Annex 3: Details of CST5 indicator

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CST5a: A system for testing and providing results for HIV/AIDS

Definition

Percentage of health facilities having a system for testing and providing results for HIV/AIDS

Purpose

To assess progress on availability of systems for HIV testing and providing results

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. All necessary supplies to conduct any one test for diagnosis of HIV on the day of the survey. Acceptable tests for Ethiopia to be defined, but the most common at this time include specific kits for Rapid Test, Western Blot, HIV SPOT, and ELISA test with plate washer and a functioning reader

2. An observed written policy or guideline on informed consent outlining the content of an informed consent message and clarifying that it is the policy to inform to the client prior to conducting HIV/AIDS test.

3. An observed written policy or guideline on confidentiality of client test results pertaining to disclosure of results and records

4. An up-to-date register or other records that provide information on HIV/AIDS tests conducted, results, and that have some means for client identification (record/register within the prior 30 days)

5. Documentation that indicates whether test results have been provided to the client or referring provider.

OR

Evidence that the facility uses written referral for laboratory test external to the facility and have an observed register or record where it is indicated whether the client returned or not with results and that meets the informed consent conditions and confidentiality outlined in (2) and (3) above.

Numerator:

a. Number of health facilities that have individual items for HIV testing and providing results

b. Number of health facilities that have all items for HIV testing and providing results

Denominator:

c. Total number of health facilities

d. Total number of health facilities that report they provide HIV testing or refer clients for an HIV test through a formal agreement.

The indicator is calculated as: a
c, a
d, b
c, b
d

Remark

WHO indicator

CST5b: Systems and qualified staff for pre and post-test counseling

Definition

Percentage of health facilities having systems and qualified staff for pre and post-test counseling

Purpose

To assess progress on availability of systems and qualified staff for pre and post-test counseling

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. A written policy or protocol or routine pre- and post-test counseling or with guidelines or protocols related to the pre-and post-test counseling content

2. At least one trained counselor (specific training for counseling, not general HIV/AIDS diagnostic or prevention education. Training that qualifies a counselor is country specific)

3. An up-to-date register or other records that document pre- and post-test counseling and test results (record/register within the prior 30 days). If the client did not return, there should be some documentation that a pre-test client did not receive post-test counseling. The register/record should have a client identifier entry.

4. Counseling conducted in an area where visual and auditory privacy are provided. Visual and auditory privacy can be provided in a private room or in a screened area of a larger room, if it is evident that people are not routinely standing or seated immediately adjacent to the screened areas.

Numerators:

a. Number of health facilities that have individual items for pre- and post-test counseling capacity

b. Number of health facilities that have all items for pre- and post-test counseling capacity

Denominators:

c. Total number of health facilities

d. Total number of health facilities that report they provide HIV testing or refer clients for an HIV test through a formal agreement and that are responsible for follow-up on the results of the HIV test.

The indicator is calculated as: a
c, a
d, b
c, b
d

Remark

WHO indicator

CST5c: Medical services, resources and supplies relevant to HIV/AIDS

Definition

Percentage of health facilities that offer services for malaria, sexually transmitted infections, and tuberculosis and that have the capacity to support provision of these services

Purpose

To assess progress on availability of medical services relevant to HIV/AIDS and resources and supplies for providing the services

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. At least one of the interviewed service providers of malaria, STI, or TB services have received any training (pre-service or in-service) related to the particular service that they provide (malaria, STI and/or TB) within the last 3 years

2. At least half of the interviewed providers of any of these services were personally supervised at least once during the last 3 months

3. Conditions for malaria treatment:

i. Observed written protocol for treating malaria

ii. Anti-malaria medicine available on the day of the survey

4. Conditions for STI treatment:

i. Observed written protocol for STI treatment in the main service area where STI management take place

ii. At least one medicine for treating each STI (chlamydia, gonorrhea, syphilis, trichomoniasis) on the day of the survey

iii. Condoms available in service area or pharmacy

5. Conditions for TB treatment:

i. Observed written protocol for treating TB

iia. Facility uses DOTS, has an observed register for DOTS patients, and has relevant medicines available

Or

iib. Facility provides TB treatment, not DOTS, and all relevant first-line medicines are available

6. TB testing procedures:

i. Facility conducts TB tests and has all items for the test (microscope and reagents for the stain used by the facility) on the day of the survey

iia. Observed register or record where TB tests conducted and results of tests are recorded

Or

iib. Facility has a formal referral system with laboratory for TB testing and an observed system for tracking whether the client or provider receives the results (may be the same system as described for HIV/AIDS testing)

Numerators:

Number of health facilities that have individual items for curative service capacity for malaria, STIs, TB care or TB diagnosis

Number of health facilities that have all items for curative service capacity for malaria, STIs, TB care or TB diagnosis

Number of health facilities that have all items for curative service capacity for malaria, STIs, TB care and TB diagnosis

Denominators:

Total number of health facilities

Total number of health facilities providing curative services for malaria

Total number of health facilities providing curative services for STIs

Total number of health facilities providing curative services for TB

Total number of health facilities providing or referring clients for TB testing

Note:

If the laboratory of the site does not perform TB or malaria testing, but refers to an external laboratory through some formal agreement, the external laboratory can be considered the “facility laboratory” and data should be collected at that laboratory. If the facility simply refers clients but has no formal agreement with the laboratory, the facility is classified as not having the testing capacity.

Remark

WHO indicator

CST5d: Elements for prevention of nosocomial infections

Definition

Percentage of health facilities with conditions for effective infection prevention capacity in each relevant service area

Purpose

To assess progress on availability of conditions and capacity for effective prevention of nosocomial infections

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. Conditions for infection control:

i. Running water (at all service areas)

ii. Hand-washing soap (at all service areas)

iii. Latex gloves (at all service areas)

iv. Sharps box (at service areas where injections or relevant procedures are conducted)

v. Chlorine based decontamination solutions (at service areas where relevant procedures are conducted)

2. Functioning equipment with power source on day of survey, or with relevant chemicals available for the process reported by the facility for sterilizing or high-level-disinfecting equipment

3. Stock supply of:

i. Disinfectant

ii. Clean latex gloves

iii. Disposable needles and syringes

Numerators:

Number of health facilities that have individual items for infection prevention capacity

Number of health facilities that have all items for infection prevention capacity

Denominators:

Total number of health facilities

Total number of health facilities that provide HIV diagnosis and/or curative care services

Remark

WHO indicator

CST5e: Trained staff and resources to provide basic services

Definition

Percentage of health facilities with staff and resources to support basic services for OIs (other than malaria, STIs and active TB) and palliative treatment for HIV/AIDS clients

Purpose

To assess progress on availability of capacity to support basic services for OIs (other than malaria, STIs and active TB) and palliative treatment for HIV/AIDS clients

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. At least one provider who has had any training in treatment of OIs for HIV/AIDS during the last 3 years (either pre-service or in-service)

2. Observed guidelines or protocols for treating common OIs for HIV/AIDS where they are treated

3. Basic medicines for treating common OIs (other than malaria, STIs and active TB). The specific medicines should be adapted to those used in the country for the indicated illnesses:

i. Fungal skill infection (e.g., gentian violet or nystatin or miconazole or ketoconazole)

ii. Pneumonia (e.g., amoxacillin or ampicillin or chloramphnicol)

iii. Other infections (doxycillin or tetracycline or nalidixic acid or norflaxacin)

iv. Micronutritional deficiencies (e.g., iron and multivitamin and vitamin B)

v. Chronic diarrhea (e.g., Loperamide or diphenoxylate or codeine phosphate)

vi. Pain medicines (paracetamol or aspirin or ibuprofen)

vii. Dyhydration (intravenous solutions – D5NS, NS, or RL – and inusion sets and oral rehydration salts)

viii. Deworming medicines (e.g., mebendazole or albendazole)

4. An observed protocol for preventive therapy for TB, and have isoniazid (INH) available

5. An observed protocol for preventive therapy for pneumonia and have cotrimoxazole available

6. Individual client records for HIV-infected clients

7. Up-to-date register where client services and symptoms for diagnosis are reported

8. Observed confidentiality protocol or guideline in all areas where HIV/AIDS clients receive curative services

Numerators:

Number of health facilities that have individual items for basic HIV care

Number of health facilities that have all items for basic HIV care

Denominators:

Total number of health facilities

Total number of health facilities that provide curative care services for HIV infected clients

Remark

WHO indicator


CST5a: A system for testing and providing results for HIV/AIDS
Definition	Percentage of health facilities having a system for testing and providing results for HIV/AIDS
Purpose	To assess progress on availability of systems for HIV testing and providing results
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement Method of measurement	Health facilities are randomly selected and assessed whether they have the following: 1. All necessary supplies to conduct any one test for diagnosis of HIV on the day of the survey. Acceptable tests for Ethiopia to be defined, but the most common at this time include specific kits for Rapid Test, Western Blot, HIV SPOT, and ELISA test with plate washer and a functioning reader 2. An observed written policy or guideline on informed consent outlining the content of an informed consent message and clarifying that it is the policy to inform to the client prior to conducting HIV/AIDS test. 3. An observed written policy or guideline on confidentiality of client test results pertaining to disclosure of results and records 4. An up-to-date register or other records that provide information on HIV/AIDS tests conducted, results, and that have some means for client identification (record/register within the prior 30 days) 5. Documentation that indicates whether test results have been provided to the client or referring provider. OR Evidence that the facility uses written referral for laboratory test external to the facility and have an observed register or record where it is indicated whether the client returned or not with results and that meets the informed consent conditions and confidentiality outlined in (2) and (3) above. Numerator: a. Number of health facilities that have individual items for HIV testing and providing results b. Number of health facilities that have all items for HIV testing and providing results Denominator: c. Total number of health facilities d. Total number of health facilities that report they provide HIV testing or refer clients for an HIV test through a formal agreement. The indicator is calculated as: a c, a d, b c, b d
Remark	WHO indicator


CST5b: Systems and qualified staff for pre and post-test counseling
Definition	Percentage of health facilities having systems and qualified staff for pre and post-test counseling
Purpose	To assess progress on availability of systems and qualified staff for pre and post-test counseling
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement	Health facilities are randomly selected and assessed whether they have the following: 1. A written policy or protocol or routine pre- and post-test counseling or with guidelines or protocols related to the pre-and post-test counseling content 2. At least one trained counselor (specific training for counseling, not general HIV/AIDS diagnostic or prevention education. Training that qualifies a counselor is country specific) 3. An up-to-date register or other records that document pre- and post-test counseling and test results (record/register within the prior 30 days). If the client did not return, there should be some documentation that a pre-test client did not receive post-test counseling. The register/record should have a client identifier entry. 4. Counseling conducted in an area where visual and auditory privacy are provided. Visual and auditory privacy can be provided in a private room or in a screened area of a larger room, if it is evident that people are not routinely standing or seated immediately adjacent to the screened areas. Numerators: a. Number of health facilities that have individual items for pre- and post-test counseling capacity b. Number of health facilities that have all items for pre- and post-test counseling capacity Denominators: c. Total number of health facilities d. Total number of health facilities that report they provide HIV testing or refer clients for an HIV test through a formal agreement and that are responsible for follow-up on the results of the HIV test. The indicator is calculated as: a c, a d, b c, b d
Remark	WHO indicator


CST5c: Medical services, resources and supplies relevant to HIV/AIDS
Definition	Percentage of health facilities that offer services for malaria, sexually transmitted infections, and tuberculosis and that have the capacity to support provision of these services
Purpose	To assess progress on availability of medical services relevant to HIV/AIDS and resources and supplies for providing the services
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement Method of measurement	Health facilities are randomly selected and assessed whether they have the following: 1. At least one of the interviewed service providers of malaria, STI, or TB services have received any training (pre-service or in-service) related to the particular service that they provide (malaria, STI and/or TB) within the last 3 years 2. At least half of the interviewed providers of any of these services were personally supervised at least once during the last 3 months 3. Conditions for malaria treatment: i. Observed written protocol for treating malaria ii. Anti-malaria medicine available on the day of the survey 4. Conditions for STI treatment: i. Observed written protocol for STI treatment in the main service area where STI management take place ii. At least one medicine for treating each STI (chlamydia, gonorrhea, syphilis, trichomoniasis) on the day of the survey iii. Condoms available in service area or pharmacy 5. Conditions for TB treatment: i. Observed written protocol for treating TB iia. Facility uses DOTS, has an observed register for DOTS patients, and has relevant medicines available Or iib. Facility provides TB treatment, not DOTS, and all relevant first-line medicines are available 6. TB testing procedures: i. Facility conducts TB tests and has all items for the test (microscope and reagents for the stain used by the facility) on the day of the survey iia. Observed register or record where TB tests conducted and results of tests are recorded Or iib. Facility has a formal referral system with laboratory for TB testing and an observed system for tracking whether the client or provider receives the results (may be the same system as described for HIV/AIDS testing) Numerators: Number of health facilities that have individual items for curative service capacity for malaria, STIs, TB care or TB diagnosis Number of health facilities that have all items for curative service capacity for malaria, STIs, TB care or TB diagnosis Number of health facilities that have all items for curative service capacity for malaria, STIs, TB care and TB diagnosis Denominators: Total number of health facilities Total number of health facilities providing curative services for malaria Total number of health facilities providing curative services for STIs Total number of health facilities providing curative services for TB Total number of health facilities providing or referring clients for TB testing Note: If the laboratory of the site does not perform TB or malaria testing, but refers to an external laboratory through some formal agreement, the external laboratory can be considered the “facility laboratory” and data should be collected at that laboratory. If the facility simply refers clients but has no formal agreement with the laboratory, the facility is classified as not having the testing capacity.
Remark	WHO indicator


CST5d: Elements for prevention of nosocomial infections
Definition	Percentage of health facilities with conditions for effective infection prevention capacity in each relevant service area
Purpose	To assess progress on availability of conditions and capacity for effective prevention of nosocomial infections
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement	Health facilities are randomly selected and assessed whether they have the following: 1. Conditions for infection control: i. Running water (at all service areas) ii. Hand-washing soap (at all service areas) iii. Latex gloves (at all service areas) iv. Sharps box (at service areas where injections or relevant procedures are conducted) v. Chlorine based decontamination solutions (at service areas where relevant procedures are conducted) 2. Functioning equipment with power source on day of survey, or with relevant chemicals available for the process reported by the facility for sterilizing or high-level-disinfecting equipment 3. Stock supply of: i. Disinfectant ii. Clean latex gloves iii. Disposable needles and syringes Numerators: Number of health facilities that have individual items for infection prevention capacity Number of health facilities that have all items for infection prevention capacity Denominators: Total number of health facilities Total number of health facilities that provide HIV diagnosis and/or curative care services
Remark	WHO indicator


CST5e: Trained staff and resources to provide basic services
Definition	Percentage of health facilities with staff and resources to support basic services for OIs (other than malaria, STIs and active TB) and palliative treatment for HIV/AIDS clients
Purpose	To assess progress on availability of capacity to support basic services for OIs (other than malaria, STIs and active TB) and palliative treatment for HIV/AIDS clients
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement Method of measurement	Health facilities are randomly selected and assessed whether they have the following: 1. At least one provider who has had any training in treatment of OIs for HIV/AIDS during the last 3 years (either pre-service or in-service) 2. Observed guidelines or protocols for treating common OIs for HIV/AIDS where they are treated 3. Basic medicines for treating common OIs (other than malaria, STIs and active TB). The specific medicines should be adapted to those used in the country for the indicated illnesses: i. Fungal skill infection (e.g., gentian violet or nystatin or miconazole or ketoconazole) ii. Pneumonia (e.g., amoxacillin or ampicillin or chloramphnicol) iii. Other infections (doxycillin or tetracycline or nalidixic acid or norflaxacin) iv. Micronutritional deficiencies (e.g., iron and multivitamin and vitamin B) v. Chronic diarrhea (e.g., Loperamide or diphenoxylate or codeine phosphate) vi. Pain medicines (paracetamol or aspirin or ibuprofen) vii. Dyhydration (intravenous solutions – D5NS, NS, or RL – and inusion sets and oral rehydration salts) viii. Deworming medicines (e.g., mebendazole or albendazole) 4. An observed protocol for preventive therapy for TB, and have isoniazid (INH) available 5. An observed protocol for preventive therapy for pneumonia and have cotrimoxazole available 6. Individual client records for HIV-infected clients 7. Up-to-date register where client services and symptoms for diagnosis are reported 8. Observed confidentiality protocol or guideline in all areas where HIV/AIDS clients receive curative services Numerators: Number of health facilities that have individual items for basic HIV care Number of health facilities that have all items for basic HIV care Denominators: Total number of health facilities Total number of health facilities that provide curative care services for HIV infected clients
Remark	WHO indicator