Implementing M&E for the Multisectoral AIDS Programme in Gauteng

1. Implementing M&E for the Multisectoral AIDS Programme in Gauteng Using Behavioural Surveillance Surveys Sue le Roux & Dr Francis Akpan, Multisectoral AIDS Unit

2. Outline • Background to Gauteng AIDS Programme • Description of M&E system and M&E Plan • The role of surveillance surveys • Behavioural surveillance surveys: Youth in school, youth out of school, taxi drivers • Comparability of findings (2003 and 2006) • Issues for M&E practitioners • Recommendations

3. Gauteng AIDS Programme • Multisectoral, government + civil society + business • Communication / education / mobilisation • 4 Goals • Prevent new HIV infections • Comprehensive care • Support for children and families • Coordinate the multisectoral response

4. M&E system and plan • Theoretical Basis: UNAIDS Guidelines and 3 Ones • Routine Reporting: reporting tool, financial & narrative • Surveillance System: • Repeat biological and behavioural surveys • Facility surveys • Research: • Evaluations of existing interventions • Evaluations of new interventions • Other Research: to inform programme development & planning • Overall System: Flowchart and database, M&E plan, Log frames with indicators

6. Why surveillance surveys • Repeat surveys of similar groups • Biological surveillance (information about biological end-points) and behavioural surveys (risk-related behaviour) • Bi-annual behavioural surveillance, using established methodologies, of priority populations – e.g. BSS of youth, taxi drivers, commercial sex workers, etc • BSS can be a useful tool in informing responses to HIV and AIDS because they monitor behaviour, attitudes and knowledge over a period of time • BSS can monitor trends which are vital to the effective creation of intervention plans and their implementation • BSS can reach hard-to-reach population groups that a more standardised household survey is incapable of

7. BSS 2003 and 2006 2003 • Youth in school • Youth out of school • Commercial sex workers • Hostel residents 2006 • Youth in school • Youth out of school • Taxi drivers

8. BSS indicators • Knowledge of HIV prevention methods • No incorrect beliefs about AIDS • Comprehensive knowledge of HIV • Multiple partners in the last 12 months • Risky sex in the last year • Condom use at last risky sex • Sex with a sex worker in the last 12 months • Condom use at last commercial sex • Accepting attitudes to those living with HIV

9. Areas of interest (Taxi drivers) • Short distance, long distance, cross border • Number of nights spent away from home • ‘Sleep-over trips’ outside of Gauteng • Circumcision • Condom use at last sex with non-regular partner • Alcohol use • VCT • Sources of information / language of preference

10. YIS / YOS sample 2003/06

11. Challenges of comparability • The ‘exact group’ cannot be compared over time • Similar populations could be fundamentally different in Gauteng • Temporality • Non-linear concept of causality / assumption of causality • Different special risk groups included

12. Issues for M&E practitioners • Challenge of identifying trends and changes • Comparability of samples • Ensuring methodological consistency (documentation, staff turnover) • Attributing changes to programmes and interventions (impossible) • Role of stakeholders / programme managers in interpretation of findings • Consider how to optimise the data and investment in research (e.g. advanced analysis)

13. Recommendations • M&E Plan and know how surveillance fits in • Allocate resources • Persist with BSS – established, comparable, credibility, replicable • If possible link biological and behavioural surveys • Utilisation of the product: interpret data in a way managers can understand; use findings to influence plans and programme design and implementation • Allocate resources for advanced analysis and ensure technical capacity (specs, project management, service provider)

14. Thank you Sue le Roux suel@gpg.gov.za