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Full List MER Key Updates and Changes
Through the past several years of quarterly, site-level monitoring, PEPFAR programs have used data to improve implementation. Changes to the MER guidance highlight key program areas (e.g., index testing services) that should be taken to scale. Tables 3 and 4 and Figure 11 on the following pages highlight the key details for the MER indicators.
This guidance goes into effect with FY 2023 reporting with the first reporting on these indicators taking place in Q1 of FY 2023 for results that occurred from October 1 – December 31, 2022.
For changes prior to version 2.6.1, refer to the MER guidance from previous years.
Indicator training videos and content have been created by PEPFAR HQ technical area experts and uploaded on the MER DATIM support page. There is a training available for each technical area (e.g., TB, Treatment, HTS, etc.). Please note that the MER training videos are available to both USG and implementing partner staff with access to DATIM.
Data entry screens reflecting the changes outlined in this guidance document are under development. Once finalized, screenshots will be captured on the DATIM support site at the following link: https://datim.zendesk.com/hc/en-us/articles/360001143166-DATIM-Data-Entry-Form-Screen-Shot-Repository.
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- CXCA_TX: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+.
- PMTCT_ART: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+.
- TB_ART: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+.
- TX_ML: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+.
- TX_NEW: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+.
- TX_PVLS: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+.
- TX_RTT: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+.
See Table 4 for more details on indicator reporting frequency. None
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- PrEP_CT: PrEP_CT is a quarterly indicator introduced for reporting beginning in FY22 Q1. It measures continued use of PrEP among patients who returned for a follow-up or re-initiation visit.
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AGYW_PREV: Added a disaggregate on Comprehensive Economic Strengthening.
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HTS_INDEX: Added a “Documented Negative” disaggregate for pediatric age/sex bands only.
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HTS_RECENT: Data on RITA results will now be disaggregated by testing modality. Added a modality on Social Network Strategies (SNS) testing.
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HTS_TST: Added a modality on Social Network Strategies (SNS) testing.
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OVC_HIVSTAT: Added pediatric age/sex bands to existing “Status Type” disaggregate.
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TX_CURR: Expanded 50+ age band to 50-54, 55-59, 60-64, 65+. Added an optional Focused Populations Disaggregate.
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TX_NEW: Added an optional Focused Populations Disaggregate.
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TX_ML: Expanded interruption in treatment disaggregate to: <3 months, 3-5 months, 6+ months on treatment before experiencing an interruption in treatment. Added an optional Key Populations disaggregate.
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TX_RTT: Added a disaggregate on duration of interruption in treatment: Experienced a treatment interruption of <3 months, 3-5 months, 6+ months before returning to treatment.
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SC_CURR: Added two additional pediatric regimens: DTG 10 (90-count) and LPV/r 100/25 tabs (60 tabs/bottle).
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SC_ARVDISP: Added two additional pediatric regimen categories: DTG 10 (90-count) and LPV/r 100/25 tabs (60 tabs/bottle).
- TB_ART: The reporting frequency moves from quarterly to annual in FY22.
- PrEP_NEW: The definition was updated to include individuals enrolled on non-oral forms of PrEP, in alignment with COP Guidance.
- PrEP_CURR: Data on PrEP will be collected using PrEP_NEW and PrEP_CT. PrEP_CURR and PrEP_CT have different definitions and should not be trended together.
- There are no new indicators for MER 2.5.
- OVC_SERV: OVC_SERV has been restructured to distinguish between beneficiaries in the three OVC_SERV program models: OVC Comprehensive, DREAMS, and OVC Preventive. The OVC Comprehensive disaggregate is reported by program participation status, age/sex, Exited or Transferred, and a new disaggregate to distinguish between OVC child beneficiaries aged 18-20 years and caregivers aged 18+. The DREAMS and OVC Preventive disaggregates are reported by age/sex.
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PrEP_NEW: The reporting frequency moves from semi-annually to quarterly in FY21.
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PrEP_CURR: The reporting frequency moves from semi-annually to quarterly in FY21.
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GEND_GBV: The reporting frequency moves from annually to semi-annually in FY21.
- KP_PREV: In order to standardize KP disaggregations across the clinical cascade indicators, KP_PREV disaggregations were updated to: FSW, MSM, PWID, TG, and People in prisons and other closed settings. The disaggregations of TG SW, TG non-SW, MSM SW, MSM non-SW, PWID male, and PWID female were retired.
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OVC_HIVSTAT: Clarifying language was added to state that the denominator of OVC_HIVSTAT will be auto-calculated from the OVC_SERV “OVC Comprehensive” disaggregate. Only beneficiaries enrolled in the OVC Comprehensive program should be reported in OVC_HIVSTAT.
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TX_RTT: Language was added to TX_RTT to state that patients reported in TX_RTT must have been experienced an interruption in treatment during any previous reporting period, successfully restarted ARVs within the current reporting period, and remained on treatment until the end of the reporting period.
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TX_ML: Clarifying language was added to outline the relationship between TX_ML and TX_RTT.
- The following changes were made in order use patient-centered language: Retention was changed to “continuity of treatment”. Lost to Follow-Up (LTFU) was changed to “interruption in treatment”. Interruption in treatment (IIT) is defined as no clinical contact or ARV drug pickup for greater than 28 days since the last expected contact.
- Financial support at the national or subnational level in areas where PEPFAR is not providing support at the site level is characterized as Central Support. Starting in FY21, PEPFAR Central Support will be collected as third support type, separate from DSD and TA. TX_PVLS will be added to the list of Central Support indicators. Central Support data will continue to be reported annually. For additional information, please refer to the section on PEPFAR Support to Communities and Sites.
- HRH_CURR: Starting in FY21, HRH_CURR will be retired. HRH Data will be collected via the HRH Inventory. Data collection through the HRH Inventory, along with more robust analysis and programmatic action, will allow PEPFAR to better capture the scope and nature of its staffing investments in order to optimize health worker utilization to advance epidemic control and inform sustainability planning once epidemic control is achieved. See Appendix G for additional information.
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SC_ARVDISP: SC_ARVDISP is a semi-annual indicator introduced for reporting beginning in Q2 of FY20. SC_ARVDISP measures the dispensing of ARV bottles at the facility level. In addition, SC_ARVDISP measures the uptake, transition, and maintenance of patients on optimized ARV regimens as well as the phasing out of non-optimal regimens.
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SC_CURR: SC_CURR is a semi-annual indicator introduced for reporting beginning in Q2 of FY20. SC_CURR measures the quantity of ARV stock available at the time of reporting to provide insight into the on-the-shelf availability of each ARV used for HIV treatment at the facility level. Data from SC_CURR can be coupled with data from SC_ARVDISP to determine how long the quantity of stock will last based on dispensing.
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TX_RTT: TX_RTT is a quarterly indicator introduced for reporting beginning in Q1 of FY20. TX_RTT counts those patients who are lost to TX_CURR for more than 28 days past the last expected clinical contact who return to treatment and restart ARVs in the reporting period. This indicator counts those previously ART experienced individuals who reinitiate ARVs after being off treatment for ≥28 days (and therefore LTFU).
- TX_CURR: Two new disaggregations have been introduced for quarterly TX_CURR reporting beginning in FY20: (1) reporting TX_CURR results by KP type and (2) reporting TX_CURR by the months of ARVs dispensed to each patient to assess the uptake of multi-month dispensing (MMD) in PEPFAR-supported sites.
As a reminder, the definition of TX_CURR was modified beginning in FY 2019 based on a new definition of lost-to-follow-up (LTFU). Patients who have not received ARVs within four weeks (i.e., 28 days) of their last missed drug pick-up should not be counted in TX_CURR.
- TX_PVLS: KP disaggregations have been added to both the numerator and denominator.
- PEPFAR collects administrative, epidemiologic, and service-related data about PEPFAR-supported facilities and subnational units (SNUs) that helps to better illuminate where services should be provided, where services are actually are provided, who is delivering these services, and what is the service capacity. Some of these attributes are routinely collected in form of MER indicators (e.g., HRH_CURR, EMR_SITE), others are collected at the time a facility is added to a master facility list and subsequently DATIM (e.g., facility name, geographic coordinates), and others are collected during the annual PEPFAR planning cycle.
Through the collection of these data, PEPFAR strives to have more complete information available on service provision facility infrastructure. Use of these data facilitates improved decision-making when country programs are determining what services should be targeted to the populations in greatest need of these services by geographic locations.
New site attributes have been added for reporting in FY20. For a full list of all required site and SNU attributes, refer to Appendix D. Additional details on the collection of these attributes will be included in the COP 20 guidance and the FY20 MOH-Data Alignment Activity.
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TX_ML: The reporting frequency moves from semi-annually to quarterly in FY20 to align with other treatment indicators and improve triangulation with TX_NEW, TX_NET_NEW, TX_CURR, and TX_RTT.
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TX_ML: The reporting frequency moves from semi-annually to quarterly in FY20 to align with other treatment indicators and improve triangulation with TX_NEW, TX_NET_NEW, TX_CURR, and TX_RTT.
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AGYW_PREV: Indicator reporting shifted in FY19 from being cumulative for the entire DREAMS programs to a to snapshot, reflecting AGYW service completion as of the past 6 months at Q2 and the past 12 months at Q4. For FY20, the numerator and denominator disaggregates have been reorganized and a denominator disaggregate has been added to capture AGYW enrolled in DREAMS that have started but not yet completed a DREAMS service/intervention in the reporting period. These changes will provide the ability to better assess completion coverage.
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HTS_RECENT: HTS_RECENT has been restructured to combine the previous numerator and denominator into a single numerator to mirror HTS_TST. As such the previous indication disaggregation (assay, RITA, and not documented) was redefined to align better with reported results and recency testing algorithms. All assay results will be reported under rapid test for recent infection (RTRI) and confirmed results through viral load testing as part of the RITA will be reported as a subset, where available.
HTS_RECENT results will be collected by modality and test result beginning in FY20 to improve alignment and triangulation with HTS_TST in order to understand which modalities are identifying recent infections. The pregnancy status disaggregation was removed due to the addition of modality as pregnancy status can be ascertained from the PMTCT ANC1 and PMTCT Post ANC1 modalities.
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TB_PREV: The denominator was changed from the number of ART patients who “are expected to complete a course of TPT” to those who were initiated on any course of TPT during the previous reporting period. The therapy type (regimen) disaggregates for the numerator and denominator were moved from the indicator to the guiding narrative questions. The APR calculation for TB_PREV was changed from a snapshot indicator, to being summed over time (i.e., previous calculation: APR=Q4, new calculation: APR=Q2+Q4).
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TX_ML: The outcome disaggregations have been simplified to the following categories: died, lost to follow-up, transferred out, and refused (stopped) treatment. Sub-disaggregations were added to the lost to follow-up outcome for patients LTFU after being on treatment for >3 months vs. patients LTFU after being on treatment <3 months. This distinction was added to highlight the critical nature of early retention for successful longer-term retention among those persons newly initiating ART, especially otherwise healthy or younger adults.
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LAB_PTCQI: Laboratory and point-of-care testing site categories have been updated to include “rapid test for recent infection” and remove “other”.
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PP_PREV: A new disaggregate has been added to the “Testing Services” disaggregate group for “Test not required based on risk assessment” for those priority populations not eligible for HTS based on HTS screening. In-text clarifications were also added to confirm that conducting an HIV risk assessment meets the required HTS component for PP_PREV.
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TX_PVLS: “Not documented” testing indication removed as efforts should have been initiated since this indicator was introduced, as described in the previous releases of the MER guidance, to move results to either “routine” or “targeted.”
- OVC_SERV: Clarifying language was added to OVC_SERV explaining exited, transferred, and graduation disaggregates should be reported cumulatively at Q4. In addition, there is an expanded definition of “child” OVC beneficiary to include children aged 18 to 20 still completing secondary education or an approved economic intervention intended to secure the livelihood of an OVC aging out of the program. Language was also added regarding counting active DREAMS beneficiaries who are not otherwise actively enrolled in the OVC program under OVC_SERV. Lastly, there is clarifying language added regarding the definition and number of caregivers per household.
- SC_STOCK: Indicator has been removed in order to introduce improvements to the supply chain indicators, including SC_ARVDISP and SC_CURR, which allows for more proactive action to address bottlenecks in the supply chain.
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AGYW_PREV: AGYW_PREV is a semi-annual indicator introduced for reporting beginning in FY19. AGYW_PREV is a DREAMS-specific indicator to measure how many adolescent girls and young women (AGYW) are being served in the DREAMS program and whether all AGYW in DREAMS have received the intended layered services and interventions to ensure that they remain HIV-free.
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CXCA_SCRN: CXCA_SCRN is a semi-annual indicator introduced for reporting beginning in Q4 of FY18. CXCA measures the percentage of HIV-positive women on ART screened for cervical cancer.
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CXCA_TX: CXCA_TX is a semi-annual indicator introduced for reporting beginning in Q4 of FY18. CXCA_TX measures the percentage of cervical cancer screen-positive women who are also HIV-positive and on ART that were eligible for and received cryotherapy, thermocoagulation or LEEP.
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HTS_INDEX: HTS_INDEX is now a standalone indicator to monitor and help guide PEPFAR programming for index testing services. Reporting for HTS_INDEX will begin in Q1 of FY19. HTS_INDEX is the first MER indicator to monitor PEPFAR programming related to HIV index testing services (often referred to as partner notification or contact tracing services). This indicator includes a cascade that will help to better understand the scale and fidelity of the index testing services provided by PEPFAR-supported programs.
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HTS_RECENT: HTS_RECENT is a quarterly indicator introduced for reporting beginning in Q1 of FY19. Testing individuals that are newly diagnosed with HIV-1 for recent infection is an emerging programmatic area of emphasis for PEPFAR. HTS_RECENT measures the percentage of newly diagnosed HIV-positive persons aged
≥15 years with a test for recent infection result of ‘recent infection’ during the reporting period. As countries progress toward epidemic control, surveillance of newly diagnosed persons will ensure that interventions target those at highest risk of acquiring or transmitting HIV infection. One approach is to identify recent HIV infections, defined as those acquired within approximately the last one year. Incorporation of rapid tests for recent HIV-1 infection into routine HIV testing services will enable the establishment of a surveillance system to quickly detect, monitor, characterize, and intervene on recent infections among newly diagnosed HIV cases. Data collected from a recent infection surveillance system can also be used to fine-tune a country’s programmatic response through prioritized programming and resource allocation.
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PrEP_CURR: PrEP_CURR is a semi-annual indicator introduced for reporting beginning in FY19. PrEP_CURR measures the number of individuals receiving oral PrEP during the reporting period and is an important addition to the MER to help PEPFAR programs understand how many clients are being sustained on PrEP after initiation.
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TX_ML: TX_ML is a semi-annual indicator introduced for reporting beginning in FY19. TX_ML is intended to drive improved tracing of patients to ensure patient outcomes are accurately documented. It is the first PEPFAR indicator to collect information on mortality among patients on ART and in care. The indicator also strives to better understand the magnitude of previously undocumented patient transfers.
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HTS_TST: A new facility-based testing modality has been introduced: Post ANC1: Pregnancy/L&D/BF. Please refer to the HTS_TST indicator reference sheet for additional details.
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PP_PREV: A new, optional priority populations type disaggregate was added to this indicator to capture the specific priority populations accessing prevention services. Age/sex-specific priority populations were not added to this disaggregate group (e.g., AGYW) because these can be calculated using the mandatory age/sex disaggregates collected within the indicator.
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TX_TB: The denominator has been updated to include a new disaggregate for “positive result returned.”
- See Table 2: Data from the Population-Based HIV Impact Assessments (PHIA) has provided valuable insight into the progress many PEPFAR countries are making towards achieving the 95-95-95 goals in all ages and sexes. Significant disparities in incidence and viral suppression among adults ages 25-49-year led 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 in FY18. Further review and analysis of age- disaggregated data during COP 2018 resulted in a shift towards disaggregation by standard five-year-age bands to align with the WHO guidance (https://www.who.int/hiv/pub/guidelines/strategic-information-guidelines/en/) for electronic systems.
Reporting on the new MER 2.0 (v2.3) age bands will be introduced beginning in Q1 of FY 2019. As discussed in the previous MER guidance as well as in the FY 18 Consolidated Guidance for Data Collection and Use in PEPFAR and the COP 2018 PEPFAR Fiscal Year 2018 Country Operational Plan (COP) Guidance for Standard Process Countries, country teams were required to discuss any barriers or challenges to reporting the new finer age disaggregations during FY 18 to address these challenges in order to fully report on new finer age bands beginning in FY19. Methods of extrapolating or estimating age disaggregated results data are not permitted. If you have questions, contact your SI Advisor and SGAC_SI@state.gov. The table below describes the evolution of the standard, required age bands for PEPFAR reporting from FY 2015 through FY 2019. Note that there are some indicator-specific variations to these requirements.
Table 2: Evolution of PEPFAR Finer Age Bands for Results Reporting | Evolution of PEPFAR Finer Age Bands for Results Reporting |
| FY 2015 - 2016 | FY 2017 | FY 2018 | FY 2019 |
|---|---|---|---|
| Age Band | Sex | Age Band | Sex |
| --------------------- | --------------------- | --------------------- | --------------------- |
| <1 | M / F | <1 | None |
| 1-4 | M / F | 1-9 | None |
| 5-9 | M / F | 5-9 | M / F |
| 10-14 | M / F | 10-14 | M / F |
| 15-19 | M / F | 15-19 | M / F |
| 20-24 | M / F | 20-24 | M / F |
| 25-49 | M / F | 25-49 | M / F |
| 30-34 | M / F | 30-34 | M / F |
| --------------------- | --------------------- | --------------------- | --------------------- |
| 50+ | M / F | 50+ | M / F |
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Auto-sum numerators and denominators: To reinforce data quality and reduce data entry, PEPFAR will begin to auto-sum the top-level numerators and denominators for most indicators in FY 2019. To reinforce data quality and reduce data entry, PEPFAR will begin to auto-sum the top-level numerators and denominators for most indicators in FY 2019. For example, the age/sex disaggregations for TX_CURR will be summed to obtain the total numerator for TX_CURR. Implementing partner staff will not need to enter both a numerator and the age/sex disaggregations into DATIM. Entering the age/sex disaggregations will auto- sum the numerator. In order to ensure completeness of reporting where age-related data is not collected fully, an option of ‘unknown age’ has been added to all indicators. Note that an ‘unknown sex’ option is not available. Data must be collected by sex, at a minimum, in order to be reported in DATIM. If you have questions about this requirement, contact your SI Advisor and SGAC_SI@state.gov. In each indicator reference sheet, within the disaggregations section, the disaggregate group that will be used to auto-sum the numerator or denominator is highlighted in BOLD text. Not all indicators will auto-calculate.
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Auto-Sum Numerators and Denominators: To reinforce data quality and reduce data entry, PEPFAR will begin to auto-sum the top-level numerators and denominators for most indicators in FY 2019. For example, the age/sex disaggregations for TX_CURR will be summed to obtain the total numerator for TX_CURR. IIImplementing partner staff will not need to enter both a numerator and the age/sex disaggregations into DATIM**. Entering the age/sex disaggregations will auto- sum the numerator. In order to ensure completeness of reporting where age-related data is not collected fully, an option of ‘unknown age’ has been added to all indicators. Note that an ‘unknown sex’ option is not available. Data must be collected by sex, at a minimum, in order to be reported in DATIM. If you have questions about this requirement, contact your SI Advisor and SGAC_SI@state.gov.
In each indicator reference sheet, within the disaggregations section, the disaggregate group that will be used to auto-sum the numerator or denominator is highlighted in BOLD text. Not all indicators will auto-calculate.
- Auto-Population of HTS_TST Modalities: New efforts to reduce data entry redundancy and reinforce the relationships between indicators are being instituted in this iteration of the MER guidance. The definitions for the PMTCT (ANC1), TB, VMMC, and index HIV testing services modalities have been aligned with their respective parent status indicators (i.e., PMTCT_STAT, TB_STAT, VMMC_CIRC, and HTS_INDEX). Results will no longer be entered for these modalities through the HTS_TST indicator directly but will instead be entered into the parent indicator and then auto-populated into HTS_TST. For example, results entered for TB_STAT newly tested positives will auto- populate into the TB modality for HTS_TST within DATIM. DATIM users will still see these modalities on the data entry screen but will no longer be able to enter data directly into the modalities. Once data is entered for the partner indicator, it will be copied into the relevant data entry form for the corresponding HTS modality. For further details, see the diagram below and review the HTS_TST reference sheet.
Table 3: Indicator Summary Table
| Indicator Code | Indicator Group | Indicator Description | Reporting Frequency |
|---|---|---|---|
| AGYW_PREV | Prevention | Percentage of adolescent girls and young women (AGYW) that completed the DREAMS primary package of evidence-based services/interventions. | Semi-Annual |
| CXCA_SCRN | Testing | Percentage of HIV-positive women on ART screened for cervical cancer | Semi-Annual |
| CXCA_TX | Treatment | Percentage of cervical cancer screen-positive women who are HIV-positive and on ART eligible for cryotherapy, thermocoagulation or LEEP who received cryotherapy, thermocoagulation or LEEP | Semi-Annual |
| EMR_SITE | Health Systems | Number of PEPFAR-supported facilities that have an electronic medical record system within the following service delivery areas: HIV Testing Services, Care & Treatment, Antenatal or Maternity Services, Early Infant Diagnosis or Under Five Clinic, or TB/HIV Services | Annual |
| FPINT_SITE | Prevention | Number of HIV service delivery points at a site supported by PEPFAR that are providing integrated voluntary family planning services | Annual |
| GEND_GBV | Prevention | Number of people receiving post-gender-based violence clinical care based on the minimum package | Annual |
| HRH_CURR | Health Systems | Number of health workers who are working on HIV- related activities and are receiving any type of support from PEPFAR, as well as total spend on these workers | Annual |
| HRH_PRE | Health Systems | 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 |
| HTS_INDEX | Testing | Number of individuals who were identified and tested using Index testing services and received their results | Quarterly |
| HTS_RECENT | Testing | Percentage of persons aged ≥15 years newly diagnosed with HIV-1 infection who have a test for recent infection result of ‘recent infection’ during the reporting period | Quarterly |
| HTS_SELF | Testing | Number of individual HIV self-test kits distributed | Quarterly |
| HTS_TST | Testing | Number of individuals who received HIV Testing Services and received their test results | Quarterly |
| KP_MAT | Prevention | Number of people who inject drugs on medication- assisted therapy for at least 6 months | Annual |
| KP_PREV | Prevention | Number of key populations reached with individual and/or small group-level HIV prevention interventions designed for the target population | Semi-Annual |
| LAB_PTCQI | Health Systems | Number of PEPFAR-supported laboratory-based testing and/or Point-of-Care Testing (POCT) sites engaged in continuous quality Improvement (CQI) and proficiency testing (PT) activities. | Annual |
| OVC_HIVSTAT | Testing | Percentage of orphans and vulnerable children (<18 years old) with HIV status reported to implementing partner. | Semi-Annual |
| OVC_SERV | Prevention | Number of beneficiaries served by PEPFAR OVC programs for children and families affected by HIV | Semi-Annual |
| PMTCT_ART | Treatment | Percentage of HIV-positive pregnant women who received ART to reduce the risk of mother-to-child- transmission during pregnancy | Quarterly |
| PMTCT_EID | Testing | Percentage of infants born to HIV-positive women who received a first virologic HIV test (sample collected) by 12 months of age | Quarterly |
| PMTCT_FO | Testing | Percentage of final outcomes among HIV exposed infants registered in a birth cohort | Annual |
| PMTCT_HEI_POS | Testing | Number of HIV-infected infants identified in the reporting period, whose diagnostic sample was collected by 12 months of age. | Quarterly |
| PMTCT_STAT | Testing | Percentage of pregnant women with known HIV status at antenatal care | Quarterly |
| PP_PREV | Prevention | Number of priority populations reached with the standardized, evidence-based intervention(s) required that are designed to promote the adoption of HIV prevention behaviors and service uptake | Semi-Annual |
| PrEP_CURR | Prevention | Number of individuals, inclusive of those newly enrolled, that received oral antiretroviral pre-exposure prophylaxis to prevent HIV during the reporting period | Semi-Annual |
| PrEP_NEW | Prevention | Number of individuals who have been newly enrolled on oral antiretroviral pre-exposure prophylaxis to prevent HIV infection in the reporting period | Semi-Annual |
| SC_STOCK | Health Systems | Percentage of stock status observations from storage sites where commodities are stocked according to plan, by level in supply system | Semi-Annual |
| TB_ART | Treatment | Proportion of HIV-positive new and relapsed TB cases on ART during TB treatment | Quarterly |
| TB_PREV | Prevention | Proportion of ART patients who completed a standard course of TB preventive therapy within the semiannual reporting period | Semi-Annual |
| TB_STAT | Testing | Percentage of new and relapse TB cases with documented HIV status | Quarterly |
| TX_CURR | Treatment | Number of adults and children currently receiving antiretroviral therapy (ART) | Quarterly |
| TX_ML | Treatment | Number of ART patients with no clinical contact since their last expected contact | Semi-Annual |
| TX_NEW | Treatment | Number of adults and children newly enrolled on antiretroviral therapy (ART) | Quarterly |
| TX_PVLS | Viral Suppression | Percentage of ART patients with a suppressed viral load (VL) result (<1000 copies/ml) documented in the medical or laboratory records/laboratory information systems (LIS) within the past 12 months | Quarterly |
| TX_TB | Treatment | Proportion of ART patients screened for TB in the semiannual reporting period who start TB treatment. | Semi-Annual |
| VMMC_CIRC | Prevention | Number of males circumcised as part of the voluntary medical male circumcision for HIV prevention program within the reporting period | Quarterly |
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PrEP_NEW: The reporting frequency moves from quarterly to semi-annually in FY19 to align the prevention indicators.
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TB_ART: The reporting frequency moves from semi-annually to quarterly in FY19 to align with the ART-related indicators and TB_STAT.
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TB_STAT: The reporting frequency moves from semi-annually to quarterly in FY19 to align with HTS_TST.
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TX_PVLS: The reporting frequency moves from annually to quarterly in FY19 to ensure that the treatment cascade can be reviewed quarterly and to emphasize the importance of regularly monitoring viral load coverage and suppression.
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HRH_CURR: The reporting of HRH_CURR by the number of full-time equivalents is no longer required. HRH_CURR has been simplified to collect the total number of staff (regardless of FTE). In addition, a new data element has been added to capture the amount of funding spent on health care workers by cadre and support type.
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PMTCT_EID: The denominator has been updated to include HIV+ pregnant women identified after ANC1, including those women who test positives later in pregnancy, at labor and delivery, and throughout the breastfeeding period. The positive results for these women will be captured under the newly added HTS modality, Post ANC1: Pregnancy/L&D/BF and will be summed with the positives (new and known) from ANC1 (i.e., PMTCT_STAT_POS) to obtain the total denominator.
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OVC_HIVSTAT: The status type disaggregates have been modified. The sub-disaggregate under “No status reported” formerly called “Test not indicated” will now be “Test not required based on risk assessment” to simplify the language.
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OVC_SERV: Age/sex and program status (i.e., active or graduated) disaggregations have been combined.
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PMTCT_ART: Age disaggregations were added to the “maternal regimen type” disaggregate to align with PMTCT_STAT. Age disaggregations were not previously collected for PMTCT_ART.
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PREP_NEW: The KP type disaggregation for this indicator has been updated. “Other key population” has been removed and replaced with “people who inject drugs” and “people in prisons and other closed settings” so that all key population disaggregate group options align between HTS_TST, TX_NEW, PrEP_CURR, and PrEP_NEW.
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TB_ART: Age/sex and “ART status” disaggregations have been combined.
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TB_PREV: Age/sex and “Type of TB preventive therapy by ART Start” disaggregations have been combined for both the numerator and the denominator.
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TB_STAT: Age/sex disaggregations were updated from coarse-only to fine age bands to allow TB_STAT to auto-populate HTS_TST via the TB modality and to align with the age bands for TB_ART.
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TX_TB: Age/sex and “ART Status” disaggregations have been combined for the numerator. Age/sex and “Start of ART by Screen Results” disaggregations have been combined for the denominator.
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VMMC_CIRC: Age disaggregations were added to the “HIV Status and Outcome” disaggregate in order for VMMC HTS results to auto-populate into the HTS_TST indicator. Note that the age disaggregations align with HTS_TST to allow for auto-population. This means the <4 disaggregations differ slightly from the indicator itself.
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GEND_GBV: Clarifying language was added to the “disaggregate descriptions and definitions” section of the indicator to ensure that clients are not double-counted under the indicator.
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OVC_SERV: Clarifying language added to this indicator reference sheet to better emphasize that only children (and their caregivers) that actually received one or more services in each of the preceding two quarters should be counted in this indicator. OVC that have registered for the program (i.e., been enrolled and assessed) but have not yet received any services should not be counted in the results. The purpose of this indicator is to assure that beneficiaries are being reached promptly and regularly with needed support. In addition, illustrative eligible interventions that qualify a beneficiary to be counted as active have been added, for both children and caregivers. For services that are not captured in the list, local USG funding agency approval must be received in order to count these services toward active OVC status. Next, minimum graduation benchmarks have been established to ensure that PEPFAR programs have aligned objectives for progressing children and their caregivers to a minimum level of stability. Children and caregivers in a household move from active to graduated status together when each has met the minimum benchmarks (reflecting the family-centered nature of OVC programming). Lastly, clarifying language has been added to the indicator reference sheet regarding the calculation of annual totals and the timeframe of data submitted for Q4 disaggregates. Individuals should only be counted once at Q4 reporting (i.e., active, graduated, transferred, and exited disaggregates are mutually exclusive).
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PMTCT_ART: Language has been added to clarify that only women initiating on treatment prior to pregnancy or during pregnancy (ANC) should be counted under PMTCT_ART. Women newly initiating or coming to the facility during L&D and breastfeeding should be counted under TX_NEW and/or TX_CURR, but not under PMTCT_ART.
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PMTCT_STAT: Language has been added to clarify that subsequent testing events during pregnancy, labor and delivery, and breastfeeding will be reported under the new HTS_TST modality: Post ANC1: Pregnancy/L&D/BF. See the PMTCT_STAT and HTS_TST indicator reference sheets for further details.
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TX_CURR: Language under the “How to Collect” section has been updated to better clarify PEPFAR reporting expectations in light of recent DQAs and to describe alignment with the new TX_ML indicator.
- TX_RET: Indicator has been removed in order to incorporate the new TX_ML indicator and strengthen reporting on TX_PVLS.
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OVC_SERV: The age/sex/service DREAMS-related disaggregate was removed and replaced with a new indicator, AGYW_PREV, to improve the tracking of layered services and interventions.
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PMTCT_STAT: The age-only disaggregate was removed to minimize duplicative reporting. Age is already captured under the status and age disaggregate group.
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TX_NEW: The “confirmed diagnosis of TB” disaggregate was removed as TB_ART results have moved to quarterly reporting.
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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.
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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.
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AGE DISAGGREGATIONS: Data from the Population-Based HIV Impact Assessments (PHIA) (https://phia.icap.columbia.edu/) 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 Q1. 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+
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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.
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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.
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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.
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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.
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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).
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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.
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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.
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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.
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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.
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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
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OVC_SERV: Clarifying language was added to the indicator definition stating that only those OVCs that actually received services in the past three months should be counted in this indicator. OVCs that have registered for the OVC program, but have not yet received any services should not be counted in the results.
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INVS_COMD: Indicator has been removed due to duplication with quarterly data submitted by principal supply chain mechanisms.
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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.
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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.
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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.
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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.
- 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.
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Required, this indicates that this indicator disaggregate is required for all countries that have programming for this area. Which includes means that the country supports a program area, defined by budget, programming and targets set during the COP process -- then it is required that there also be results. Required program indicators may consist of both DSD and TA results.
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Conditional indicator disaggregates include those for which some additional condition must be filled. In MER 2.0 there are no full indicators that are conditional, but only additional disaggregations that are conditional on additional funding and / or programming. In MER 2.0 there are two main types of conditional indicator disaggregation’s; 1) having received additional funds for special programming, i.e., DREAMS SNU (with or without additional DREAMS funding) or, 2) having received permission for the OGAC SI advisor to complete coarse age disaggregations instead of the finer age disaggregations. This is considered conditional based on approval from S/GAC.
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Optional indicator disaggregates, should be completed by those for which the indicators is useful to determine the success of their program (e.g., KP National and Subnational data) or for which the partner has strong methodological sources (KP catchment area -denominator) or for which it is both relevant and safe to enter the data at the site and/or community level (KP disaggregations for TX_NEW, HTS_TST, please see additional guidance on Key populations changes).
- KEY POPULATIONS: In order to better understand the HIV epidemic among key populations and program response, there have been several substantial changes to the data collection for key populations. These changes have positively affected both the KP and PP prevention program indicators as well as the clinical cascade indicators.
For the prevention program, to align PEPFAR indicators better with WHO and UNAIDS indicators, the key populations have been separated MSM and transgender and added Prisoners and other people living in enclosed places. Additionally, KP disaggregations were added to the PrEP_NEW indicator.
Where appropriate these key population have also been added as disaggregations to indicators in the clinical cascade including, HTS_TST and TX_NEW. These were not added to TX_CURR or TX_RET or TX_PVLS, specifically as identifying as KP may not be life-long and may change over time and therefore not possible to collect retrospectively. To better determine the KPs of interest for each indicator, please review Appendix 1, the key population classification document.
- TB/HIV: The TB indicators have been enhanced this year to better correspond to global changes in TB policy and to better reflect the increasing emphasis on patient outcomes. We have maintained the TB_STAT indicator (and increased the frequency of collection to quarterly) and have added a disaggregate to TX_NEW and TB_ART to identify the number of new patients who have TB at the time of enrollment. These will allow us to characterize the HIV testing of TB patients, and the linkage to HIV treatment.
Elements of TB_SCREEN/ TB_SCREENDX (COP16 target setting) have been transformed into a new indicator, TX_TB, which will allow 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.
Corresponding to the sharper focus of the End TB Strategy, and the emphasis on TB prevention, we have transformed TB_IPT into a new indicator, TB_PREV, which will now be required. By identifying the proportion that completes or is maintained on continuous preventive therapy, we will be able to monitor relevant outcomes, rather than just the number that initiate TB preventive therapy. These indicators will allow us to document the care cascade from TB screening to the desired outcomes: TB therapy or TB preventive therapy.
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Host Country National Program: Monitoring host country HIV program response is critical to understand the achievements and gaps in HIV programs in National and subnational context and by population. These data are used to inform PEPFAR programs and guide PEPFAR resources 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.
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Host Country National 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. Pin the narratives, please indicate what months the data include (e.g., October 2015-September 2016; or July 2015 to June 2016). Results should be consistently reported on the same time period to be able to monitor trends over time.
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Host Country National Targets: Developing targets for the next year (FY2017) 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 target 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.
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Host Country Subnational Targets and Results: Data are needed from both the national and subnational level. The subnational level is considered that in which the country team has prioritized their program (PSNU). This data should be entered 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.
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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 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.
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Expenditure Analysis (EA) & MER 2.0 Alignment: PEPFAR Expenditure Analysis (EA) is conducted annually in order to better understand the costs the USG incurs to provide a broad range of HIV services and support and subsequently use this information to improve program planning. Additional information about EA methodology, process, and timeline can be found in the EA annual Guidance. PEPFAR results reported through the MER are linked to EA program areas to calculate a “unit expenditure” (UE). The UE represents the amount (in USD) PEPFAR spent per beneficiary reached within a program area tied to the relevant indicator. Unit expenditures are only calculated when appropriate indicators are available and align with EA expenditure reporting, and therefore EA uses only a selection of MER indicators. The general framework of EA-MER underscores 1) The benefit of logic checks that ensure consistency and completeness in MER reporting within and across partners in an OU, and 2) that reporting to EA and MER are aligned – i.e. expenditures are reported in the same locations (at EA SNU level, typically district or province) and program areas in which results are reported (please note: expenditures can also be reported in SNUs and/or program areas in which results are not reported).
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DREAMS Specific Guidance: In addition to required MER reporting, it is essential that all DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) countries – Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe – 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 narratives. MER 2.0 Indicators. Reporting frequency by program area (quarterly, semi-annual, annual)
| Program Area Group | Indicator Code | Indicator Name | Reporting Frequency | |
|---|---|---|---|---|
| 1 | Prevention | PREP_NEW | Number of individuals who have been newly enrolled on (oral) antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period. | Quarterly |
| 2 | Prevention | VMMC_CIRC | Number of males circumcised as part of the voluntary medical male circumcision (VMMC) for HIV prevention program within the reporting period | Quarterly |
| 3 | 90: 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 |
| 4 | 90: 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 |
| 5 | 90: 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, disaggregated by HIV result | Quarterly |
| 6 | 90-90: On ART | TX_NEW | Number of adults and children newly enrolled on antiretroviral therapy (ART) | Quarterly |
| 7 | 90-90: On ART | TX_CURR | Number of adults and children currently receiving antiretroviral therapy (ART) | Quarterly |
| 8 | 90-90: 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 |
| 9 | 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 |
| 10 | Prevention | PP_PREV | 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 | Semi-Annual |
| 11 | Prevention | TB_PREV | Proportion of ART patients who completed a standard course of TB preventive therapy within the reporting period | Semi-Annual |
| 12 | 90: Knowing Your HIV Status | TB_STAT | Percentage of new and relapse TB cases with documented HIV status, disaggregated by HIV result | Semi-annual |
| 13 | 90-90: On ART | TB_ART | Percentage of HIV-positive new and relapsed TB cases on ART during TB treatment | Semi-Annual |
| 14 | 90-90: On ART | TX_TB | The proportion of ART patients who were screened who are receiving TB treatment | Semi-Annual |
| 15 | Prevention | OVC_SERV | Number of beneficiaries served by PEPFAR OVC programs for children and families affected by HIV | Semi-Annual |
| 16 | 90: 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 |
| 17 | Health Systems | SC_STOCK | Percentage of storage sites where commodities are stocked according to plan, by level in supply system | Semi-Annual |
| 18 | Prevention | KP_MAT | Number of people who inject drugs (PWID) on medication-assisted therapy (MAT) | Annual |
| 19 | 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 |
| 20 | 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 |
| 21 | 90: Knowing Your HIV Status | PMTCT_FO | Percentage of final outcomes among HIV exposed infants registered in a birth cohort | Annual |
| 22 | 90-90-90: 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 |
| 23 | 90-90-90: 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 |
| 24 | 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 |
| 25 | 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-site level | Annual |
| 26 | 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 |
| 27 | 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 |
| 28 | 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 |
| 29 | Health Systems | INVS_COMD | Number of HIV program related commodities purchased and dollars spent in the last 12 months | Annual |
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nan
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How to read the Indicator Reference Sheet: All indicators are in a standard format in order to easily understand them. Please use this layout as a reference guide to understand how to read the reference sheets.
| Indicator Name |
|---|
| Description: |
| Numerator: |
| Denominator |
| MER 1.0 to 2.0 Change |
| How to use: |
| How to collect: |
| EA & SIMS considerations |
| Reporting level |
| How often to report: |
| How to review for data quality: |
| How to calculate annual total: |
| Data Elements (Components of indicator) |
| PEPFAR Support definition |
| DREAMS Local Areas Specific Guidance |
- 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, this indicates that this indicator disaggregate is required for all countries that have programming for this area. Which includes means that the country supports a program area, defined by budget and targets set during the COP process -- then it is required that there also be results. Required program indicators may consist of both DSD and TA results.
-
Conditional indicator disaggregates include those for which some additional condition must be filled. In MER 2.0 there are no full indicators that are conditional, but only additional disaggregations that are conditional on additional funding and / or programming. In MER 2.0 there are two main
types of conditional indicator disaggregation’s; 1) having received additional funds for special programming, i.e., DREAMS funds or 2 having received permission for you SI advisor to complete coarse age disaggregations instead of the finer. This is conditional on approval from S/GAC.
- Optional indicator disaggregates, should be completed by those for which the indicators is useful to determine the success of their program (e.g., KP National and Subnational data) or for which the partner has strong methodological sources (KP catchment area -denominator) or for which it is both relevant and safe to enter the data at the site and/or community level (KP disaggregations for TX_NEW, HTS_TST, please see additional guidance on Key populations changes).
- Key Population: In order to better understand the HIV epidemic among key populations and program response, there have been several substantial changes to the data collection for key populations. These changes have positively affected both the KP and PP prevention program indicators as well as the clinical cascade indicators.
For the prevention program, to align PEPFAR indicators better with WHO and UNAIDS, the key populations have been separated MSM and transgender and added Prisoners and other people living in enclosed places.
Where appropriate these key population have also been added as disaggregations to indicators in the clinical cascade including, HTS_TST and TX_NEW. These were not added to TX_CURR or TX_RET or TX_PVLS, specifically as identifying as KP may not be life-long and may change over time and therefore not possible to collect retrospectively. Additional KPs were added as a disaggregation for the PrEP_NEW indicator. To better determine the KPs of interest for each indicator, please review Appendix 1, the key population classification document.
-
TB/HIV: The TB indicators have been enhanced this year to better correspond to global changes in TB policy and to better reflect the increasing emphasis on outcome. We have maintained TB_STAT and have added a disaggregate to TX_NEW and TB_ART to identify the number of new patients who have TB at the time of enrollment. These will allow us to characterize the HIV testing of TB patients, and the linkage to HIV treatment. Elements of TB_SCREEN have been transformed into a new indicator, TX_TB, which will allow us to document the number of patients who are screened for TB, and the proportion of those who are eventually started on TB therapy. Corresponding to the sharper focus of the End TB Strategy, and the emphasis on TB prevention, we have transformed TB_IPT into a new indicator, TB_PREV, which will now be required. By identifying the proportion that completes or is maintained on continuous preventive therapy, we will be able to monitor relevant outcomes, rather than just the number that initiate TB preventive therapy. These indicators will allow us to document the care cascade from TB screening to the desired outcomes: TB therapy or TB preventive therapy.
-
Host Country National Program: Monitoring host country HIV program response is critical to understand the achievements and gaps in HIV programs in National and subnational context and by population. These data are used to inform PEPFAR programs and guide PEPFAR resources 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.
-
Host Country National Results: At Q4 of the USG fiscal year, results from the host national systems should be reported up until the month recent month of collection. 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 data, although may differ due to different reporting periods. Results should be consistently reported on the same time period to be able to monitor trends over time.
-
Host Country National Targets: Developing targets for the next year (FY2017) at the national and subnational data is an important step in understanding the national program and determining geographic investments (including host country, Global Fund and other donors). When PEPFAR better understands the target 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).
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Host Country Subnational Targets and Results: Data are needed from both the National and subnational level. The subnational level is considered that in which the country team has prioritized their program (PSNU). This data should be entered for all subnational unit, regardless of PEPFAR funding supporting these geographical area; so that the total of the subnational results or targets should equal the total number of National results and targets.
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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 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.
-
Expenditure Analysis (EA) & MER 2.0 Alignment: PEPFAR Expenditure Analysis (EA) is conducted annually in order to better understand the costs the USG incurs to provide a broad range of HIV services and support and subsequently use this information to improve program planning. Additional information about EA methodology, process, and timeline can be found in the EA annual Guidance. PEPFAR results reported through the MER are linked to EA program areas to calculate a “unit expenditure” (UE). The UE represents the amount (in USD) PEPFAR spent per beneficiary reached within a program area tied to the relevant indicator. Unit expenditures are only calculated when appropriate indicators are available and align with EA expenditure reporting, and therefore EA uses only a selection of MER indicators.
The general framework of EA-MER underscores 1) The benefit of logic checks that ensure consistency and completeness in MER reporting within and across partners in an OU, and 2) that reporting to EA and MER are aligned – i.e. expenditures are reported in the same locations (at EA SNU level, typically district or province) and program areas in which results are reported (please note: expenditures can also be reported in SNUs and/or program areas in which results are not reported).
- DREAMS Specific Guidance: In addition to required MER reporting, it is essential that all 10 DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) countries – Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe – ensure that all implementing Partners in DREAMS SNUs report their results for and use data from all 13 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 narratives.
| Program Area Group | Indicator Code | Indicator Name | Reporting Frequency |
|---|---|---|---|
| Prevention | PREP_NEW | Number of individuals who have been newly enrolled on (oral) antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period. | Quarterly |
| Prevention | VMMC_CIRC | Number of males circumcised as part of the voluntary medical male circumcision (VMMC) for HIV prevention program within the reporting period | Quarterly |
| 90: 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 |
| 90: 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 |
| 90: 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, disaggregated by HIV result | Quarterly |
| 90: Knowing Your HIV Status | TB_STAT | Percentage of new and relapse TB cases with documented HIV status, disaggregated by HIV result | Quarterly |
| 90-90: On ART | TX_NEW | Number of adults and children newly enrolled on antiretroviral therapy (ART) | Quarterly |
| 90-90: On ART | TX_CURR | Number of adults and children currently receiving antiretroviral therapy (ART) | Quarterly |
| 90-90: 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 |
| 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 |
| Prevention | PP_PREV | 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 | Semi- Annual |
| Prevention | TB_PREV | Proportion of ART patients who completed a standard course of TB preventive therapy within the reporting period | Semi- Annual |
| Prevention | OVC_SERV | Number of beneficiaries served by PEPFAR OVC programs for children and families affected by HIV | Semi- Annual |
| 90: 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 |
| 90-90: On ART | TB_ART | Percentage of HIV-positive new and relapsed TB cases on ART during TB treatment | Semi- Annual |
| 90-90: On ART | TX_TB | The proportion of ART patients who were screened who are receiving TB treatment | Semi- Annual |
| Health Systems | SC_STOCK | Percentage of storage sites where commodities are stocked according to plan, by level in supply system | Semi- Annual |
| Prevention | KP_MAT | Number of people who inject drugs (PWID) on medication-assisted therapy (MAT) | 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 |
| 90: Knowing Your HIV Status | 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 |
| 90: Knowing Your HIV Status | PMTCT_FO | Percentage of final outcomes among HIV exposed infants registered in a birth cohort | Annual |
| 90-90-90: 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 |
| 90-90-90: Viral Suppression | TX_PLVS | 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 |
| 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_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- site level | 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 |
| 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 |
| 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 |
| Health Systems | INVS_COMD | Number of HIV program related commodities purchased and dollars spent in the last 12 months | Annual |
-
P1.1D: Number of pregnant women with known HIV status (includes women who were tested for HIV and received their results)
-
Known positives at entry; Number of new positives identified
-
P1.2.D: Number of known positive pregnant women (denominator of #P1.1.D)
-
P4.1.D: Number of injecting drug users (IDUs) on opioid New substitution therapy
-
P5.1.D: Number of males circumcised as part of the minimum package of MC for HIV prevention services *by age: <1, 1-14, 15+
-
P5.2.D: Number of clients circumcised who experienced one or more moderate or severe adverse event(s) within the reporting period
-
by severity (moderate and/or severe)
-
P6.1.D: Number of persons provided with post-exposure prophylaxis (PEP)
-
By exposure type: Occupational, Rape/Sexual Assault Victims, or Other Non-Occupational
-
P7.1.D: Number of People Living with HIV/AIDS (PLHIV) reached with a minimum package of Prevention with PLHIV (PwP) interventions
-
By setting where reached: in a clinic/facility‐ based and in a community/home‐based
-
P8.3.D: Number of MARP reached with individual and/or small group level interventions that are based on evidence and/or meet the minimum standards
-
By sex: Male and Female
-
By MARP type: CSW, IDU, MSM, Other Vulnerable Populations
-
P11.1.D: Number of individuals who received Testing and Counseling (T&C) services for HIV and received their test results
-
By age: <15 and 15+
-
P11.1.D: Number of individuals who received Testing and Counseling (T&C) services for HIV and received their test results
-
By test result: Positive, Negative
-
P11.1.D: Number of individuals who received Testing and Counseling (T&C) services for HIV and received their test results
-
By type of counseling/test: Individual, Couple
-
P11.1.D: Number of individuals who received Testing and Counseling (T&C) services for HIV and received their test results
-
In concentrated epidemics, by MARP type (CSW, IDU, MSM)
-
P11.3.N: Percentage of health facilities that provide HIV testing and counselling services
-
Healthcare facilities, stand alone sites, Mobile Units
-
C2.1.D: Number of HIV‐positive adults and children receiving a minimum of one clinical service
-
By Age: <15, 15+
-
By sex
-
C2.2.D: Number of HIV‐positive adults and children receiving a minimum of one clinical service
-
Number of HIV‐positive persons receiving cotrimoxazole prophylaxis
- By Age: <15, 15+
-
C2.4.D: TB/HIV: Percent of HIV‐positive patients who were screened for TB in HIV care or treatment settings
-
C4.1.D: Percent of infants born to HIV‐positive women who received an HIV test within 12 months of birth
-
Infants who received virological testing in the first 2 months
-
Infants that were tested either virologically between 2 and 12 months, or by serology between 9 and 12 months
-
T1.5.D: Number of health facilities that offer ART
-
by type of sit: Public, Private, NGO
-
T1.3.D: Percent of adults and children with HIV known to be on treatment 12 months after initiation of antiretroviral therapy
-
H1.1.D: Number of testing facilities (laboratories) with capacity to perform clinical laboratory tests
-
H1.2.D: Percent of testing facilities (laboratories) that are accredited according to national or international standards
-
H2.1.D: Number of new health care workers who graduated from a pre‐service training institution
-
By Specific Types: Doctors, Nurses
-
By Specific Types: Other cadres
-
By SPecific Types: Clinical/non-clinical
-
H2.2.D: Number of community health and para‐social workers who successfully completed a pre‐service training program
-
H6.1.D: Monitoring policy reform and development of PEPFAR supported activities (Required for Partnership Framework Countries)
-
Human Resources for Health (HRH)
-
Gender
-
Orphans and other Vulnerable Children
-
Counseling and Testing
-
Access to high-quality, low-cost medications
-
Stigma and Discrimination
-
Strengthening a multi-sectoral response and linkages with other health and development programs
-
Pain Management for PLWHA
-
Post Exposure Prophylaxis
-
Laboratory Accreditation
-
Injection safety and waste management
-
Other policy areas identified by country team
-
H6.3.N: National Composite Policy Index (NCPI)
-
H6.4.N: Existence of national costed HIV implementation plan
-
H6.5.N: Existence of effective civil society organizations
- H2.3.D: All in‐ service training will be captured within this indicator. Only a few priority program areas will be subset for more specific information on people trained. This change will have impact on ability to track the trends of disaggregates (at HQ), trends for total people trained will need to be interpreted with caution.
Number of health care workers who successfully completed an in‐service training program
- H2.3.D: All in‐ service training will be captured within this indicator. Only a few priority program areas will be subset for more specific information on people trained. This change will have impact on ability to track the trends of disaggregates (at HQ), trends for total people trained will need to be interpreted with caution.
Number of health care workers who successfully completed an in‐service training program
- By Specific Types: Male Circumcision, Pediatric Treatment
-
C2.3.D: * Number of HIV‐positive clinically malnourished clients who received therapeutic or supplementary food
-
T1.1.N: Percent of adults and children with advanced HIV infection receiving antiretroviral therapy
-
C3.1.D: Number of TB patients who had an HIV test result recorded in the TB register
The actual testing of TB patients can still be counted under CT indicator
-
C1.1.D: Number of eligible adults and children provided with a minimum of one care service
-
By Age: <18, 18+
-
By sex: Male and Female
-
C1.1.N: Number of eligible adults and children provided with a minimum of one care service (By Age: <18, 18
+)
-
P11.3.N: Percentage of health facilities that provide HIV testing and counselling services
-
C2.3.D: Number of HIV‐positive adults and children receiving a minimum of one clinical service
-
Number of HIV‐positive clinically malnourished clients who received therapeutic or supplementary food
-
P1.1D: Number of pregnant women with known HIV status (includes women who were tested for HIV and received their results)
-
P1.1.N: Percent of pregnant women who were tested for HIV and know their results.
-
Known positives at entry; Number of new positives identified
-
P8.1.D: Number of the targeted population reached with individual and/or small group level preventive interventions that are based on evidence and/or meet the minimum standards required
-
By sex: Male and Female
-
By age: (10-14, 15+)
-
P8.2.D: Number of the targeted population reached with individual and/or small group preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required
- P1.2.D: Number of HIV‐positive pregnant women who received antiretrovirals to reduce risk of mother‐to‐ child‐transmission
Should not impact trend analysis
- C2.5.D: TB/HIV:Percent of HIV‐positive patients in HIV care or treatment (pre‐ART or ART) who started TB treatment
Should not impact trend analysis for numerator
- P1.2.N: Percentage of HIV‐positive pregnant women who received antiretrovirals to reduce the risk of mother‐to‐child transmission
- By Prophylactic Regimens: (Single Dose Nevirapine Only, Prophylactic Regimens using a combination of 2 ARVs; Prophylactic Regimens of 3 ARVs; ART)
- C5.1.D: Disaggregation can be mapped back to original indicators
Number of eligible clients who received food and/or other nutrition services
- By Age: <18
- Pregnant/lactating women
-
P11.1.D: Number of individuals who received Testing and Counseling (T&C) services for HIV and received their test results
-
By sex: Male and Female
-
T1.1.D: Addition of <1.
Number of adults and children with advanced HIV infection newly enrolled on ART
-
By sex: Male and Female
-
By age: <1, <15, 15+
-
Pregnant women
-
T1.2.D: Change to disaggregation: Pregnant female all ages dropped.
Number of adults and children with advanced HIV infection receiving antiretroviral therapy (ART) [CURRENT]
-
By sex: Male and Female
-
By age: <1, <15, 15+
-
T1.4.D: Pregnant female all ages dropped.
Number of adults and children with advanced HIV‐ infection who ever started on ART
-
By sex: Male and Female
-
By age: <15 and 15+
-
T1.5.D: Number of health facilities that offer ART
-
P1.3.D: Number of health facilities providing ANC services that provide both HIV testing and ARVs for PMTCT on site
-
2.1a: Number of individuals reached through community outreach that promotes HIV/AIDS prevention through abstinence
-
3.1: Number of service outlets carrying out blood safety activities
-
6.1: Total number of service outlets providing HIV‐ related palliative care (including TB/HIV)
-
6.4: Total number of services outlets providing HIV‐ related palliative care (excluding TB/HIV) [for COP
Table 3 only]
-
6.5: Total number of individuals provided with HIV‐ related palliative care (excluding TB/HIV) [for COP Table 3 only]
-
7.1: Number of service outlets providing treatment for tuberculosis (TB) to HIV‐infected individuals (diagnosed or presumed) in palliative care setting
-
9.4: Number of individuals who received counseling and testing for HIV and received their test results (excluding TB) [for COP Table 3 only]
-
12.1: Number of laboratories with capacity to perform
- HIV tests and 2) CD4 tests and/or lymphocyte
tests
-
12.2: Number of individuals trained in the provision of laboratory‐related activities
-
12.3: Number of tests performed at USG‐supported laboratories during the reporting period: 1) HIV testing, 2) TB diagnostics, 3) syphilis testing, and
- HIV disease monitoring
- 13.1: Number of local organizations provided with technical assistance for strategic information
activities
-
14.1: Number of local organizations provided with technical assistance for HIV‐related policy development
-
14.2: Number of local organizations provided with technical assistance for HIV‐related institutional capacity building
-
Three Food & Nutrition indicators have been added to program-level indicators – in PMTCT, OVC, and Treatment. Two Food & Nutrition indicators with no particular program area have been added under “wrap-around” category.
-
There are additional appendices – Palliative Care Categories, Additional Guidance on the new TB/HIV indicator, Examples of Eligible and Ineligible Activities for Core Program Areas for OVCs, Example for Calculating Wrap-around Food and Nutrition Support, Additional Guidance on the new program-level food and nutrition indicators (PMTCT, ART, OVC), Additional Guidance on the PMTCT Indicator #1.3, and Sample Tools for Tracking Program Geographic Coverage and Tracking Indicators/Partners.
-
The document is labeled FY2007 Reporting/FY2008 Planning – and references to these dates have been changed where appropriate. This document replaces all previous versions of the guide.
-
OVC and Palliative Care indicators have additional clarification on what services are in which domains (additional appendices further explain the eligible services).
-
The TB C&T indicator has been moved to the TB program area.
-
For the PMTCT indicator #1.3, this indicator has been harmonized with UNAIDS to reflect HIV-infected pregnant women who received any antiretroviral prophylaxis for PMTCT in a PMTCT setting.
-
For UNGASS indicators for which there is a corresponding PEPFAR outcome/impact indicator, these indicators have been updated to reflect the UNGASS 2007 guide.
- Cambodia, Malawi, and India were removed from the list of Mini-COP countries – and are now under the category “Full COP (Non- Focus) Countries”.