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Table 2 Avahan evaluation framework and the data sources used for evaluation

From: Increase in condom use and decline in prevalence of sexually transmitted infections among high-risk men who have sex with men and transgender persons in Maharashtra, India: Avahan, the India AIDS Initiative

Evaluation question

Indicator

Data source

1. Is the coverage of Avahan adequate?

A. Scale

 

a. Geographical coverage: Description of rollout in number of districts and change in the number of implementing NGOs over time

CMIS*

b. Proportion of HR - MSM / TG ever contacted and ever visited clinic: Number of MSM ever contacted by Avahan peer educators or ever visited Avahan program STI clinics, divided by the estimated size of MSM as of March 2009

CMIS

c. Proportion of MSM c ontacted monthly by peer educators or visited program STI clinics for STI consultations: Number of MSM contacted monthly by peer educators or visited program STI clinics monthly, divided by the estimated size of MSM as of March 2009

CMIS

d. Proportion of MSM / TG contacted in the last month: Percentage of MSM from IBBA who reported that they had been contacted by Avahan peer educators in the month preceding the survey

IBBA**

B. Intensity

 

a. Number of peer educator / outreach workers 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 Maharashtra; 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

1. Absolute number of free condoms distributed by the Avahan program annually and condom sales from project-supported condom social marketing during 2005–2008

2. Condom needs analysis: Ratio of average monthly condoms available per MSM — total condoms distributed by Avahan and available through project-supported condom social marketing sales, divided by the estimated number of MSM in area covered by Avahan; ratio of number of condoms distributed to monthly commercial sex acts per MSM/TG, where sex acts are calculated based on the number of sex acts with paying and paid male partners per month, multiplied by the total estimated number of MSM covered by Avahan, multiplied by four to get monthly sex acts***.

3. Proportion of MSM reporting source of obtaining condoms last time from outreach worker/peer educator/NGO

IBBA

 

c. Frequency of contact by peers: MSM/TG reporting the number of times they were contacted by peer educators in the month preceding the survey

IBBA

d. Frequency of visit to clinic: MSM reporting the number of times they visited Avahan program clinics for STI services

Individual level CMIS data

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

Change in condom use pattern

 

a. Proportion of MSM reporting last time condom use with paying male partners over the two rounds of IBBA

IBBA

b. Proportion of MSM reporting consistent condom use with paid male partners over the two rounds of IBBA

IBBA

c. Proportion of MSM reporting consistent condom use with regular male partners over the two rounds of IBBA

IBBA

d. Proportion of MSM reporting consistent condom use with other non-commercial male partners over the two rounds of IBBA

IBBA

3. Has there been a reduction in STI prevalence 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 STIs (NG, or CT or high-titre syphilis)

IBBA

Change in HIV prevalence and new HIV infections

IBBA

a. HIV prevalence among MSM aggregated from all districts in the two rounds of IBBA

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

Association of program exposure with intermediate outcomes and STI prevalence

IBBA

a. Program exposure is defined as exposure to any one of the following: ever contacted by Avahan peer educators, ever visited Avahan program clinic, and ever received condoms from peer educators; its association with consistent condom use with commercial and non-commercial partners using pooled data from the two rounds of IBBA

b. Duration of program exposure and its association with condom use with commercial and non-commercial partners using pooled data from the two rounds of IBBA

c. Program exposure, as defined above, and its association with presence of any STI (gonorrhoea, chlamydia or high-titre syphilis [>1:8])

  1. ***In both rounds, MSM were asked about the number of times they had 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 the past one month.
  2. *CMIS: Avahan’s computerized management information system.
  3. **IBBA: Integrated behavioral and biological assessment.