UNAIDS’ 90-90-90 targets focus on three global goals to be achieved by the year 2020: 90 percent of all people living with HIV will know their status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression. To successfully reach this goal, key populations (KPs) most at risk for HIV – including men who have sex with men, people who inject drugs, sex workers, and transgender people – need to be at the center of prevention, care, and treatment programs.

Tracking KPs’ successful access to these services is an essential part of the process of reaching 90-90-90. This is achieved by using a systematic approach to data collection and analysis through a strategic information (SI) system. SI is designed to support and shape long-term strategies for program planning and implementation, responding to stakeholder’s needs, and supporting innovations. More specifically, SI in KP programs generates data so that the decisions made in planning clinical, behavioral, and structural interventions are rooted in evidence.

SI in KP programming

HIV programs that focus on KPs require a specialized SI system to monitor the changes that occur within each population during a program’s implementation. KPs face special challenges in accessing HIV prevention, care, and treatment including their legal status, stigma and discrimination, and the influence of power structures. The information generated by an SI system can be used to identify and manage structural barriers to service uptake and understand the dynamic nature of KP individual’s behavior.

With an SI system, data are collected to ensure that KP programs are monitored from all fronts. Ideally, the system collects information beyond the standard PEPFAR indicators to ensure that data are helping shape program strategies. In the LINKAGES project, an SI system is used to collect data relating to structural interventions, including activities related to violence, stigma and discrimination, advocacy, sensitization, and peer navigation for HIV-positive KPs to ensure improved adherence to care and treatment. It also tracks activities that affect KPs in their day-to-day life and influence their behaviors. This SI system can be further customized based on country or regional needs. The SI system helps program teams with routine monitoring of the quality of their services along the HIV cascade and their progress toward reaching 90-90-90 targets.

The SI system for any KP program includes carefully tailored monitoring tools used to collect data at the grassroots level and subnational level and track the trends and gaps within a program. Data are then aggregated and used for analysis at the national level. The SI system also includes simple analytical tools that show site-level statistics on the various services provided to KPs, including behavioral, clinical, and structural interventions. SI provides the evidence needed to establish and maintain a program-wide approach to data collection, data analysis, data use, and action-oriented program planning processes.

Resources on SI

Many efforts are underway to ensure that SI systems being developed are KP-friendly and help KP-specific programs make effective use of data for strategic planning. Listed below are resources that can be used for systematic monitoring of KP programs through an SI system:

• Monitoring guide and toolkit for key populations HIV prevention, diagnosis, treatment, and care programs
• Operational guidelines for monitoring and evaluation of HIV programs for sex workers, men who have sex with men, and transgender people: Vol. I, national and sub-national levels (2013, UNAIDS/PEPFAR/Global Fund)
• Operational guidelines for monitoring and evaluation of HIV programs for sex workers, men who have sex with men, and transgender people: Vol. II, service delivery providers (2013, UNAIDS/PEPFAR/Global Fund)
• Use it or lose it: How Avahan used its data to shape its HIV prevention program in India (2008, Bill & Melinda Gates Foundation)
• ACQUA: Aastha Continuous Quality Assessment (FHI 360/Aastha, India)