Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive

Abstract

The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015.1 To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child HIV transmission (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and, importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda’s development and use of a weekly reporting system for PMTCT using short message service (SMS) technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a “treat all” approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda’s work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.

Eliminating Mother-to-Child Transmission of HIV by 2030: 5 Strategies to Ensure Continued Progress

“…The Global Plan brought significant improvements to measuring PMTCT program outcomes, including low-tech longitudinal registers to track mother–infant pairs and an updated monitoring framework as countries moved to providing lifelong ART for women under Option B+. 61 , 62 Despite these advances, ongoing core challenges to monitoring and evaluation include tracking women who move between general ART and PMTCT programs, monitoring maternal viral suppression, and assessing final infant HIV status. The individual medical record data needed to accurately determine these PMTCT outcomes are challenging to track in settings where health infrastructure is limited and electronic systems are not available.…”

Adaptation of an electronic dashboard to monitor HIV viral load testing in Côte d’Ivoire

“…The adaptation, development and launch of the VL dashboard in Côte d’Ivoire is a collaborative success story and a milestone achievement for the national HIV programme and for international donors such as the United States President’s Emergency Plan for AIDS Relief. The information available through the dashboard will help accelerate decision-making and programmatic response time, 11 especially the ability to monitor key subpopulations. For example, paediatric and adolescent viral suppression rates are observably lower (53.4%) than adults aged 25 years or older (79.8%), and the dashboard is being used to monitor this population subset and track their clinical outcomes.…”

“…In Uganda, Option B+ usage has been documented since 2013 via a nationwide weekly reporting system using short message service technology. 11 Kenya also uses a dashboard to support the national review of VL and infant virologic test programme data through the integration of open-source laboratory information systems with cloud-based servers. 12 Namibia developed a Pharmaceutical Management Information Dashboard that interlinks four pharmaceutical information tools to serve as a platform for analysis and dissemination to improve anti-retroviral therapy delivery.…”

Differences in Reasons for Late Presentation to HIV Care in Uganda Among Men and Women

“…Some women have documented that male partners may become violent, deny transport funding for testing and treating HIV, or throw away their HIV medications. Since routine prenatal HIV testing is standard of care globally [ 20 ], many women are diagnosed with HIV early while they are asymptomatic. Prevention of mother-to-child transmission programs reduce late presentation to HIV care among women [ 21 , 22 ], but this reduced late presentation is not seen in their male partners [ 21 ].…”