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Table 1 Framework for evaluation

From: Increasing condom use and declining STI prevalence in high-risk MSM and TGs: evaluation of a large-scale prevention program in Tamil Nadu, India

Evaluation question Indicator Data source
1. Is coverage of Avahan adequate? A. Scale  
a. Geographical coverage- Description of rollout in number of districts and change in number of implementing NGOs over time Central monitoring information system (CMIS)
b. Proportion of HR-MSM ever contacted and ever visited clinic- Number of HR-MSM ever contacted by Avahan peer educators or ever visited Avahan program STI clinics divided by the estimated size of HR-MSM as of March 2009 CMIS
c. Proportion of HR-MSM c ontacted monthly by peer educators or visited program STI clinics for STI consultations – Number of HR-MSM contacted every month by peer educators or visited program STI clinics monthly, divided by the estimated denominator/size of HR-MSM as of March 2009 CMIS
d. Proportion of HR-MSM/TGs contacted in last month- Percentage of HR-MSM from IBBA who reported that they had been contacted by Avahan peer educators in the month preceding survey IBBA
B. Intensity  
a. Number of peer educator/outreach worker and ratio of MSM to peer educators- The total number of active outreach workers and peer educators in the Avahan intervention areas across implementation districts in Tamil Nadu; number of estimated MSM/TG covered per peer educator in the coverage area CMIS
b. Condom distribution and availability CMIS and condom social marketing data (CSM)
1. Absolute number of free condoms distributed by the Avahan program annually and condom sales from project-supported condom social marketing by program from 2005 to 2008.
2. Condom needs analysis- Ratio of average monthly condoms available per MSM; total condoms distributed by Avahan and made available through project-supported condom social marketing sales, divided by the estimated number of MSM in the area covered by Avahan; and ratio of number of condoms distributed to monthly commercial sex acts per MSM/TG, where sex acts are calculated based on number of sex acts with paying and paid male partners per month multiplied by total estimated number of MSMs covered by Avahan multiplied by four to get monthly sex acts***.
3. Proportion of HR-MSM reporting source of obtaining condom last time from outreach worker/peer educator/nongovernmental organization IBBA
  c. Frequency of contact by peers HR- MSM/TG reporting number of times they were contacted by peer educators in the month preceding the survey IBBA
d. Frequency of visit to clinic HR- MSM reporting the number of times they visited the Avahan program clinics for STI services Individual level CMIS data
2. Has there been an increase in condom use by HR-MSM? Change in condom use pattern  
a. Proportion of HR-MSM reporting last time condom use with paying male partners during two rounds of IBBA IBBA
b. Proportion of HR-MSM reporting consistent condom use with paid male partners during two rounds of IBBA IBBA
c. Proportion of HR-MSM reporting consistent condom use with regular male partners during two rounds of IBBA IBBA
d. Proportion of HR-MSM reporting consistent condom use with other non-commercial male partners during two rounds of IBBA IBBA
3. Has there been a 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 (NG, or CT or high-titre syphilis) IBBA
Change in HIV prevalence and new HIV infections IBBA
a. HIV prevalence among HR-MSM aggregated from all districts in two rounds of IBBA
c. HIV prevalence among HR-MSM in the age group of 18–20 years
4. Is Avahan exposure associated with increase in condom use and declining STIs? Association of intermediate outcomes and STIs to program exposure IBBA
a. Program exposures, defined as exposure to any one — ever contacted by peer, ever visited program clinic, and ever received condoms from peer educators; its link to consistent condom use with commercial and non-commercial partners, using pooled data from two rounds of IBBA
b. Duration of program exposure and its link to condom use with commercial and non-commercial partners, using pooled data from two rounds of IBBA
  b. Program exposure, as defined above, and its link with presence of any STIs (NG, CT or high-titre syphilis)  
  1. *** In both rounds of IBBA, HR-MSM were asked about the number of times they had anal sex with a paying male partner in the past one week; for paid male partners, it was the number of times they had anal sex in past one month.