Table 2 Framework for assessment

a. Geographical coverage

Description of roll out in number of districts and change in number of implementing NGOs over time

CMIS

b. Proportion of FSWs ever contacted and ever visited clinic

Number of FSWs ever contacted by Avahan peer educator and ever visited Avahan program clinics using the estimated size of FSWs as on March 2009 (data is from the Avahan CMIS and are based on mapping exercises taken up by Avahan NGOs once every 12 to 24 months in the coverage districts). This was compared with IBBA data among FSWs who reported ‘ever been contacted by Avahan program’ and ‘ever visited Avahan program clinics’

CMIS and IBBA

c. Monthly contacts by peer educators and monthly visits for STI consultations

FSWs contacted monthly by Avahan PEs and consultations for STIs by visit for STI in the month.

CMIS

d. Proportion contacted in last month

Percentage of FSWs from IBBA who reported that they had been contacted by Avahan peer educators in the month preceding survey using the estimated population size of FSWs as on March 2009

IBBA

B. Intensity

a. Number of peer educator/outreach worker and Ratio of sex worker to peer educator

The total number of active outreach workers and peer educators in the Avahan intervention areas across implementation districts in Andhra Pradesh; and number of estimated FSWs covered per peer educators in the coverage area

CMIS and Condom Social Marketing data (CSM)

b. Condom distribution and availability

1. Absolute number of free condom distributed by Avahan programme annually and condom sales from project supported condom social marketing by program between 2005 and 2008

CMIS, CMS and IBBA

2. Condom need analysis: Ratio of average monthly condoms available per FSW- total condoms distributed by Avahan and available through project supported condom social marketing sales divided by the estimated number of FSWs in area covered by Avahan; and ratio of number of condoms distributed to monthly commercial sex acts per FSW where sex acts are calculated based on mean number of commercial clients per FSW per week reported in IBBA multiplied by total estimated number of FSWs covered by Avahan multiplied by four to get monthly sex acts.

IBBA

3. Proportion of FSW reporting source of obtaining condom last time from outreach worker / peer educator / non-governmental organization

c. Frequency of contact by peers

FSW reporting number of times they were contacted by peer educators in the month preceding the survey

IBBA

d. Frequency of visit to clinic

FSW reporting number of times visiting the Avahan program clinics for STI services

Individual level CMIS data

C. Quality

a. Improvement of quality of clinic services

Quality monitoring of STI clinical services of Avahan clinics using a supervisory tool for all Andhra Pradesh intervention districts from 2005 to 2009.

Clinic data

2. Has there been an increase in condom use in HRGs?

Change in condom use pattern

a. Proportion of FSW reporting consistent condom use with occasional clients (clients who were unknown to the FSW) and regular clients (who visited repeatedly and were thus known to FSW) from two rounds of IBBAs

IBBA

b. Proportion of FSW reporting no unprotected sex acts with clients from two rounds of IBBA

c. Proportion of FSW reporting consistent condom use with regular partners (husband or steady boyfriend of FSWs) from two rounds of IBBA

3. Has there been reduction in STIs and new HIV infections?

Change in STI prevalence and visits to clinic with STI symptoms

a. STI prevalence (reactive syphilis serology, high-titre syphilis, gonorrhoea (NG), chlamydia (CT), any STI (GC or CT or high-titre syphilis)

IBBA

Change in HIV prevalence and new HIV infections

a. HIV prevalence among FSWs aggregated from eight districts in Andhra Pradesh in two rounds of IBBAs

IBBA

b. HIV prevalence among FSWs who are in sex work for duration of less than one year (as a proxy for incidence)

c. HIV prevalence among FSWs in the age group of 18-20 years

4. Is Avahan exposure associated with increase in condom use and declining STIs?

Association of program exposure with intermediate outcomes and STIs

Exposure to Avahan program was based on self-reported responses to three Avahan program core services during last one year Viz; (a) ever or last year contacted by peer educators; (b) ever visited Avahan STI clinics; and (c) received condoms from peer educators. A composite variable for ‘having received any one service’ was used.

IBBA

a. Association of Avahan program with consistent condom use with commercial and non-commercial partners using pooled data from two rounds of IBBA

b. Program exposure, as defined above, its association with having any STI (NG, CT or high-titre syphilis)