Table 1

Indicators with definitions used in analysis

AreaData source/indicator(s)Comments/description
DenominatorProgramme data: number of FSWs and HR-MSM in geographic area
  • Avahan HRG size estimates: at the start of an intervention in a district or subdistrict, NGOs conducted a formal external mapping and size estimation exercise. Some state-level lead implementing partners updated these numbers on a regular basis, every 12 to 18 months, using programme data; some did formal size estimation exercises; and some used programme data alone to estimate numbers through subtracting individuals currently in the programme (determined on a 3 to 6 month basis depending on the lead implementing partner) from individuals ever registered.17 Size estimates are separate for FSWs and HR-MSM. The size estimate used in this analysis is the number as of December 2008

  • District HRG size estimates: size estimates are available from the Project Implementation Plans for third National AIDS Control Programme. Data are based on previous mapping exercises conducted by the states and where applicable Avahan size data.

AvailabilityMIS
  1. NGOs subcontracted

  2. DICs established

  3. Static project owned clinics established

  4. Number of active peer educators (FSW and HR-MSM) and outreach staff, and the ratio of peer educator to the community member

  5. Number of condoms distributed to FSW and HR-MSM both for free and through lead implementing partner condom social marketing by NGOs

  1. Some NGOs provided services uniquely to FSWs or HR-MSM, but the majority provided services to both. NGOs are not stratified by population served.

  2. DICs are places for HRG members to gather, meet and rest in comfortable, safe environment. DICs were established with community input regarding location, hours and available services, and managed by community.

  3. In addition to providing static STI clinics (eg, clinics in a permanent location) which were chosen, staffed and operated with input from the community, other STI services delivery sites were provided. These sites included fixed-time, fixed-location mobile clinics, preferred private providers and health camps. These other STI service sites are not included in the infrastructure analysis because reporting was not standardised across lead implementing partners but are included in the STI utilisation indicator.

  4. Outreach contacts are made by peer educators and the outreach staff. The number of peer educators is available as FSWs and HR-MSM separately but the number of outreach staff is present as a total figure. The target ratio per programme guidelines of a peer to community members is 1:50.

  5. Lead implementing partners distributed condoms free to the FSWs and HR-MSM through peer educators, outreach staff, clinics, depots and social marketing. In 2006, state-level lead implementing partners were instructed to ensure that enough condoms were distributed to meet the estimated condom needs of the individual FSWs and HR-MSM at the implementing site level. The method to estimate this need was determined at the state-level lead implementing partner level.

UtilisationMIS
  1. Number of individuals ever contacted

  2. Number of individual contacted monthly

  3. Number of individual ever visiting the clinic for STI services

  4. Number of individual visiting the clinic for STI services monthly

  • (1) and (3) All individuals at a site were given an identification number used at clinical services and for outreach. Ever contacted or came to the clinic services is determined by this number locally and reported in aggregate.

  • (2) and (4) Individuals contacted during outreach or seen in clinic are aggregated at the site level on a monthly basis and reported. Number of unique individuals contacted is known only on a monthly basis. Number of times an individual contacted over time or the frequency of contacts cannot be determined from central MIS. Programme targets for monthly outreach contacts varied across partners but were at a minimum at least one contact per month. Programme targets for routine STI clinic consultations were once a quarter, resulting in a target of 33% per month attending the clinic.

Estimated condom need
  • MIS—number of contacts by typology of FSWs based on solicitation venue served during outreach

  • IBBA—mean number of reported commercial sex partners both regular and occasional for FSWs and mean number of male partners for HR-MSM

  • For FSWs, IBBA reports commercial partner number by three FSW solicitation typologies—brothel-based, home-based, public-based. For the analysis of condom requirement, all sex work typologies recorded in the MIS that were not brothel-based or home-based were classified as public-based (street, tamasha, lodge, bar based, private and others).

  • For FSWs, total sex acts are calculated on a state level using MIS reported FSW typology, and mean and median partner number by typology by state reported in the IBBA. State level numbers are summed for overall commercial sex acts by FSW. At the time of calculation, one commercial partner=one sex act=one condom is assumed for FSWs. Estimation of total condoms needed for FSWs was 34 condoms per FSW per month to cover all commercial sex acts using the median reported number of sexual partners according to partner type.

  • For HR-MSM—the commodity need was not calculated, as the relevant required information was not available.

Validity of MIS data
  • MIS—(1) contacted this month, (2) ever visited the clinic

  • IBBA—(1) contacted by peer in the year, (2) visited a project STI clinic in last year (except Karnataka; see comments)

  1. All districts except Karnataka reported receiving services from a peer educator in the last month (IBBA) compared with percentage contacted through outreach in the last month (MIS) (number over 2008 district denominator). In Karnataka districts (Belgaum, Bellary, Shimoga), the reference period for the IBBA question was the last 1 year.

  2. For all districts except Karnataka, reported visiting programme STI clinics in the past 1 year (IBBA) compared with the percentage that ever visited programme clinics (number over 2008 district denominator). For Karnataka districts, the IBBA question was last 6 months.

  • DIC, drop-in centre; FSW, female sex worker; HRG, high-risk group; HR-MSM, high-risk men who have sex with men; IBBA, Integrated Behavioural and Biologic Assessment; MIS, monitoring information system.