MER 2.0 Indicator Reference Guide

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January 2018

Version 2.2

Monitoring, Evaluation, and

Reporting (MER 2.0)

Indicator Reference Guide

Updated Release

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MER 2.0 INTRODUCTION 
3 
 
CONTENTS 
Contents ............................................................................................................................................3 
Abbreviations ....................................................................................................................................6 
Introduction ......................................................................................................................................7 
Key Changes: MER 2.0 (V.1) to MER 2.0 (V.2) ......................................................................................8 
New Indicators: ......................................................................................................................................... 8 
HTS_SELF ............................................................................................................................................... 8 
PMTCT_HEI_POS ................................................................................................................................... 8 
New Disaggregations: ............................................................................................................................... 8 
Age disaggregations .............................................................................................................................. 8 
HTS_TST................................................................................................................................................. 9 
LAB_PTCQI............................................................................................................................................. 9 
Modifications to Existing Indicators .......................................................................................................... 9 
OVC_SERV ............................................................................................................................................. 9 
Modifications to Existing Disaggregations ................................................................................................ 9 
VMMC_CIRC .......................................................................................................................................... 9 
PrEP_NEW ............................................................................................................................................. 9 
OVC_SERV ............................................................................................................................................. 9 
TB_PREV ................................................................................................................................................ 9 
TX_TB .................................................................................................................................................. 10 
GEND_GBV .......................................................................................................................................... 10 
Deleted Indicators ................................................................................................................................... 10 
INVS_COMD ........................................................................................................................................ 10 
OVC Essential Survey Indicators.......................................................................................................... 10 
Deleted Disaggregations ......................................................................................................................... 10 
HTS_TST............................................................................................................................................... 10 
PMTCT_EID .......................................................................................................................................... 10 
HRH_CURR .......................................................................................................................................... 10 
Indicator Clarifications ............................................................................................................................ 11 
Key Populations................................................................................................................................... 11 
PMTCT_STAT ....................................................................................................................................... 11 
TB_PREV .............................................................................................................................................. 11 
TX_TB .................................................................................................................................................. 11 
TX_PVLS: .............................................................................................................................................. 11 
PEPFAR Support to Communities and Sites ....................................................................................... 11 
DSD: ......................................................................................................................................................... 12 
TA-SDI: ..................................................................................................................................................... 12 
Support in Centrally Supported Areas .................................................................................................... 12 
Disaggregated Monitoring ................................................................................................................ 13 
Required Disaggregations ....................................................................................................................... 13 
Conditional Disaggregations ................................................................................................................... 13 

 
4 
 
Optional Disaggregations ........................................................................................................................ 13 
MER Indicator Narratives ................................................................................................................. 13 
Guiding Narrative Questions ................................................................................................................... 14 
Implementing Mechanism (IM) Level Narratives ................................................................................... 14 
Technical Area Level Narratives .............................................................................................................. 14 
National and Subnational Level Results Narratives ................................................................................ 15 
Host Country National Program ........................................................................................................ 15 
Host Country National and Subnational Results ..................................................................................... 16 
Host Country National and Subnational Targets .................................................................................... 16 
Host Country indicators by reporting level, targets, and results ............................................................ 16 
SIMS in Relation to MER 2.0 ............................................................................................................. 17 
DREAMS Specific Guidance ............................................................................................................... 17 
MER 2.0 Infographic ......................................................................................................................... 18 
Indicator Reporting Frequency by Program Area ................................................................................... 19 
How to read a PEPFAR indicator reference sheet................................................................................... 21 
Prevention & Support Indicators ...................................................................................................... 22 
PrEP_NEW ............................................................................................................................................... 23 
VMMC_CIRC ............................................................................................................................................ 25 
KP_PREV .................................................................................................................................................. 27 
PP_PREV .................................................................................................................................................. 31 
OVC_SERV ............................................................................................................................................... 36 
TB_PREV .................................................................................................................................................. 41 
KP_MAT ................................................................................................................................................... 44 
GEND_GBV .............................................................................................................................................. 46 
FPINT_SITE .............................................................................................................................................. 50 
Knowing Your HIV Status Indicators .................................................................................................. 55 
HTS_TST (including HTS_TST_POS) ......................................................................................................... 56 
HTS_SELF ................................................................................................................................................. 65 
PMTCT_STAT (including PMTCT_STAT_POS) .......................................................................................... 69 
PMTCT_EID .............................................................................................................................................. 72 
PMTCT_HEI_POS ..................................................................................................................................... 75 
TB_STAT (including TB_STAT_POS) ......................................................................................................... 79 
OVC_HIVSTAT .......................................................................................................................................... 81 
PMTCT_FO............................................................................................................................................... 85 
On ART Indicators ............................................................................................................................ 89 
TX_NEW .................................................................................................................................................. 90 
TX_CURR ................................................................................................................................................. 93 
PMTCT_ART ............................................................................................................................................. 96 
TB_ART .................................................................................................................................................... 99 
TX_TB .................................................................................................................................................... 101 
Viral Suppression Indicators ........................................................................................................... 104 
TX_RET .................................................................................................................................................. 105 

 
   
 
MER 2.0 INTRODUCTION 
5 
 
TX_PVLS ................................................................................................................................................. 110 
Health Systems Indicators .............................................................................................................. 114 
SC_STOCK .............................................................................................................................................. 115 
HRH_PRE ............................................................................................................................................... 118 
HRH_STAFF ............................................................................................................................................ 121 
HRH_CURR ............................................................................................................................................ 124 
EMR_SITE .............................................................................................................................................. 129 
LAB_PTCQI ............................................................................................................................................ 132 
Host-Country National & Subnational Indicators ............................................................................. 139 
DIAGNOSED_NAT/SUBNAT ................................................................................................................... 140 
VL_SUPPRESSION_NAT/SUBAT ............................................................................................................. 142 
TX_CURR_NAT/SUBNAT ........................................................................................................................ 144 
KP_MAT_NAT/SUBNAT ......................................................................................................................... 146 
PMTCT_STAT_NAT/SUBNAT ................................................................................................................. 147 
PMTCT_ART_NAT/SUBNAT ................................................................................................................... 149 
VMMC_CIRC_NAT/SUBNAT .................................................................................................................. 152 
VMMC_TOTALCIRC_NAT/SUBNAT ........................................................................................................ 154 
Appendices .................................................................................................................................... 156 
Appendix 1: Key Population Classification Document .......................................................................... 157 
Appendix 2: MER and SIMS Mapping ................................................................................................... 158 
Appendix 3: DREAMS and DREAMS-Like SNU Reporting Requirements .............................................. 169 
Appendix 4: Frequency & Level of Reporting Table .............................................................................. 171 
Appendix 5: Implementation and Planning Attributes (IMPATTS) ....................................................... 172 
Appendix 6: HRH_CURR Example Calculation....................................................................................... 173 
  

ABBREVIATIONS

CQI continuous quality improvement

DATIM Data for Accountability, Transparency, and Impact

DREAMS Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe

EID early infant diagnosis

EMR electronic medical record

FSW female sex worker

GBV gender-based violence

HEI HIV-exposed infant

HIVST HIV self-testing

HRH human resources for health

HTS HIV testing services

IP implementing partner

KP key populations

MER monitoring, evaluation, and reporting indicators

MOH Ministry of Health

MSM men who have sex with men

OVC orphans and vulnerable children

PEPFAR United States President’s Emergency Plan for AIDS Relief

PITC provider-initiated testing and counseling

PLHIV people living with HIV

PMTCT prevention of mother-to-child transmission

POCT point-of-care testing

PP priority populations

PT proficiency testing

PVLS patient viral load suppression

PWID people who inject drugs

SID sustainability index

SIMS site improvement through monitoring systems

TB tuberculosis

TG transgender people

TX treatment

UNAIDS Joint United Nations Programme on HIV/AIDS

USG United States Government

VL viral load

VMMC voluntary medical male circumcision

WHO World Health Organization

MER 2.0 INTRODUCTION

INTRODUCTION

PEPFAR's focus on optimizing impact is a driving force behind global efforts to reach HIV epidemic

control. PEPFAR is partnering with the international community to accelerate towards the UNAIDS 95-

95-95 global goals: 95 percent of people living with HIV know their HIV status, 95 percent of people who

know their HIV status are accessing treatment, and 95 percent of people on treatment have suppressed

viral loads. Progress towards epidemic control will be successfully measured, in part through an effective

strategic information framework that not only monitors program outputs, but also key outcomes and

programmatic impact.

Given the global HIV progress over the past decade, planning, monitoring and resource allocation needs

to occur at the subnational, community, and site levels in order to achieve the greatest impact.

Collection and use of disaggregated data that characterizes the populations served in the lowest

geographic areas where HIV services are being provided is critical in understanding current program

performance and planning for future performance. Consequently, the PEPFAR Monitoring, Evaluation,

and Reporting (MER) indicators continue to evolve in order to reflect the progression of U.S.

government (USG) support and global HIV response guidelines. Measuring the impact of national and

regional above-service delivery area support down to support provided for direct services at the site-

level is paramount to PEPFAR’s monitoring and reporting approach.

The objectives of the MER guidance document are to streamline and prioritize indicators for PEPFAR

programs. As the PEPFAR MER Indicators were being updated the following was taken into

consideration:

• Reduction of indicators to focus program monitoring on what matters most for epidemic

control;

• Standardization of age, sex and key population disaggregations across the prevention and

clinical cascades to monitor which populations are being reached with high quality evidence-

based services, and to identify which populations are not being reached;

• Alignment of indicators with multilaterals and partner governments to avoid duplication of data

collection where possible, and to focus on improved data and programmatic quality;

• Input from community stakeholders, technical experts, implementing partners, and PEPFAR field

staff;

• Alignment with other PEPFAR data streams such as site improvement through monitoring

systems (SIMS), financial monitoring, and the sustainability index (SID).

KEY CHANGES: MER 2.0 (V.1) TO MER 2.0 (V.2)

New Indicators:

HTS_SELF: HTS_SELF is a new indicator introduced for reporting beginning in Q1 of FY18. This indicator

assesses the distribution of HIV self-test kits disaggregated by directly assisted versus unassisted self-

testing. While age/sex disaggregates are requested for this indicator, it’s important to remember that

this indicator is assessing the distribution of self-test kits so the disaggregated data should be focused on

the individual the self-test kit was distributed to and not necessarily the end use of the test kit. For more

information and examples, please refer to the indicator reference sheet for HTS_SELF.

PMTCT_HEI_POS: PMTCT_HEI_POS is a new indicator for reporting beginning in Q1 of FY18. This

indicator is being introduced in response to challenges with the former PMTCT_EID_POS indicator

disaggregation in the collection of test results among those tests that were performed within the same

quarter. Previously, a significant proportion of results were reported as “unknown” each quarter since

results reporting was based on the date of DBS collection, but turnaround times from DBS collection to

result return to site are often ≥4 weeks. DBS collected within 4 weeks of the end of the quarter generally

did not have a result reported.

PMTCT_HEI_POS addresses these monitoring challenges by collecting only the positive results that

returned during the reporting period. PMTCT_HEI_POS indicator was introduced to describe both early

testing coverage and linkage of HIV+ infants to ART and to ensure collection of the number of infants

identified as HIV+ in the first year of life that would be accurate and meaningful to program monitoring

and planning. PMTCT_EID will continue to collect the virologic tests performed.

New Disaggregations:

AGE DISAGGREGATIONS: Data from the Population-Based HIV Impact Assessments (PHIA) provided

valuable insight into the progress many PEPFAR countries have made towards achieving the 95-95-95

goals in all ages and sexes. Significant disparities in incidence and viral suppression among adults within

the PEPFAR 25-49-year-old reporting age band lead PEPFAR to reassess the required reporting age

bands and further disaggregate the 25-49-year old age band into the following four age bands: 25-29,

30-34, 35-39, and 40-49. Reporting on the new PEPFAR age bands will commence in FY18 Q2.

New age bands: <1, 1-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-49, and 50+

Previous age bands: <1, 1-9, 10-14, 15-19, 20-24, 25-49, and 50+

Reporting on the new MER 2.0 (v2.2) will be introduced in FY 18. Country teams that are unable to meet

the requirements for reporting the new age bands in FY 18 can continue reporting on the previous

aggregated 25-49 year old age band through FY 18. However, reporting on the new finer

disaggregations to align with targets set is COP 18 is required beginning in FY 19. Country teams should

discuss barriers to reporting on the new disaggregations during COP 18 to determine what systems and

resources can be realigned in FY 18 to ensure seamless reporting on the new age in Q1 of FY 19.

MER 2.0 INTRODUCTION

HTS_TST: Two new facility-based testing modalities have been introduced for FY18 reporting:

emergency department and STI clinic. Please refer to the indicator reference sheet for HTS_TST for

additional details on the new facility-based testing modalities.

LAB_PTCQI: A new disaggregate was introduced beginning in FY18 for the number of specimens

received for testing at all PEPFAR-supported laboratories and point-of-care testing (POCT) sites within a

testing category for the following categories: HIV serology/diagnostic testing, HIV IVT/EID, HIV Viral

Load, TB Xpert, TB AFB, TB Culture, and CD4. LAB_PTCQI is an annual indicator so PEPFAR teams will

begin reporting on this change at FY18 Q4.

Modifications to Existing Indicators

OVC_SERV: Requirements for OVC_SERV have changed significantly in FY 2018. The indicator

calculation has been updated and OVC_SERV will return to being a snapshot indicator again for FY 18

reporting. Results should not be summed across reporting periods.

The numerator for OVC_SERV will be auto-calculated using the program participation status

disaggregation for (1) active beneficiaries and (2) graduated beneficiaries. Beneficiaries that transferred

or exited without graduation should no longer be reported in the numerator. However, these data will

still be collected as OVC_SERV disaggregates.

Transferred will be further disaggregated into “transferred to a PEPFAR-supported partner” or

“transferred to a non-PEPFAR-supported partner.”

These changes will be reflected in the data entry screens in DATIM beginning in FY 18 Q2.

Modifications to Existing Disaggregations

VMMC_CIRC: The VMMC follow-up status disaggregate has been updated to capture instances where

post-VMMC follow-up did not take place within 14 days of the procedure or within the reporting period.

PREP_NEW: The KP type disaggregation for this indicator was updated to include ‘Other KP Type’ in

addition to the MSM, TG, and FSW options that were already available.

OVC_SERV: The Age/Sex/Service Area disaggregate [DREAMS Conditional Disaggregate] was updated

to include the age bands for children under 10 (<1, 1-9).

TB_PREV: Corresponding to the sharper focus of the End TB Strategy and the emphasis on TB

prevention, we now report TB_PREV which identifies the proportion of patients that complete or are

maintained on continuous preventive therapy. The disaggregation for “Type of TB preventive therapy”

has been updated for FY18 reporting to include ART start (i.e., newly enrolled on ART vs. previously

enrolled on ART). TB preventive therapy regimen disaggregates include IPT or an alternative TB

preventive therapy regimen by newly or previously enrolled on ART.

TX_TB: TX_TB allows us to document the number of patients who are screened for TB and the

proportion of those who are eventually started on TB therapy. This indicator also captures the number

of ART patients who had a specimen sent for bacteriologic diagnosis (and type) of active TB disease. The

denominator disaggregation for ‘Screen Result’ has been updated for FY18 reporting to include ART start

to help understand if patients that screen for TB (i.e., either screen positive or screen negative) are

either newly enrolled or previously enrolled on ART.

GEND_GBV: Age/sex disaggregations were added to the post-exposure prophylaxis (PEP)

disaggregation. This change will help us to better understand which individuals are receiving PEP among

those that have experienced sexual violence. GEND_GBV is an annual indicator so PEPFAR teams will

begin reporting on this change at FY18 Q4.

Deleted Indicators

INVS_COMD: Indicator has been removed due to duplication with quarterly data submitted by

principal supply chain mechanisms.

OVC ESSENTIAL SURVEY INDICATORS: The OVC MER Essential Survey Indicators are currently under

review. Countries that have not yet started data collection should hold on conducting surveys until the

review is complete. Countries that are in the process of data collection, or have already conducted at

least one round, should continue as planned. Questions about the OVC MER essential survey indicators

and related requirements can be directed to SGAC_SI@state.gov.

Deleted Disaggregations

HTS_TST: Home-based testing was removed as a community-based testing modality. Country teams

that targeted for programming for FY18 within the home-based testing modality should assess the

approaches outlined before implementation of these activities begins. Country teams were discouraged

from planning home-based testing activities for COP 17 (FY18 implementation) as previous program

data from this modality yielded sub-optimal results. Door-to-door and family testing activities targeted

under this indicator should be reevaluated and shifted to alternative testing modalities that will lead to

higher yield and greater programmatic progress towards the identification of positives.

PMTCT_EID: Infants’ diagnoses through virologic test results (positive, negative, unknown) are no

longer reported within this indicator beginning in FY18 Q1. PEPFAR is introducing the PMTCT_HEI_POS

indicator which will now be used for reporting on those infants diagnosed HIV positive and their linkage

to treatment. PMTCT_EID will still be collected to monitor the number of EID tests conducted.

HRH_CURR: Changes were made to the above-service delivery area reporting for this indicator. The

‘Cadre Category & Support Type’ disaggregation was updated to remove the ‘Staff Receiving ONLY Non-

Monetary Support (FTE)’ option. Results should be reported at the above-service delivery area by cadre

category and the following support types: ‘Salaried Staff (FTE)’ or ‘Staff Receiving Stipends (FTE).’

Requirements for HRH_CURR reporting at the facility and community-levels remain unchanged. This

change goes into effect with FY17 Q4 reporting.

MER 2.0 INTRODUCTION

Indicator Clarifications

KEY POPULATIONS: Language changes for key populations categories were made to align with WHO

guidance. ‘Transgender’ was changed to ‘Transgender People.’ ‘People in prison and other enclosed

setting’ was changed to ‘People in prison and other closed settings.’

In addition, KP guidance has been modified to avoid double-counting and ensure that the KP data

reported can be meaningfully interpreted. Despite persons potentially falling into more than one KP

disaggregate (e.g., FSW who injects drugs, MSM), implementing partners should be instructed to report

an individual in only one KP category with which s/he is most identified. This guidance is applicable to

KP_PREV and the KP disaggregates for PrEP_NEW, HTS_TST, and TX_NEW. To better determine the KPs

of interest for each indicator the key population classification document found in Appendix 1.

PMTCT_STAT: Clarifying language was added to the indicator definition. Data collected for this

indicator should be testing data associated with the first ANC visit (ANC1) of the pregnancy. This

reduces the risk of double counting pregnant women who could be tested multiple times during

pregnancy.

TB_PREV: Language updated to note that this is a snapshot indicator like TX_CURR. Results should not

be summed across reporting periods.

TX_TB: Language updated to note that this is a snapshot indicator like TX_CURR. Results should not be

summed across reporting periods.

TX_PVLS: Clarifying language added to specify that only patients who have been on ART for at least 3

months should be counted under this indicator. This will ensure that all viral load test outcomes

reported will be for patients who have been on ART long enough for it to be efficacious in reducing viral

load. Shift in categorization of follow-up VL test done after an initial VL test result of VL>1,000. Follow-

up viral loads done after an initial VL test result of VL>1,000 should be counted under routine and not

targeted tests since all patients who receive an initial VL test result of VL>1000 should routinely receive

a follow-up VL test after completing some enhanced adherence counseling. Guiding narrative questions

were modified.

PEPFAR SUPPORT TO COMMUNITIES AND SITES

Completing the third year of quarterly site-level monitoring by all PEPFAR implementing agencies and

implementing partners have provided granular data that demonstrate important differences in patient

outcomes and site performance. These results should be used to prioritize resources, staff, and

interventions among sites to determine the appropriate extent of support and monitoring needed based

on site-level outputs and quality outcomes.

There are three categories of PEPFAR support that correspond to attained, scale-up, sustained and

centrally supported areas. In areas where PEPFAR is supporting attained, scale-up, and sustained

services the type of support should be categorized as Direct Service Delivery (DSD) or Technical

Assistance-Service Delivery Improvement (TA-SDI). In areas where PEPFAR support is not at the site

level, but is financial support at the national or subnational levels then this support should be

characterized as Central Support (CS). DSD and TA include all sites receiving 1 or more PEPFAR-

supported visits during the year. Importantly, site-level quarterly results and SIMS data should be

analyzed and used to determine the number of program support visits needed each year to optimize the

quality of HIV/AIDS services and impact. PEPFAR teams should work with implementing partners to

ensure that programmatic data (including MER and SIMS results) are being used in this way. The key is

to ensure that PEPFAR-supported sites receive the appropriate number of technical assistance visits

based on their performance.

DSD: Individuals will be counted as receiving direct service delivery support from PEPFAR when BOTH of

the below conditions are met: Provision of key staff or commodities AND support to improve the quality

of services through site visits as often as deemed necessary by the partner and country team.

TA-SDI: Individuals will be counted as supported through TA-SDI when the point of service delivery

receives support from PEPFAR that meets the second criterion ONLY: support to improve the quality of

services through site visits as often as deemed necessary by the partner and country team.

1. PEPFAR is directly interacting with the patient or beneficiary in response to their health

(physical, psychological, etc.) care needs by providing key staff and/or essential commodities for

routine service delivery. Staff who are responsible for the completeness and quality of routine

patient records (paper or electronic) can be counted here; however, staff who exclusively fulfill

MOH and donor reporting requirements cannot be counted. Each indicator reference sheet

includes a list of key staff and/or essential commodities that meet this condition.

AND/OR

2. PEPFAR provides an established presence at and/or routinized support for those services at the

point of service delivery. Each indicator reference sheet includes a list of activities that count

toward support for service delivery improvement.

Support in Centrally Supported Areas: In areas where PEPFAR is providing solely financial support

at the national, regional or district level, site level support will be through annual visits. However, to

support government with quality monitoring results reported through national health information

systems should be jointly monitored with host country government on a quarterly basis. SIMS visits may

be conducted at these sites if quality issues are identified.

While site-specific activities have transitioned to government or other support, PEPFAR continues

provide support for overarching activities, such as quality assurance and quality improvement (QA/QI) to

ensure that patients continue to receive quality services. As such, PEPFAR will continue monitoring

activities in centrally supported sites annually via the following indicators: PMTCT_STAT, PMTCT_ART,

HTS_TST, TX_CURR, TX_NEW, and TX_RET. Due to the financial investments PEPFAR provides at the

above-service delivery area in centrally supported sites and SNUs, it is important that results be

provided to ensure that quality assurance initiatives are having the intended impact. PEPFAR programs

MER 2.0 INTRODUCTION

should be focused on moving the national program in their respective country to 90% ART coverage for

PLHIV. Therefore, it is extremely important to have an understanding of the services being provided to

PLHIV in the entire country.

Results for all centrally supported SNUs and sites should be reported for all 23 Standard Process COP

Operating Units (i.e., Botswana, Burundi, Cameroon, Cote d'Ivoire, Democratic Republic of the Congo,

Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South

Sudan, Swaziland, Tanzania, Uganda, Ukraine, Vietnam, Zambia, and Zimbabwe) via the MOH data

alignment process. Standard process countries that did not participate in the MOH data alignment

process in FY 17 will be required to do so in FY 18.

DISAGGREGATED MONITORING

There are 3 categories of MER indicator disaggregations for the MER 2.0, which can be seen in the

indicator reference sheets and the data entry screens.

Required Disaggregations: Required indicates that this indicator disaggregate is required for all

countries that have programming for this area. This means that if the country supports a program area,

defined by budget and targets set during the COP process -- then it is required to report results.

Conditional Disaggregations: Indicator disaggregates that are conditions include those for which

some additional condition must be fulfilled. In MER 2.0 there are no full indicators that are conditional,

but only additional disaggregations that are conditional based on additional funding or programming.

There are two main types of conditional indicator disaggregations:

a. Disaggregations for those programs that have received additional funds for special

programming such as DREAMS

b. Disaggregations that field teams have received permission or a waiver from their OGAC

SI advisor to report on such as reporting on the coarse age disaggregations instead of

the finer age disaggregations. In this case reporting is considered conditional based on

approval from OGAC.

Optional Disaggregations: Optional disaggregates should be completed by those for which the

indicator is useful to determine the success of their program (e.g., KP national and subnational data), for

which the partner has strong methodological sources (e.g., KP catchment area-denominator), or when it

is both relevant and safe to enter the data at the site and/or community level (e.g., KP disaggregations

for PrEP_NEW, HTS_TST, and TX_NEW).

MER INDICATOR NARRATIVES

Three types of narratives are required as part of quarterly submissions: (1) IM level narratives, (2)

technical area level narratives, and (3) national and sub-national level results narratives. Specific

requirements are defined for each type of narrative. In addition, guiding narrative questions have been

introduced to provide additional technical detail and continuity within the narrative submitted across

PEPFAR countries.

Guiding Narrative Questions

New for FY18, PEPFAR has included “guiding narrative questions” for each indicator. These questions or

prompts can be found on the subsequent indicator reference sheets and were developed to ensure that

there is continuity in the technical information reported in the narratives that will be most relevant to

subject matter experts in triangulating the narrative data with the quantitative results.

Each indicator has 2-3 questions or prompts that should guide both implementing partners and USG

technical area experts in the development and framing of both the IM and technical area narratives – in

addition to the narrative requirements provided in the paragraphs below.

Implementing Mechanism (IM) Level Narratives

Narratives are required each quarter. These narratives are an opportunity to convey additional context

to accompany the quantitative results. IM level narratives are required for each indicator, and should

describe current quarterly achievements as well as overall achievements against the fiscal year targets,

and provide additional information related to specific data quality concerns or programmatic issues that

may impact the assessment of partner performance. If appropriate, reference specific site-level issues

that were encountered during the reporting period that may prevent achievement of the IM target. If

additional information is useful for the interpretation of the results on an indicator-specific basis, please

add this to the narrative. Please also indicate whether on-the-ground data quality assessments were

conducted during the FY and the impact the assessment had on the results and program.

IM level narratives must also address any result discrepancies that cannot be reconciled after

completing the Data Completeness and Logic Checks. Finally, the IM narratives should specifically

describe the nature of support the partner is providing that qualifies the results to be categorized as

Direct Service Delivery (DSD) or Technical Assistance for Service Delivery Improvement (TA-SDI) in

accordance with PEPFAR guidance.

Technical Area Level Narratives

Technical area level narratives summarize the de-duplicated partner achievements against summary FY

2017 targets. Technical area level narratives are required for each indicator, and should provide an

overall assessment of the performance against FY 2017 targets. These narratives should also provide

additional information related to specific data quality concerns or programmatic issues that may impact

the assessment of overall performance. If additional information is useful for the interpretation of the

results on an indicator-specific basis, please add this to the narrative.

Additionally, the technical area level narratives should specifically describe the nature of support the

partners are providing that qualifies the results to be categorized as Direct Service Delivery (DSD) or

Technical Assistance for Service Delivery Improvement (TA-SDI) in accordance with PEPFAR MER

guidance. Further focus the narratives by describing the following achievements in light of expected

MER 2.0 INTRODUCTION

trajectories for the technical area, information related to specific data quality concerns or programmatic

issues that may impact the interpretation of results, data quality assessment (DQA) completion in the

last 12 months, address any result discrepancies that cannot be reconciled (at the interagency level)

after completing the Data Completeness and Logic Checks. Narratives should also address achievements

by prioritization level and DSD and TA-SDI support. For example, is there an overlap between PEPFAR

and the Global Fund in support for ART services?

National and Subnational Level Results Narratives

National level indicator narratives provide an opportunity for teams to discuss the host country

response beyond PEPFAR supported activities. For national indicators, both a justification and a source

narrative are required for each indicator. Also take note that narratives for both National (_NAT) and

Subnational (_SUBNAT) should be recorded in the _NAT narrative section in DATIM.

• Justification Narrative

o How does the national number relate to the PEPFAR number?

o What proportion of results does PEPFAR contribute to the national response

o If the PEPFAR result is larger than the national number please explain

o Note the actual reporting time frame for entered data

• Source narrative

o What is the source of these data?

o When were these data collected/calculated?

HOST COUNTRY NATIONAL PROGRAM

Monitoring the host country HIV response is critical to understanding both the achievements and the

gaps at the subnational level and by population. Host country data are used to inform PEPFAR programs

and guide how PEPFAR resources are allocated at all levels. The key program areas for monitoring host

country targets and results are: prevention of mother to child transmission programs, key populations,

voluntary male medical circumcision and HIV diagnosis and treatment, including viral suppression. Data

are needed from both the national and subnational level. The subnational level is considered the

organizational level in which the country team has prioritized their program (PSNU). Data on the hous

country national program is reported to PEPFAR for all subnational units, regardless of PEPFAR funding

supporting these geographical areas; so that the total of the subnational results or targets should equal

the total number of national results and targets.

At the host country national level, to sufficiently monitor its national response, the host country

government’s national set of indicators should include the minimum set of harmonized global indicators

(Global AIDS Response Reporting) and additional indicators that represent the needs of the country’s

program. The PEPFAR Country team should collaborate with the host country government and other

stakeholders to make sure that PEPFAR reporting requirements are taken into consideration in the host

country’s national set. In constructing its own comprehensive set of requirements for monitoring the

USG response in support of the host country national program, each PEPFAR country team will review all

of the PEPFAR essential host country national indicators for applicability to the PEPFAR activities being

conducted in the host country.

The PEPFAR host country national and subnational level indicators represent results obtained within the

entire host country regardless of PEPFAR support. Both Standard Process and STAR Process Countries

should report host country results at Q4 each fiscal year.

Host Country National and Subnational Results

At Q4 of the USG fiscal year, results from the host national systems should be reported up until the most

recent month of collection and include 12 months of data. These may not align with end USG fiscal year

results. These data should be collected continuously at the subnational level as part of service delivery

areas. Data should be in line with GARPR and UNAIDS reported data, where available, although may

differ due to different reporting periods. In the narratives, please indicate what months the data include

(e.g., October 2017-September 2018; or July 2016 to June 2017). Results should be consistently reported

on the same time period to be able to monitor trends over time.

Host Country National and Subnational Targets

Developing targets for the next year at the national and subnational data is an important step in

understanding the national program and determining geographic investments (including host country,

The Global Fund and other donors). When PEPFAR better understands the targets of the national

program setting process, then it is better placed to support the program and to fill necessary impactful

programmatic gaps. Please describe the target setting process that the host country employs in the

narratives and partnering donors). The national targets should cover the next calendar or fiscal year; the

timeframe should be indicated in the narratives. Targets for the host country national and subnational

indicators should be reported into DATIM during COP.

Host Country indicators by reporting level, targets, and results

Indicator

Results

Targets

National

Sub-National

KP_MAT

✓

PMTCT_ART

✓

PMTCT_STAT

✓

TX_CURR

✓

DIAGNOSED

✓

VL_SUPPRESSION

✓

VMMC_CIRC

✓

VMMC_TOTALCIRC

✓

MER 2.0 INTRODUCTION

SIMS IN RELATION TO MER 2.0

SIMS evaluates the quality of service delivery or program oversight to identify performance issues that

may impact patient outcomes or the integrity of reporting for MER targets or disaggregates. Low final

scores (reds and yellows) from these CEEs highlight potential issues with service delivery, site

performance or oversight, and/or documentation of patient results. The SIMS 2.0 Linkage Reference

Table in Appendix 2 provides a listing of all SIMS 2.0 CEEs that have been directly linked to a given MER

indicator; linkage data may be used for data triangulation activities to inform and contextualize MER

results.

DREAMS SPECIFIC GUIDANCE

In addition to required MER reporting, it is essential that all DREAMS (Determined, Resilient,

Empowered, AIDS-free, Mentored, and Safe) and DREAMS-like countries ensure that all implementing

Partners in DREAMS SNUs report their results for and use data from all DREAMS-related indicators and

their required disaggregations. DREAMS countries are encouraged to monitor interventions progress

using custom indicators for program components that do not have existing MER indicators (e.g.,

contraceptive method mix, condom promotion and provision). Appendix 3 includes a full list of the

DREAMS-related indicators reported for MER 2.0 and the required disaggregation for each indicator.

Please note there are also specific reporting requirements for DREAMS narratives.

• DREAMS countries: Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania,

Uganda, Zambia and Zimbabwe

• DREAMS-like countries: Botswana, Cote d’ Ivoire, Haiti, Namibia, and Rwanda

MER 2.0 INFOGRAPHIC

MER 2.0 INTODUCTION

Indicator Reporting Frequency by Program Area

Program Area Group

Indicator Code

Indicator Name

Reporting

Frequency

Knowing Your HIV

Status

HTS_TST

Number of individuals who received HIV Testing Services

(HTS) and received their test results, disaggregated by

HIV result

Quarterly

Knowing Your HIV

Status

HTS_SELF

Number of individual HIV self-test kits distributed

Quarterly

On ART

PMTCT_ART

Percentage of HIV-positive pregnant women who

received ART to reduce the risk of mother-to-child-

transmission (MTCT) during pregnancy

Quarterly

Knowing Your HIV

Status

PMTCT_EID

Percentage of infants born to HIV-positive women who

had a virologic HIV test done within 12 months of birth

Quarterly

Knowing Your HIV

Status

PMTCT_HEI_POS

Number of HIV-infected infants identified in the reporting

period, whose diagnostic sample was collected by 12

months of age.

Quarterly

Knowing Your HIV

Status

PMTCT_STAT

Percentage of pregnant women with known HIV status at

antenatal care (includes those who already knew their

HIV status prior to ANC), disaggregated by HIV result

Quarterly

Prevention

PrEP_NEW

Number of individuals who have received (oral)

antiretroviral pre-exposure prophylaxis (PrEP) to prevent

HIV infection.

Quarterly

On ART

TX_CURR

Number of adults and children currently receiving

antiretroviral therapy (ART)

Quarterly

On ART

TX_NEW

Number of adults and children newly enrolled on

antiretroviral therapy (ART)

Quarterly

Prevention

VMMC_CIRC

Number of males circumcised as part of the voluntary

medical male circumcision for HIV prevention program

Quarterly

Prevention

KP_PREV

Number of key populations reached with individual

and/or small group-level HIV prevention interventions

designed for the target population

Semi-Annual

Knowing Your HIV

Status

OVC_HIVSTAT

Percentage of orphans and vulnerable children (<18 years

old) with HIV status reported to implementing partner

(including status not reported), disaggregated by status

type

Semi-Annual

Prevention

OVC_SERV

Number of beneficiaries served by PEPFAR OVC programs

for children and families affected by HIV

Semi-Annual

Prevention

PP_PREV

Number of the priority populations reached with

standardized HIV prevention intervention(s) that are

evidence-based.

Semi-Annual

Health Systems

SC_STOCK

Percentage of storage sites where commodities are

stocked according to plan, by level in supply system

Semi-Annual

On ART

TB_ART

Percentage of HIV-positive new and relapsed TB cases on

ART during TB treatment

Semi-Annual

Prevention

TB_PREV

Proportion of ART patients who completed a standard

course of TB preventive therapy within the reporting

period

Semi-Annual

Knowing Your HIV

Status

TB_STAT

Percentage of new and relapse TB cases with

documented HIV status, disaggregated by HIV result

Semi-Annual

On ART

TX_TB

The proportion of ART patients who were screened who

are receiving TB treatment

Semi-Annual

Program Area Group

Indicator Code

Indicator Name

Reporting

Frequency

Health Systems

EMR_SITE

Number of PEPFAR-supported facility-based service

delivery points supported by your organization that have

an electronic medical record system

Annual

Prevention

FPINT_SITE

Number of HIV service delivery points (SDP) at a site

supported by PEPFAR that are providing integrated

voluntary family planning (FP) services

Annual

Prevention

GEND_GBV

Number of people receiving post-gender based violence

(GBV) clinical care based on the minimum package NOTE:

The indicator DOES NOT measure delivery of GBV

prevention activities.

Annual

Health Systems

HRH_CURR

Number of health worker full-time equivalents who are

working on any HIV-related activities i.e., prevention,

treatment and other HIV support and are receiving any

type of support from PEPFAR at facility and sites,

community sites, and at the above-service delivery area

level

Annual

Health Systems

HRH_PRE

Number of new health workers who graduated from a

pre-service training institution or program as a result of

PEPFAR-supported strengthening efforts, within the

reporting period, by select cadre

Annual

Health Systems

HRH_STAFF

Number of health worker full-time equivalents who are

working on any HIV-related activities i.e., prevention,

treatment and other HIV support at PEPFAR-supported

facility sites

Annual

Prevention

KP_MAT

Number of people who inject drugs (PWID) on

medication-assisted therapy (MAT) for at least 6 months

within the reporting period

Annual

Health Systems

LAB_PTCQI

Number of laboratories and blood centers/banks:

A. Engaged in Continuous Quality Improvement (CQI)

activities

B. Audited and achieved accreditation

C. Performing an HIV-related test and participating in and

passing Proficiency Testing (PT)

Annual

Knowing Your HIV

Status

PMTCT_FO

Percentage of final outcomes among HIV exposed infants

registered in a birth cohort

Annual

Viral Suppression

TX_PVLS

Percentage of ART patients with a viral load result

documented in the medical record and/or laboratory

information systems (LIS) within the past 12 months with

a suppressed viral load (<1000 copies/ml)

Annual

Viral Suppression

TX_RET

Percentage of adults and children known to be on

treatment 12 months after initiation of antiretroviral

therapy (Note: reporting 24 and 36 months is

recommended, but optional)

Annual

MER 2.0 INTODUCTION

How to read a PEPFAR indicator reference sheet

All indicators in this guidance are provided in a specific format to allow the reader to easily understand

their specific indicators requirements. Please use this layout as a guide to understand how to read the

reference sheets.

Indicator Code

Description:

Long name of the indicator

Numerator:

Long name of the numerator

Additional information about numerator

definition

Denominator:

Long name of the denominator

Additional information about denominator

definition

Changes in indicator:

Highlights any differences in the indicator from MER 1.0 to 2.0 and between MER 2.0

(versions 2.1 and 2.2)

How to use:

Defines how the data is used to monitor PEPFAR program activities

How to collect:

Defines how the data is collected (highlighting data source, issues with double counting,

and important components of data collection that ensure data quality)

Reporting level:

Defines the level at which the indicator is reported: facility, community, and/or above-

service delivery area

How often to report:

Defines the period at which the indicator is reported: Quarterly, Semi-Annually, or

Annually

How to review for

data quality:

Outlines specific data quality considerations for the indicator

How to calculate

annual total:

Defines how annual totals are calculated for the indicator at the end of the fiscal year.

Data elements

(components of

indicator):

Numerator:

Long name of the

numerator

Disaggregate Groups

Disaggregates

Name of Disaggregate Group(s)

Disaggregations

Denominator:

Long name of the

denominator:

Disaggregate Groups

Disaggregates

Name of Disaggregate Group(s)

Disaggregations

Disaggregate Descriptions & Definitions

Describes and defines the disaggregates relevant to the indicator in greater detail.

PEPFAR-support

definition:

Lists the indicator-specific definition for DSD vs. TA support that differ from the standard

definitions outlined in the introduction section of the guidance.

Guiding narrative

questions:

Lists the indicator-specific questions that implementing partners and USG country teams

should address in the implementing mechanism and technical area summary narratives.

Prevention & Support

Indicators

PREVENTION

PrEP_NEW

Description:

Number of individuals who have been newly enrolled on (oral) antiretroviral pre-

exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period

Numerator:

Number of individuals who have

received (oral) antiretroviral pre-

exposure prophylaxis (PrEP) to prevent

HIV infection

The numerator is generated by counting the

number of people newly enrolled in oral PrEP

(including WHO specified regimens

“tenofovir-containing PrEP” which could be

TDF alone, TDF/FTC, or TDF/3TC) during the

reporting period, in accordance with the

demonstration project guidance or the

nationally approved protocol (or

WHO/UNAIDS standards).

Denominator:

N/A

Changes in indicator:

• PrEP_NEW is now reported across PEPFAR programs. It is no longer a DREAMS-

specific indicator (MER 1.0 to MER 2.0).

• A denominator for PrEP_NEW will no longer be collected (MER 1.0 to MER 2.0).

• KP disaggregations were added (MER 1.0 to MER 2.0).

• Age disaggregations updated (MER 2.0 v2.1 to v2.2).

• KP disaggregation updated to include ‘Other KP Type’ (MER 2.0 v2.1 to v2.2).

How to use:

The indicator measures the ongoing growth of PrEP services. This measure is critical to

assess progress in the program’s response to the epidemic in specific geographic areas,

and the uptake and utility of PrEP among persons at substantially increased risk of HIV

infection.

This indicator permits monitoring trends in use, but does not attempt to distinguish

between different modes or regimens of PrEP or to measure the cost, quality or

effectiveness of PrEP provided. These will each vary within and between countries and

are liable to change over time.

PrEP has been shown to reduce incident infections among several populations including

serodiscordant heterosexual couples, MSM, FSW, and transgender people (TG). The

WHO now recommends that oral PrEP containing tenofovir should be offered as an

additional prevention choice for people at substantial risk, defined as HIV incidence >

3/100 person-years.

How to collect:

The numerator can be generated by counting the number of people who are newly

enrolled on PrEP in the reporting period, in accordance with national guidelines (or

WHO/UNAIDS standards). NEW is a state defined by an individual’s beginning in a PrEP

program. It is expected that the characteristics of new clients are recorded at the time

they newly initiate into a program. Patients are “new” on PrEP only if they are naive to

antiretroviral therapy for prevention of HIV infection and have not received oral or

topical prophylaxis previously in any program.

Reporting of the key population disaggregation should be consistent with what is

described under the KP_PREV “How to review for data quality” section on mutual

exclusivity of an individual who falls under multiple KP categories (e.g., FSW who injects

drugs). In such instances, the individual should only be reported in ONE KP

disaggregation category with which this person is most identified. See Appendix 1 to

support the identification of key populations at service delivery.

NOTE: In accordance to PrEP guidance, not all PrEP beneficiaries are expected to fall

within the KP disaggregates, therefore the total disaggregations for KP does not have to

sum to the numerator total. Both KP-specific and clinical partners have the option to

complete these KP disaggregation, but only if safe to maintain these files and to report.

Reporting level:

Facility

How often to report:

Quarterly

How to review for

data quality:

Numerator ≥ subtotal of the age/sex disaggregation: The total number people newly

enrolled on PrEP (numerator) should be greater or equal to the subtotal of the age/sex

disaggregate group.

How to calculate

annual total:

Sum results across quarters.

Data elements

(components of

indicator):

Numerator:

Number of

individuals who

have received

(oral)

antiretroviral pre-

exposure

prophylaxis (PrEP)

to prevent HIV

infection.

Disaggregate Groups

Disaggregates

Age/Sex

[Required]

15-19 M, 15-19 F, 20-24 M, 20-

24 F, 25-29 M, 25-29 F, 30-34

M, 30-34 F, 35-39 M, 35-39 F,

40-49 M, 40-49 F, 50+ M, 50+ F

Key Population Type:

[Optional]

MSM: Men who have sex with

men

TG: Transgender people

FSW: Female sex workers

Other KP Type: Other key

population type

Disaggregate Descriptions & Definitions

Age Description: Age is defined as the age at the time of initiation of PrEP. For example,

if a 19-year-old woman begins PrEP and then shortly after turns age 20, she will still be

counted under NEW in the 15-19 F age/sex category.

PEPFAR-support

definition:

Standard definition of DSD and TA used.

Provision of key staff or commodities for PrEP services include: ongoing procurement of

critical commodities such “tenofovir-containing PrEP” which could be TDF alone,

TDF/FTC, or TDF/3TC or funding for salaries of personnel providing any of the prevention

package components (i.e., clinicians, outreach workers, program managers). Staff

responsible for the completeness and quality of routine patient records (paper or

electronic) can be counted here; however, staff who exclusively fulfill MOH and donor

reporting requirements cannot be counted.

Ongoing support for HIV prevention among PrEP services includes: mentoring and

supportive supervision; training; organizational strengthening; QA/QI; program design

like development of training curricula, PrEP guidance development, or standard

operating procedures (SOPs) and follow-up to ensure quality of care; regular assistance

with monitoring and evaluation functions and data quality assessments; or supply chain

management

Guiding narrative

questions:

1. Roughly what proportion of those offered PrEP at the site agrees to start PrEP?

2. Of those initiating PrEP, how many are estimated to continue at one and three

months?

3. What strategy is used to determine PrEP eligibility at the site:

• Screening tool?

• All clients considered at risk and eligible?

• Client request?

PREVENTION

VMMC_CIRC

Description:

Number of males circumcised as part of the voluntary medical male circumcision

(VMMC) for HIV prevention program within the reporting period

Numerator:

Number of males circumcised as part of

the voluntary medical male circumcision

(VMMC) for HIV prevention program

The numerator can be generated by counting

the number of males circumcised.

Denominator:

N/A

Changes in indicator:

• Age disaggregations updated (MER 2.0 v2.1 to v2.2).

• Follow-up status disaggregation updated to capture instances where VMMC follow-

up did not take place within 14 days or within the reporting period (MER 2.0 v2.1 to

v2.2).

How to use:

Tracks the number of male circumcisions conducted during the reporting period and

assists in potentially determining coverage of circumcision in the population over time.

The total number of males circumcised indicates a change in the supply of and/or

demand for VMMC services. Additionally, disaggregations are required and are used to

evaluate whether prioritized services have been successful at reaching the intended

population (by age, HIV status, and circumcision technique), targets have been achieved,

and whether modeling inputs should be adjusted. An additional level of disaggregation

below the circumcision technique level is required for follow-up status, since post-

operative clinical assessments are part of good clinical care and low follow-up rates may

indicate a problem in program quality.

How to collect:

The numerator can be generated by counting the number of males circumcised as part

of the VMMC for HIV prevention program. This information can generally be found in

VMMC Register, or client medical records maintained by each program/site/service

provider.

Reporting level:

Facility

How often to report:

Quarterly

How to review for

data quality:

Numerator ≥ subtotal of each of the disaggregation.

How to calculate

annual total:

Sum results across quarters.

Data elements

(components of

indicator):

Numerator:

Number of males

circumcised as

part of the

voluntary medical

male circumcision

(VMMC) for HIV

prevention

program

Disaggregate Groups

Disaggregates

Age

[Required]

0-60 days, 2 months - 9 years,

10-14, 15-19, 20-24, 25-29, 30-

34, 35-39, 40-49, 50+

HIV Status and Outcome

[Required]

• Number of HIV-positive

clients (tested HIV positive at

VMMC site)

• Number of HIV-negative

clients (tested HIV negative

at VMMC site)

• Number of clients with

indeterminate HIV status or

not tested for HIV at site

(regardless of previous

documentation)

Circumcision Technique

[Required]

• Surgical VMMC

• Device-based VMMC

Circumcision Technique/Follow-

up Status (Sub-disaggregation

of the VMMC circumcision

technique disaggregation)

[Required]

• Surgical VMMC: Followed-up

within 14 days of surgery;

• Surgical VMMC: Did not

follow-up within 14 days of

surgery or did not follow-up

within the reporting period;

• Device-based VMMC;

Followed-up within 14 days

of device placement. May

include device removal;

• Device-based VMMC: Did

not follow-up within 14 days

of device placement or did

not follow-up within the

reporting period

Disaggregate Descriptions & Definitions

For HIV Status and Outcome: As VMMC_CIRC is a status indicator and not testing

indicator, ALL men tested through the VMMC program should also be counted in the

general HTS indicator “HTS_TST” under the VMMC service delivery modality.

PEPFAR-support

definition:

Standard definition of DSD and TA-SDI used.

Provision of key staff or commodities for VMMC include: medical instruments, supplies,

or medicines needed for the VMMC procedure, or funding for salaries for HCW who

deliver VMMC services.

Ongoing support for VMMC service delivery improvement includes: training of VMMC

service providers; clinical mentoring and supportive supervision of HCW at VMMC sites;

infrastructure/facility renovation; support of VMMC service-related data collection,

reporting, data quality assessments (DQA); CQI/EQA of VMMC services at point of

service delivery; or commodities consumption forecasting and supply chain

management support.

Guiding narrative

questions:

1. Is the age distribution of males 60% or more 15+ years of age?

• Is this age distribution getting older as compared to previous quarters?

2. If OU is using compression collar type device for VMMC

• Are they adhering to WHO Guidelines for tetanus immunization?

• Were there any tetanus AEs reported?

3. What proportion of clients are returning for follow-up? (Should be at least 80%)

4. What barriers are there to further scaling up VMMC services?

PREVENTION

KP_PREV

Description:

Number of key populations reached with individual and/or small group-level HIV

prevention interventions designed for the target population

Numerator:

Number of key populations reached

with individual and/or small group-level

HIV prevention interventions designed

for the target population

The numerator can be generated by counting

the number of unique individuals from an

activity who are reached with prevention

interventions designed for the intended key

population.

Denominator:

[Optional,

recommended if

available]

Total estimated number of key

populations in the catchment area

The denominator is the estimated number of

key populations in a defined catchment area.

Programs need to define their geographic

catchment area from which key population

beneficiaries receive HIV prevention services.

Country teams should encourage

methodological harmonization across their

KP partners when estimating KP population

size within a catchment area.

Changes in indicator:

• KP type disaggregations changed, three testing service disaggregations were added,

and HIV testing or referral of an individual to HIV testing services (HTS) is required to

be offered to those who do not know their status or are self-identified as HIV

negative (MER 1.0 to 2.0).

• The denominator is now optional, but recommended for those with good size

estimation metrics (MER 1.0 to 2.0).

How to use:

This indicator provides information on the total number of unique individuals that have

received individual-level and/or small-group level intervention(s). This indicator will help

determine the reach of key populations (if no denominator) and may help understand

the relative saturation (coverage) of PEPFAR-supported KP prevention programs when

reliable population size estimates are included as the denominator.

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

one setting.

HIV testing services (HTS) or referring an individual to HTS is required to be offered (at

least once during the reporting period and/or in accordance with WHO/national

guidance) unless the individual had previously been tested positive for HIV. If the

individual is self-identified as HIV positive, then HTS provision or referral to HTS will

not be a required element of this indicator.

A partner may count an individual (with unknown HIV serostatus or self-identified as HIV

negative) as having received a prevention activity if they have provided, offered, or

referred to HTS AND at least one additional listed prevention activities below (outside of

HTS) during the reporting period. If an individual is already known to be HIV positive at

the time of the outreach, s/he should receive at least one of the interventions listed in

the table (outside of HTS) to qualify as being counted under this indicator.

The table below lists the prevention interventions that a partner may offer in addition to

HTS (or HTS referral).

Prevention Interventions for Key Populations

• Offer or refer to HTS* (Required)

• Targeted information, education, and communication (IEC)

• Outreach/Empowerment

• Condoms

• Lubricant

• Offer or refer to STI screening, prevention, and treatment

• Link or refer to ART

• Offer or refer to prevention, diagnosis, treatment of TB

• Offer or refer to screening and vaccination for viral hepatitis

• Offer or refer to Reproductive Health (Family Planning; PMTCT), if applicable

• Refer to medication-assisted therapy (MAT), if applicable

• Offer or refer to needle syringe program (NSP), if applicable

*Partner should also report the number of individuals tested under the indicator

“HTS_TST” if HTS was conducted (and results were given) as part of the outreach

activity. If it was a documented complete HTS referral to the facility, it can be counted

as HTS_TST_TA. Please refer to the HTS_TST indicator definition sheet for details.

How to collect:

Tracking systems must be able to reduce double-counting of individuals in a reporting

period. The numerator can be generated by counting the number of de-duplicated

individuals who were reached and had completed the appropriate prevention

intervention(s) designed for the intended key population. For example, this means that

when a unique individual receives HTS referral plus condoms and lubricant at more than

one occasion during the reporting period, the person is counted only once for being

reached for this indicator.

Furthermore, de-duplication of all returning beneficiaries within the Q3-Q4 reporting

period (April 1 – September 30) will also need to take place in Q4 reporting if they had

already been counted under KP_PREV in Q1-Q2 of the same fiscal year. For example, if

an individual had received prevention interventions under KP_PREV through PEPFAR-

supported program in January 2017 and was counted as being reached in FY17 Q2

reporting cycle, and this same individual was later reached with prevention services

again by PEPFAR-supported program in June 2017, that individual should NOT be

reported again in the FY17 Q4 reporting period. This de-duplication is critical to

accurately track the ANNUAL number of unique individuals reached by PEPFAR within a

given fiscal year. Trend analysis of past performance of KP_PREV data will be adversely

affected with the change in frequency of KP_PREV reporting from annually to semi-

annually if this de-duplication is ignored (i.e., annual number of KP_PREV reported

within the same fiscal year would be inflated as the same individual would be counted

twice if this de-duplication does not occur at Q4 reporting).

If possible, a unique identifier can be assigned. The use of a unique identifier can help

programs monitor the frequency of contact/outreach of a single individual over time

(i.e., Beneficiary A with unique identifier AW0901 had four documented outreach visits

in FY17 but was only counted once under KP_PREV in FY17).

Reporting level:

Facility & Community

How often to report:

Semi-Annual

How to review for

data quality:

Data should be reviewed regularly for the purposes of program management, to monitor

progress towards achieving targets, and to identify and correct any data quality issues.

Potential data quality issues with KP_PREV are:

• Numerator

PREVENTION

o The Numerator is = to the sum of the disaggregation: The number of KP

reached with individual and/or small-group level preventive interventions

should be equal to the sum of KP disaggregates.

o Despite persons potentially falling into more than one KP disaggregate (e.g.

FSW who injects drugs), implementing partners should be instructed to report

an individual in only one KP category with which s/he is most identified.

• Denominator ≥ Numerator: The total estimated number of key populations should

be greater or equal to the number of key populations provided with individual and/or

small group level preventive interventions.

How to calculate

annual total:

Sum across both reporting periods; de-duplicating unique individuals already reached

and reported in Q1-Q2 of the same fiscal year in Q4 reporting.

Data elements

(components of

indicator):

Numerator:

Number of key

populations

reached with

individual and/or

small group-level

HIV prevention

interventions

designed for the

target population

Disaggregate Groups

Disaggregates

KP Type

[Required]

• MSM who are SW;

• MSM who are not SW;

• TG who are SW;

• TG who are not SW;

• Female SW;

• PWID male;

• PWID female;

• People in prisons and other

closed settings

Testing Services

[Required]

• KP known positive;

• KP was newly tested and/or

referred for testing;

• KP declined testing and/or

referral

Denominator:

Total estimated

number of key

populations in the

catchment area.

[Optional,

recommended if

available]

Disaggregate Groups

Disaggregates

KP Type

• MSM who are SW;

• MSM who are not SW;

• TG who are SW;

• TG who are not SW;

• Female SW;

• PWID male;

• PWID female;

• People in prisons and other

closed settings

Disaggregate Descriptions & Definitions

Testing Services Disaggregates Definitions:

• Known Positive: Persons within each key population type for whom HIV testing is

not indicated because they are known to be HIV-positive. HIV-positive test results

should be verified, if possible, for all persons accessing HIV prevention services

during the reporting period. Implementing partners should maintain records

(without personally identifiable information) on whether the HIV-positive client is

linked to treatment. Patients tested positive in previous reporting periods should be

counted as Known Positives.

• Newly Tested and/or Referred for Testing: Persons within each key population type

for whom HIV testing is indicated because they do not know their HIV status or their

last HIV-negative test was more than 3-6 months ago (or more/less frequently as

indicated by National Guidelines) should either be offered an HIV test on site or

given information about where and when they can access an HIV test at another

nearby clinic. Every attempt should be made to ensure the client is linked with HIV

testing services that are KP-friendly, and where possible the completed referral

should be documented (i.e., the client accessed HIV testing). Note: Persons who

access testing and whose results are newly tested HIV-positive in the reporting

period should also be counted under “newly tested” even if they return for

additional prevention services during that reporting period.

• Declined Testing and/or Referral: Persons who, after explaining the benefits of HIV

testing and the reason for testing every 3-6 months (or more/less frequently as

indicated by National Guidelines), decline to be tested on-site or referred to a site

where HIV testing is offered. Although every attempt should be made to support key

populations with HIV testing as part of the package of HIV prevention services and

to provide HIV testing on site or KP-friendly sites, programs should also respect the

autonomy of clients to decline this service. Clients who decline testing and/or

referral can still receive other prevention services, as long as the benefits of HIV

testing were explained and testing or a referral for testing was offered.

PEPFAR-support

definition:

Standard definition of DSD and TA-SDI used.

Provision of key staff or commodities for KP receiving HIV prevention services include:

ongoing procurement of critical commodities such as test-kits, condoms, lubricants, or

funding for salaries of personnel providing any of the prevention package components

(i.e., peer navigators, outreach workers, program managers). Staff responsible for the

completeness and quality of routine patient records (paper or electronic) can be

counted here; however, staff who exclusively fulfill MOH and donor reporting

requirements cannot be counted.

Ongoing support for HIV prevention among KP improvement includes: mentoring and

supportive supervision; training; organizational strengthening; QA/QI; program design

like development of training curricula, prevention guidance development, or standard

operating procedures (SOPs) and follow-up to ensure fidelity to the program design;

regular assistance with monitoring and evaluation functions and data quality

assessments; or condom forecasting and supply management.

Guiding narrative

questions:

1. Did the IMs de-duplicate all returning beneficiaries in Q3-Q4 who have already been

counted in Q1-Q2 of this fiscal year? If not, why not?

2. Are there mechanisms in place (i.e. unique identifier) in which IMs can de-duplicate

multiple outreach encounters within a fiscal year? What are these mechanisms? If

mechanisms are not in place, how does the IM report individuals and not encounters

within the fiscal year?

3. Do the testing service disaggregations equal the total number of KP_PREV reported?

If not, why not?

4. What were the barriers in collecting testing service disaggregations for this indicator?

5. If the denominator was reported, what methodology was used to estimating the

number of key populations in a defined catchment area?

PREVENTION

PP_PREV

Description:

Number of the priority populations (PP) reached with the standardized, evidence-based

intervention(s) required that are designed to promote the adoption of HIV prevention

behaviors and service uptake

Numerator:

Number of the priority populations

reached with standardized HIV

prevention intervention(s) that are

evidence-based

The numerator is the number of individuals

from each priority population reached with

HIV prevention interventions during the

reporting period. For the purposes of

reporting, the team will sum the numbers

reached in each of the priority populations

and report that total (details of the priority

populations reached should be explained in

the narratives).

Denominator:

[Optional,

recommended if

available]

Total estimated number of priority

populations in the catchment area

The denominator is the estimated number of

individuals in the priority populations.

Programs need to define their geographic

catchment area from which priority

population clients receive HIV prevention

services. Country teams should encourage

methodological harmonization across their

priority partners when estimating population

size within a catchment area.

Changes in indicator:

• The denominator is now optional, but recommended for those with good estimation

metrics (MER 1.0 to 2.0).

• Updated the minimum required standardized HIV prevention interventions and

included the requirement that HIV testing or referral to HIV testing service must be

offered to those who are not known as diagnosed HIV positive (MER 1.0 to 2.0).

• Age/sex disaggregations updated (MER 2.0 v2.1 to v2.2).

• Clarifying language added for Key Populations disaggregation the notes that KP

should be counted in only one KP group to avoid double-counting. More information

is provided below (MER 2.0 v2.1 to v2.2).

How to use:

The indicator represents PEPFAR-supported programming only and helps to determine

PEPFAR’s reach to priority populations (if no denominator). It may also help inform

coverage of PEPFAR-supported programming for priority populations when reliable

population size estimates are included as the denominator.

Priority populations: Priority populations should be defined by each country in the

indicator narrative and must have a documented HIV prevalence or incidence greater

than the general population of the country. Groups that might be counted as priority

populations include:

• Adolescent girls and young women

• Clients of sex workers

• Military and other uniformed services

• Mobile populations (e.g., migrant workers, truck drivers)

• Non-injecting drug users

Size estimation: The IP/country team will estimate the size of each of the priority

populations in the geographic areas where the IP will implement the program. These

areas are chosen based upon epidemiological data with attention to avoiding duplication

of activities with those funded by donors (estimating the catchment area should be

explained in the narratives).

Package of interventions: Together with the IP, the country team designs a set of

interventions for each of the priority populations. In a defined catchment area for the

specific priority population, all prevention interventions may not be offered by one IP.

However, all required intervention must be available in the catchment area for the

priority population. Interventions must adhere to written protocols, include goals and

activities, and be designed to promote adoption of key behaviors that support HIV

prevention and service uptake among the priority population(s). The interventions

should comprise multiple encounters with the same individuals or groups.

HIV testing services (HTS) or referring an individual to HTS is required to be offered (at

least once during the reporting period and/or in accordance with WHO/national

guidance) unless the individual had previously been tested positive for HIV. If the

individual is self-identified as HIV positive, then HTS provision or referral to HTS will not

be a required element of this indicator.

The table below lists the interventions that must be offered in addition to HTS (or HTS

referral).

Required Interventions for

Adult Populations

Required Interventions for

Youth Populations

• Promotion of relevant prevention and

clinical services and demand creation to

increase awareness, acceptability, and

uptake of these services.

• Promotion of relevant youth-friendly

prevention and clinical services and

demand creation to increase awareness,

acceptability, and uptake of these

services.

• Information, education, and skills

development to: reduce HIV risk and

vulnerability; correctly identify HIV

prevention methods; adopt and sustain

positive behavior change; and promote

gender equity and supportive norms and

stigma reduction.

• Information, education and skills

development to: reduce HIV risk and

vulnerability; correctly identify HIV

prevention methods; adopt and sustain

positive behavior change; and promote

gender equity and supportive norms and

stigma reduction.

• Referral to or provision of HIV testing;

facilitated linkage to care and

prevention services; and/or support

services to promote use of, retention in,

and adherence to care.

• Referral to or provision of HIV testing;

facilitated linkage to care and

prevention services; and/or support

services to promote use of, retention in,

and adherence to care.

• Condom and lubricant (where feasible)

promotion, skills building, and facilitated

access to condoms and lubricant (where

feasible) through direct provision or

linkages to social marketing and/or

other service outlets.

• Condom and lubricant (where feasible)

promotion, skills training, and facilitated

access to condoms and lubricant (where

feasible) through direct provision or

linkages to social marketing and/or

other youth-friendly, community-based

service outlets.

• Programs targeting adults to raise

awareness of HIV risks for young people,

promote positive parenting and

mentoring practices, and effective adult-

child communication about sexuality

and sexual risk reduction.

PREVENTION

How to collect:

Data collection requires reliable tracking systems that are designed to count the number

of one-on-one encounters or participation in group interventions and that reduce

double-counting of individuals in a reporting period. Data should be collected at every

encounter/point of service and aggregated in time for PEPFAR reporting cycles. This

indicator only counts those interventions at the individual and/or group level.

A partner may count an individual (with unknown HIV sero-status or self-identified as

HIV negative) as having received a prevention intervention if they have provided HTS

and/or referral to HTS AND at least one of the other listed prevention interventions

during the reporting period. If an individual is already known to be HIV positive at the

time of service delivery, s/he should receive at least one of the interventions listed in the

table (outside of HTS) to qualify as being counted under this indicator.

Tracking systems must be able to reduce double-counting of individuals in a reporting

period. An individual will be reported when he/she first receives any of the required

interventions in the reporting period; if the same individual receives any subsequent

interventions during the same reporting period they will be reported as a returning

beneficiary and not counted again in the reporting period.

Furthermore, de-duplication of all returning beneficiaries within the Q3-Q4 reporting

period (April 1 – September 30) will also need to take place in Q4 reporting if they had

already been counted under PP_PREV in Q1-Q2 of the same fiscal year. For example, if

an individual had received prevention interventions under PP_PREV through PEPFAR-

supported program in January 2017 and was counted as being reached in FY17 Q2

reporting cycle, and this same individual was later reached with prevention services

again by PEPFAR-supported program in June 2017, that individual should NOT be

reported again in the FY17 Q4 reporting period. This de-duplication is critical to

accurately track the ANNUAL number of unique individuals reached by PEPFAR within a

given fiscal year. Trend analysis of past performance PP_PREV data will be adversely

affected with the change in frequency of PP_PREV reporting from annually to semi-

annually if this de-duplication is ignored (i.e., annual number of PP_PREV reported

within the same fiscal year would be inflated as the same individual would be counted

twice if this de-duplication does not occur at Q4 reporting).

If possible, a unique identifier should be assigned to program participants or names can

be collected to track individual participation in the prevention interventions/sites.

Site (facility and community) level system should maintain accurate registers for each

individual priority population, and sum these individual populations when reporting this

indicator.

Reporting level:

Facility & Community

How often to report:

Semi-Annual

How to review for

data quality:

Data should be reviewed regularly for the purposes of program management, to monitor

progress towards achieving targets, and to identify and correct any data quality issues.

Potential data quality issues for PP_PREV:

Denominator is greater than or equal to the Numerator: The total number of people

from priority populations must be greater than or equal to the total number of

individuals from priority populations who completed a standardized HIV prevention

program.

Numerator is greater than or equal to the subtotal of the age/sex disaggregation: The

number of individuals from priority populations who completed a standardized HIV

prevention program should be greater or equal to the sum of the disaggregation by

age/sex.

How to calculate

annual total:

Sum across both reporting periods; de-duplicating unique individuals already reached

and reported in Q1-Q2 of the same fiscal year in Q4 reporting.

Data elements

(components of

indicator):

Numerator:

Number of the

priority

populations

reached with

standardized HIV

prevention

intervention(s)

that are evidence-

based.

Disaggregate Groups

Disaggregates

Age/Sex

[Required]

10-14 M, 10-14 F, 15-19 M, 15-

19 F, 20-24 M, 20-24 F, 25-29

M, 25-29 F, 30-34 M, 30-34 F,

35-39 M, 35-39 F, 40-49 M, 40-

49 F, 50+ M, 50+ F

Testing Services

[Optional]

• Known positive;

• Newly tested and/or

referred for testing;

• Declined testing and/or

referral

Denominator:

Total number of

people in each

priority

populations

[Optional,

recommended if

available]

Disaggregate Groups

Disaggregates

Country teams should

encourage methodological

harmonization across their

priority population partners

when estimating priority

population size within a

catchment area

N/A

Disaggregate Descriptions & Definitions

Testing Services Disaggregates Definitions:

• Known Positive: Persons within each key population type for whom HIV testing is

not indicated because they are known to be HIV-positive. HIV-positive test results

should be verified, if possible, for all persons accessing HIV prevention services

during the reporting period. Implementing partners should maintain records

(without personally identifiable information) on whether the HIV-positive client is

linked to treatment. Patients tested positive in previous reporting periods should be

counted as Known Positives.

• Newly Tested and/or Referred for Testing: Persons within each key population type

for whom HIV testing is indicated because they do not know their HIV status or their

last HIV-negative test was more than 3-6 months ago (or more/less frequently as

indicated by National Guidelines) should either be offered an HIV test on site or

given information about where and when they can access an HIV test at another

nearby clinic. Every attempt should be made to ensure the client is linked with HIV

testing services that are PP-friendly, and where possible the completed referral