondary schools separately each
by private/public status and by urban/rural setting. Faith-based schools should be treated as private schools for
this purpose. If school provides both primary and secondary education, information should be collected and
reported separately for both levels of education.

Annex III
33
INTERPRETATION
It is important that life-skills-based HIV education is initiated in the early grades of primary school and
then continued throughout schooling with contents and methods being adapted to the age and experience
of the students. Where schools provide both primary and secondary education, at least one teacher
should have been trained to teach life-skills-based HIV education at each of these levels.
The indicator provides useful information on trends in the coverage of life-skills-based HIV education
within schools. However, the substantial variations in the levels of school enrolment must be taken into
account when interpreting (or making cross-country comparisons of) this indicator.
Consequently, primary and secondary school enrolment rates for the most recent academic year should
be included in the supporting information provided for this indicator.
Complementary strategies that address the needs of out-of-school youth will be particularly important
in countries where school enrolment rates are low.
Indicator is a measure of coverage. The quality of education provided may differ by country and over
time.
34

Annex III
Number of health care providers trained or retrained in the

management of STIs
PT-28
Training refers to new training or retraining of individuals and assumes that training is conducted according to
national or international standards when these exist. A training must have specific learning objectives, a course
outline or curriculum, and expected knowledge, skills and/or competencies to be gained by participants.
Number of health providers trained or re-trained in the management of Sexually Transmitted

Infections, according to national guidelines
PURPOSE
This provides a means to gauge progress toward training and STI service delivery targets which are incorporated
into national plans
FREQUENCY: Annual
Each agency and partner counts the number of health care providers/health workers trained in the management
of sexually transmitted infections (based on national treatment guidelines) by staff (HQ or field based) or partners
during the specified reporting period (12 months for annual report). Participants who complete the full training
course should be counted. If a training course covers more than one topic related to STIs, individuals should
only be counted once for that training course. If a training course is conducted in more than one session/training
event, only individuals who complete the full course should be counted. Do not sum the participants for each
training event.
Staff responsible for compiling the annual reporting data should use a training log submitted by each agency
and partner reporting on this indicator in order to count the total number of individuals trained in the management
of sexually transmitted infections. Individuals trained in training courses co-funded by more than one agency
partner should only be counted once within the specified reporting period (12 months for annual report).
In order to avoid double counting, countries will need to monitor their activities by partner, programmatic area,
and geographic area. This matrix is an excellent program management tool as well as helping to adjust for
double counting by partners, among partners, and among agencies.
INTERPRETATION
This indicator does not measure the quality of the training, nor does it measure the outcomes of the training in
terms of the competencies of health care providers trained, nor their job performance.
The indicator simply measures the number of health care providers/health workers trained in the management
of sexually transmitted infections.

Annex III
35
Individuals trained in counselling and testing
PT-29
Training refers to new training or retraining of individuals and assumes that training is conducted according to
national or international standards when these exist. A training must have specific learning objectives, a course
outline or curriculum, and expected knowledge, skills and/or competencies to be gained by participants.
Number of individuals trained or re-trained in counselling and testing.

PURPOSE
This provides a means to gauge progress toward any training targets which may be incorporated into national
plans
FREQUENCY: Annual
Each agency and partner counts the number of individuals trained in prevention by staff (HQ or field based) or
partners during the specified reporting period (12 months for annual report). Participants who complete the full
training course should be counted. If a training course covers more than one counselling and testing topic,
individuals should only be counted once for that training course. If a training course is conducted in more than
one session/training event, only individuals who complete the full course should be counted. Do not sum the
participants for each training event.
The staff responsible for compiling the annual reporting data should use the training log submitted by each
agency and partner reporting on this indicator in order to count the total number of individuals trained in counselling
and testing. Individuals trained in training courses co-funded by more than one agency partner should only be
counted once within the specified reporting period (12 months for annual report).
INTERPRETATION
terms of the competencies of individuals trained, nor their job performance.
This indicator simply measures number trained in counselling and testing as opposed to the percent of health
facilities with trained staff, which may be measured through health facility surveys.
36

Annex III
Health care workers trained or retrained on PMTCT
PT-30
Training includes both in-service and pre service training. Retrained health care workers are those that have
undergone in-service training, i.e. they are already in the work force and have been practising for several years.
The minimum package varies between different types of health care facility. Several kinds of facility that may
provide services for the prevention of HIV infection in infants and young children are outlined below, together
with the services that should be available. Providers working in these settings should be trained in each of the
components mentioned. Antenatal care (ANC)/maternal and child health (MCH) clinic: counselling on risk
reduction, infant feeding, and referral or provision of the following: HIV counselling and testing, ARV prophylaxis,
Family Planning (including counselling on dual protection), attended delivery in birth facilities where safe obstetric
practices are observed, long-term care Family planning clinics counselling on dual protection; referral to or
provision of HIV counselling testing and long-term care; and referral to ANC/MCH services if appropriate. Maternity
hospitals observance of safe obstetric practices, and referral to or provision of HIV counselling and testing, ARV
prophylaxis, counselling on infant feeding, MCH services, FP and long-term care.
The number of health care workers newly trained or retrained in the minimum package
during the preceding 12 months.
PURPOSE
For the purpose of planning it is important to assess the resources available to address health needs. Before
the implementation or expansion of services it is vital to know not only what facilities and equipment are available
but also what training and human resources exist. Only with this information can health systems provide services
that meet the needs of and are acceptable to the populations concerned.
FREQUENCY: Annual
MEASUREMENT TOOL: This indicator quantifies the human resources that are trained in preventing HIV
infection in women and children and are available to provide the required services.
The number of staff able to provide preventive services for HIV infection among infants and young children, is
calculated on the basis of the number of health care providers working at sites where women could potentially
receive the services included in the minimum package. This can be calculated on the basis of a review of training
records in each facility that has implemented services or serves women who could benefit from the minimum
package for preventing HIV in infants and young children.
If, however, such records do not exist, a survey of facilities can be carried out. A random sample of health care
providers in these facilities should be asked about training they may have received in the prevention of HIV
infections among infants and young children. (In some countries a national, provincial or district training coordinator
keeps records of the training given to individual health workers. Such data can be used instead of a facility
survey). Interviewers should investigate the composition of the training, which varies with the type of site. The
minimum package for each type of facility is outlined in the definition of the indicator. These data can be obtained
from ministry and health facility records. The numerator should be collected every year. The denominator, if
based on facility surveys are more expensive but is necessary for the calculation of the percentage and should
be obtained every two years. After the initial collection of data it may be of interest to disaggregate data for those
health care workers who have been newly trained or retrained during the preceding 12 months as well as to
maintain a record of how many health workers have been trained since the first time the indicator was measured.

Annex III
37
Numerator: The number of health care workers newly trained or retrained in the minimum package during the
preceding 12 months.
Denominator: The total number of health care workers working in facilities that have implemented the minimum
package, with women who could benefit from it, for preventing HIV infection in women and infants.
INTERPRETATION
This indicator tracks the number of health workers trained to provide services for the prevention of HIV infection
in infants and young children over time. It attempts to document increasing capacity to deliver preventive
interventions.
However, no conclusions should be drawn regarding quality, because this is affected by the practices employed
rather than by the existence of trained personnel. It should not be expected that all health workers in all countries
will have been trained, nor even that a high percentage of those who could be trained will have been trained.
The indicator should be interpreted in relation to the size and nature of the epidemic in particular countries.
Difficulties may occur in determining the denominator, as some countries may have limited information on the
pool of human resources available in various facilities. Frequent transfers of personnel between facilities, or high
rates of attrition, may complicate the interpretation of the indicator. It should be noted that the assumption is
made that only formal health workers are counted, i.e. those remunerated either financially or in kind. In many
settings, however, informal health workers make a significant contribution.
38

Annex III
Health workers trained on ART delivery in accordance with

national or international standards
PT-31
Total number of health care providers trained to deliver ART, according to national/international
standards (including PMTCT)
PURPOSE
This indicator measures the availability of a trained workforce for achieving national scale-up targets. It includes
both clinical and non-clinical health workers who contribute to the development and implementation of ART
services and provide critical support services.
Number of health workers (by type) newly trained or retrained on ART delivery in accordance with national or
international guidelines during the preceding 12 months. This covers health workers who have been trained to
a level enabling them to take up a direct function in support of the scaling up of ART. The training should include
the provision of clinical ART services, programme management, prevention services or monitoring. The following
types of health workers are included.
(a)
Physicians and health workers with physician skills (e.g. medical officers);
(b)
Nurses and other health workers with nursing skills (e.g. midwives, clinical officers);
(c)
Other health care workers and lay staff in clinical settings, including TB centres;
(d)
Counsellors;
(e)
Laboratory technicians and staff;
(f)
Pharmacy/dispensing staff;
(g)
Programme managers;
(h)
Other support staff (including record-keepers);
(i)
Community treatment supporters (peer educators, outreach workers, volunteers, informal carers).
It is assumed that, in most settings, such training occurs through specialized programmes that health workers
attend after their regular education (in-service training). Only health workers who haveundergone such training
should be included.
FREQUENCY: Annually during the scale-up phase, every two years thereafter.
The information for this indicator can be obtained from either of two sources:
A)
Programme records of organizations (private or public organizations, or NGOs) that are providing
the indicator: the majority of ART-related training in a given country. In most countries a limited number
of such organizations is responsible for all training (usually known to the national AIDS coordination
body), and the information for this indicator can be collected from their records.
B)
Facility-based surveys (of facilities providing ART).
If data are obtained from programme records:
1.
The source (name, type of organization, date and persons contacted) should be noted when the
information is collected.
2.
The indicator gives information on the overall size of the health workforce trained on HIV and AIDS in
the country concerned.

Annex III
39
3.
4.
The indicator does not, however, assess whether trained health workers are working in facilities providing
ART. This link is crucial for monitoring progress in the scaling up of ART services: Core Indicator 5,
section (f) in the present document allows for this link to be made; it assesses whether a facility has
at least one staff member providing ART who has been trained in the preceding 12 months.
In combination with information on facilities this indicator can help to identify bottlenecks in human
resource management. For example, reports on personnel shortages in facilities can be compared with
information on the nationally trained workforce and judgements can be made as to whether such
shortages are absolute or relative, e.g. if associated with hindrances to recruitment such as geographical
barriers and/or a lack of incentives. A guide to indicators for monitoring and evaluating national
antiretroviral programmes. If data are obtained from facility-based surveys (records of training
kept in facilities):
Numerator: Number of newly trained or retrained health care workers in the selected health facilities providing
ART
Denominator: Total number of health care workers in selected facilities providing ART.
INTERPRETATION
This indicator is most useful in the initial phases of a countrywide response to HIV and AIDS, when the cumulative
number of trained health professionals is expected to be continuously increasing until it reaches a critical mass
(or desired ceiling). At this point the quantitative focus of the indicator on the number of health workers trained
may become redundant, and measurement may shift so as to capture the quality of training, refresher training
and the testing/supervision of health care practices as outlined below.
Assessment of training programme: its content and duration; its compliance with international standards and
issues of local relevance. Assessment of results of training, involving measurement of health providers' knowledge
and attitudes, self-assessment and direct observation of their practice. Measurement of continuous and improving
competence over time (e.g. recertification, continuous education, knowledge and performance assessments,
practice audits). Implementation of certification schemes that attest to the competence of individuals to practice.
WHO is working with partners on the development of guidelines and tools for the development and implementation
of certification programmes. Additionally, some countries may be able to evaluate the performance of health
workers through operations research.
Reference: WHO (2005). National AIDS Programmes:
A Guide to Monitoring and Evaluating Antiretroviral Programmes. Geneva: WHO.
40

Annex III
Individuals trained to provide home based care
PT-32
A training must have specific learning objectives, a course outline or curriculum, and expected knowledge, skills
and/or competencies to be gained by participants. Training on HIV-related palliative care services may include:
A) clinical/medical including TB/HIV, B) psychological, C)spiritual, and/or D) support care services for HIV-infected
individuals and family members. Clinical care services include: prevention and treatment of TB/HIV, prevention
and treatment of other opportunistic infections (OIs), alleviation of HIV-related symptoms and pain, nutritional
rehabilitation for malnourished PLWHA. Psychological care services include: interventions that address the
non-physical suffering of individuals and family members such as mental health counselling, support groups,
identification and treatment of HIV-related psychiatric illnesses such as depression and related anxieties, and
bereavement services. Spiritual care services include: culturally-sensitive interventions that support individuals
and families through faith and ritual life review, assessment and counselling on hopes, fear, meaning of life, guilt,
forgiveness and life completion tasks. Supportive care services include: assisting individuals and family members
in linking to care services such as child care, adherence to treatment, legal services, housing, food support and
incomegenerating programmes.
Number of individuals trained to provide HIV-related palliative care for HIV-infected individuals
(diagnosed or presumed), including those trained in facility-based, community-based and/or
home-based care including TB/HIV
PURPOSE
This indicator measures the total number trained for HIV-related palliative care training refers to new training
or retraining of individuals and assumes that training is conducted according to national or international standards
when these exist.
FREQUENCY: Annual
MEASUREMENT TOOL: Routine Programme reporting data.
Agencies and partners should keep a training log including the type of training, date, location and participants
This indicator if the total number of individuals receiving training for facility-based palliative are (including those
trained in TB/HIV). Each agency and funded partner counts the number of individuals trained in HIV-related
palliative care by staff (HQ or field-based) or funded partners during the specified reporting period (12 months
for annual report). Only participants who complete the full training course should be counted. If a training course
covers more than one palliative care topic, for example clinical care and psychological care, individuals should
only be counted once for that training course. If a training course is conducted in more than one session/training
event, only individuals who complete the full course should be counted. Do not sum the participants for each
training event. The staff responsible for compiling the annual reporting data should use the training log submitted
by each agency and funded partner reporting on this indicator in order to count the total number of individuals
trained in HIV-related palliative care. Individuals trained in training courses co-funded by more than one
agency/partner should only be counted once within the specified reporting period 12 months for annual report).
INTERPRETATION
terms of the competencies of individuals trained, nor their job performance.
This indicator simply measures number trained in palliative care as opposed to the percent of health facilities
with trained staff, which may be measured through health facility surveys.
Annex III
41
Government funding for HIV and AIDS
NCA-33
Amount of national funds disbursed by the Government of Nepal for HIV and AIDS
At present, there are two methodologies used to thoroughly monitor HIV and AIDS resources in low- and middleincome countries which are collectively termed as HIV and AIDS National Spending Assessments (NSAs).
1. National AIDS Accounts in the context of National Health Accounts.
2. Stand-alone National AIDS Accounts.
Efforts have been made to harmonize National AIDS Accounts in the context of National Health Accounts and
the stand alone National AIDS Accounts. Any of these two approaches provide information on prevention and
public health, care and treatment, mitigation, infrastructure and administration. Other approaches, such as HIV
and AIDS-budget analysis, have been limited to the description of budgets. Amendments will be made to ensure
that expenditures are also accounted for. In the meantime, it might be a useful proxy measurement of the public
expenditures as shown in the list on page 17. There are also surveys on financial resource flows conducted by
the Resource Flows Project (joint UNFPA/UNAIDS/NIDI project); however, these need to be thoroughly analysed
to assess their completeness for HIV and AIDS since the major focus of such surveys is on reproductive health.
Those reports might not be based on standard methodologies, meaning that they might not include estimates
of public expenditures which are not clearly identified in the public budgets.
For countries that have access to information or databases on public budgets, careful attention is required in
assessing that the budgets are actually spent using the same budget lines as described in the original budget.
Also, it is essential to ensure the inclusion of expenditures which are not traditionally included within explicit
budget lines (e.g., treatment of opportunistic infections is not a single budget item; yet it is usually paid for using
public resources within hospital budgets).
Countries that do not have developed any of the tools described above (NSA, AIDS-budget analysis or special
surveys on financial resource flows) may provide information on this indicator using the executed public budgets.
However, again, they should supplement this information with the costing of other activities not included explicitly
in budget items. In a number of countries, most of the expenditures might occur at the health facilities and not
be clearly labelled as HIV and AIDS e.g., treatment of opportunistic infections in public hospitals, etc. To include
these public expenditures as part of the indicator, there are no options but to cost the provision of these services
and acknowledge the source of the funding to differentiate public and private expenditures.
It is also important to include in the total public expenditures relevant costs on non-health areas derived from
budgets of different ministries. This indicator should not be limited to data from the National AIDS Commission
or the National AIDS Programme within the Ministry of Health and Population.
Description of tools used for HIV and AIDS National Spending Assessments
National AIDS Accounts
PURPOSE
Comprehensive approach to monitoring HIV and AIDS spending across all sectors
FREQUENCY: Annual
MEASUREMENT TOOL: Desk review
42

Annex III
Examination of primary and secondary data sources from donors, public and private entities.
1.
Relevant government agencies.
2.
Employers.
3.
Households living with HIV and AIDS (free standing household survey; or service providers and patients
based).
4.
Nongovernmental organizations.
5.
Donors.
6.
Insurance companies.
7.
Providers of HIV and AIDS services including hospitals, clinics, physician offices, pharmacies, and
traditional healers.
A. HIV and AIDS health-care expenditures - expenditures on those activities that are:
1.
Primarily intended to have impact on the health status of people living with HIV and AIDS in a given
period of time; and
2.
Intended to prevent the spread of HIV, which may target the population at large (e.g., recipients of
condom distribution programmes intended to curb the spread of HIV).
B. Direct health-care expenditures - expenses primarily or entirely associated with health care
1.
HIV-prevention activities.
2.
Treatment and diagnostic services for HIV case management.
3.
Administration of HIV and AIDS services.
4.
Care and support activities.
C. Health-care related expenditures - expenses contributing to health but that are non-medical and/or intersect
with other disciplines
1.
Mitigation.
2.
Training and support.
3.
Capital formation for provider institutions.
D. Non health-care related expenditures - all other HIV and AIDS related expenditures in sectors outside of
health
1.
Education and social sectors.
2.
Orphaned and vulnerable children.
3.
In-kind or monetary benefits to people living with HIV.
INTERPRETATION
The methodology:
Allows for cross country, regional and international comparison of data:
Identifies how resources are being mobilized within a country.
Who pays?
Who finances?
Under what schemes?
Identifies how resources are being managed within a country.
Identifies who provides HIV and AIDS services and who benefits from these services:
Measures additionality: and
Provides possibility to conduct beneficiary analysis.

Annex III
43
HIV and AIDS Budget Analysis

PURPOSE
1.
2.
3.
To track national HIV and AIDS budget allocations and analyse from an
HIV and AIDS perspective.
To compare the amounts of state and donor funding to HIV and AIDS
activities
To use allocations in the national budget as indicators of human rights
achievements or violations.
FREQUENCY
1.
Ad hoc based on country request
MEASUREMENT TOOL
1.
2.
Literature review
Official budget documents (medium-term expenditure frameworks,
expenditure records)
Face-to-face interviews with key officials and stakeholders
3.
TERMINOLOGY USED
LIMITATIONS
Budgetary allocation to health and HIV and AIDS

1.
2.
3.
4.
5.
Inaccessibility and unavailability of budget documentation, little

dis-aggregation
Varying budgetary and accounting systems-undermined comparability
Lack of central database of donor funds
Difficulty in ensuring quality and validity of data in country reports, especially
if done by non-academic civil-society organizations.
Inability to measure allocations against actual expenditures: outputs
according to programming indicators and impact expenditure.
INTERPRETATION
The methodology:
Develops a common framework for tracking HIV and AIDS targeted allocations and expenditure in the
national budget.
Provides an indication of he attainment of human rights-issues of equity and efficiency in resource
allocation, if based on need;
Indicates prioritization of interventions; and
Provides an overview and recommendations to policy-makers on the effectiveness and efficiency of
budgeting and funding mechanisms for governments responses to HIV and AIDS.
44

Annex III
Government HIV and AIDS policies
NCA-34
National Composite Policy Index

PURPOSE
To assess progress in the development and implementation of national-level HIV and AIDS policies and strategies
FREQUENCY: Biennial
MEASUREMENT TOOL: Country assessment questionnaire (see appendix 3)
The composite index covers the following broad areas of policy.
Part A
1.
2.
3.
4.
5.
Strategic plan.
Political support.
Prevention.
Care and support.
Monitoring and Evaluation.
Part B
1.
2.
3.
4.
Human rights.
Civil Society involvement.
Prevention.
Care and support.
A number of specific policy indicators have been identified for each of these policy area (see appendix 3).
INTERPRETATION
The revised National Composite Policy Index attempts to assess both policy development and effectiveness
using elements of the AIDS Programme Effort Index Survey conducted in selected countries by the Policy Project.

Annex III
45
Bilateral and multilateral financial flows to benefit low- and

middle-income countries.
NCA-35
Amount of bilateral and multilateral financial flows (commitments and disbursements) for the
control of HIV and AIDS in Nepal
PURPOSE
To monitor financial flows (commitments and disbursements) from DAC member countries and multilateral
agencies (the Global Fund to Fight AIDS, TB and Malaria, the UN System and selected Development Banks)
to low-and middle-income countries3.
FREQUENCY: Annual
MEASUREMENT TOOL: Annual questionnaire by the Organisation for Economic Co-operation and Development
(OECD) Development Co-operation Directorate (DCD).
1.
Sexually transmitted infection control including HIV-all activities related to sexually transmitted diseases
and HIV control (Creditor Reporting System code 13040).
2.
Official Development Assistance (ODA) and their Official Aid (OA) to low-and middle-income countries.
INTERPRETATION
The indicator permits cross donor comparability of data.
This indicator reflects statistical data on donor assistance to HIV control. It does not capture the private
sector flows (international nongovernmental organizations and foundations, and corporate).
At present the code is limited to interventions within the health sector. Efforts are currently being made
to introduce one additional code to account for non-health related donor assistance to HIV and AIDS
and to identify HIV and AIDS components in wider programmes. (see footnote)
The indicator does not distinguish between resources devoted to HIV and AIDS prevention, treatment
and care, social mitigation and support.
Trends have shown that some donors include funding for Research and Development in their reporting
to the OECD/DAC under the current HIV and AIDS definition, this however is not unique to all donors.
For these reasons, the indicator is likely to be an under-estimate of total donor assistance to HIV and AIDS and
fluctuations in the indicator will reflect variations in response to the survey due to refinement of the current
4
methodology .
Four funding streams support the financing of AIDS programmes - bilateral, multilateral, private and domestic flows. Bilateral
multilateral and private flows are referred to as International flows.
One additional CRS code covering social mitigation of HIV and AIDS (provision of social and legal assistance to people with
HIV/AIDS: special programmes to address social consequences of HIV and AIDS) is presently under consideration with the
OECD, Development Co-operation Direction (DCD), DAC - Working Party on Statistics. The Working Party is also discussing
a multiple purpose code system. This would allow for the identification of HIV and AIDS related activities within wider health
and other programmes.
46

Annex III
Workplace HIV and AIDS control
OP-36
The workplace is often a highly convenient and conducive setting for HIV control activities and workplace-based
interventions have been proven to be effective.
Percentage of large enterprises/companies which have HIV and AIDS workplace policies and
programmes
PURPOSE
To assess progress in implementing workplace policies and programmes to combat HIV and AIDS in large
enterprises/companies
FREQUENCY: Annual
MEASUREMENT TOOL: Desk review and key informant interviews
The United Nations Conference on Trade and Development (UNCTAD) list of 100 largest trans-national companies
ranked by foreign assets plus an addition 10 trans-nationals in mining and tourism sectors are asked to state
whether they are currently implementing personnel policies and procedures that cover, as a minimum, all of the
following aspects.
1.
Prevention of stigmatization and discrimination on the basis of HIV infection status in: (a) staff recruitment
and promotion; and (b) employment, sickness and termination benefits.
2.
Workplace-based HIV-prevention activities that cover: (a) the basic facts on HIV and AIDS; (b) specific
work-related HIV transmission hazards and safeguards; (c) condom promotion; (d) confidential voluntary
counselling and testing; (e) sexually transmitted infection diagnosis and treatment; and (f) provisions
for HIV and AIDS related drugs.
Numerator: Number of employers with HIV and AIDS policies and programmes that meet all of the above criteria.
Denominator: Number of employers surveyed (110). Copies of written personnel policies and regulations should
be obtained and assessed wherever possible.
INTERPRETATION
People employed in small businesses and the informal sector often constitute a significant proportion
of the workforce but are less likely to be reached by workplace HIV and AIDS programmes. Nevertheless,
trends in this indicator will provide a useful guide to incremental improvements In national coverage.
The indicator is useful even in countries where HIV prevalence is low because early action in educating
workers on HIV prevention is essential if the likelihood of serious economic and social consequences
from HIV and AIDS is going to be reduced.

Annex III
47
REFERENCES
1.
UNAIDS (2005). UNGASS: Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on

construction of core indicators, 2006 reporting, Geneva, Switzerland, May 2005.
2.
WHO (2005). National AIDS Programmes: A Guide to Monitoring and Evaluating Antiretroviral Programmes.
Geneva: WHO
3.
UNICEF (2005). Guide to Monitoring and Evaluation of the national response for Children Orphaned and
Made Vulnerable by HIV/AIDS. Geneva: UNICEF
4.
UNAIDS/MEASURE (2000). National AIDS Programmes: A Guide to Monitoring and Evaluation.

(http://www.cpc.unc.edu/measure/guide/guide.html)
5.
WHO/UNAIDS (2004). National AIDS programmes: A Guide to Monitoring and Evaluating HIV/AIDS Care
and Support. (http://www.who.int/hiv/pub/epidemiology/en/)
6.
OGAC (2005). The Presidents Emergency Plan for AIDS Relief: Indicators, Reporting Requirements, and
Guidelines for Focus Countries, Revised for FY2006 Reporting.
7.
Millennium Development Goals Indicators (MDG) (http://www.developmentgoals.org/Goals.htm)
8.
USAID/Nepal (2005-2006). HIV/AIDS Performance Monitoring Plan.
9.
USAID (2003). Expanded Response Guide to Core Indicators for Monitoring and Reporting on HIV/AIDS
programs. (http://www.usaid.gov/our_work/global_health/aids/TechAreas/monitoreval/)
10. GFATM (2006). Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis, and Malaria.
(http://www.theglobalfund.org/pdf/4_pp_me_toolkit_4_en.pdf)
11. WHO/UNAIDS (2004). Guide to Monitoring and Evaluating National HIV/AIDS Programmes for Young
People.
12. WHO Safe Injection Global Network Toolbox (2002). Injection Practices: Rapid Assessment and Response
Guide. (http://www.who.int/injection_safety/toolbox/en/)
13. UNICEF (2004). National Guide to Monitoring and Evaluating Programmes for the Prevention of HIV in
Infants and Young Children. (http://www.who.int/hiv/en)
14. WHO (2006). Revised Clinical Staging and Immunological Classification of HIV/AIDS and Case Definitions
of HIV-Related Definitions.
15. WHO (1999). Regional Consultation on HIV, AIDS and STI.
16. WHO (2004). A Guide to Monitoring and Evaluation for Collaborative TB/HIV Activities
17. WHO (2006). Guidelines on Co-Trimoxazole Prophylaxis for HIV-Related Infections among Children,
Adolescents and Adults in Resource-Limited Settings.
18. WHO (2006). WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological
Classification of HIV-Related Disease in Adults and Children.
48

Annex III
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Indicator Definitions

Sources: UNGASS, GFATM, WHO, PEPFAR, USAID etc.

Number of people [MAR] diagnosed and treated for STIs ......................................................................... 17

Counselling and Testing

Number of health facilities providing the minimum package of PMTCT .................................................. 23

HIV and AIDS Treatment/ARV Services

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Cross-cutting component objectives:

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

People infected with HIV

Number of people infected with HIV (by age and sex)

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Most-at-risk populations: reduction in HIV prevalence

Percentage of [most-at-risk population(s)] who are HIV-infected

Reference: UNAIDS (2005). UNGASS: Monitoring the Declaration of Commitment on HIV/AIDS:

Cases of advanced HIV infection

Number of new cases of advanced HIV Infection reported

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

HIV treatment: survival after 12 months on anti-retroviral therapy

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Reduction in mother-to-child transmission

Percentage of infants born to HIV infected mothers, who are infected

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Sex workers: condom use

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Men who have sex with men: condom use

Injecting drug users: safe injecting and sexual practices

Reference: UNAIDS (2005). UNGASS: Monitoring the Declaration of Commitment on HIV/AIDS:

Most-at-risk populations: knowledge about HIV prevention

Percentage of [most-at-risk population(s)] who both correctly identify ways of preventing

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Young people: knowledge about HIV prevention

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Most-at-risk populations: prevention programmes

Percentage of [most-at-risk population(s)] reached with HIV-prevention programmes

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Percentage of transfused blood units screened for HIV

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Number of new cases diagnosed and treated for STIs

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Sexually transmitted infections: comprehensive case management

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Number and location of service delivery points providing

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Most-at-risk populations: HIV testing

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Public and private laboratories performing HIV testing

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Number of Service Delivery Points providing the minimum

MEASUREMENT TOOL: Routine Programme monitoring data

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Women completing the testing and counselling process

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Prevention of mother-to-child transmission: antiretroviral

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Reference: UNAIDS (2005). UNGASS: Monitoring the Declaration of Commitment on HIV/AIDS:

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Health facilities providing advanced HIV and AIDS clinical

HIV treatment: antiretroviral combination therapy

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal

Monitoring and Evaluation Guidelines for HIV and AIDS in Nepal