Date Published: January 25, 2017
Publisher: Springer US
Author(s): T. Alfvén, T. Erkkola, PD Ghys, J. Padayachy, M. Warner-Smith, D. Rugg, P. de Lay.
Since 2001 the UNAIDS Secretariat has retained the responsibility for monitoring progress towards global commitments on HIV/AIDS. Key critical characteristics of the reporting system were assessed for the reporting period from 2004 to 2014 and analyses were undertaken of response rates and core indicator performance. Country submission rates ranged from 102 (53%) Member States in 2004 to 186 (96%) in 2012. There was great variance in response rates for specific indicators, with the highest response rates for treatment-related indicators. The Global AIDS reporting system has improved substantially over time and has provided key trend data on responses to the HIV epidemic, serving as the global accountability mechanism and providing reference data on the global AIDS response. It will be critical that reporting systems continue to evolve to support the monitoring of the Sustainable Development Goals, in view of ending the AIDS epidemic as a public health threat by 2030.
Setting targets in international development became commonplace in the 1960s, the first “UN Development Decade”. Targets were set to address a range of development issues, ranging from education to food security and health. However, mechanisms for developing and implementing appropriate plans of action and for monitoring progress towards the targets were not established and results often fell far short of target levels. A significant change came with the UN World Summit for Children in 1990 when Jim Grant, then UNICEF (The United Nations Children’s Fund) Executive Director, along with colleagues and social activists set in motion the implementation and monitoring processes to instigate momentum behind the Summit’s Declaration: countries established national programs and conducted surveys using recognized, standardized indicators in an unprecedented way. The importance of ongoing follow-up and monitoring of UN commitments was shown to make critical differences in establishing national ownership, global financial support and overall accountability.
Updated guidelines on the construction of the indicators have been made available in advance of each reporting round. These guidelines describe in detail the full indicator specifications and data collection methods to ensure consistent data across countries. They also provide guidance on the analysis of the indicator data for country use.
Key characteristics of the Global AIDS reporting system over time are summarized below. The important issue of data sharing and transparency is summarized in text box no 1.
The reporting rate increased from 53% (52 Member States) in the 2004 round to a maximum of 96% (186 Member States) in the 2012 round and 92% (180 Member States) in the 2015 round (Fig. 2).Fig. 2Global AIDS Reporting rates, 2004–2015. In the x-axis labels, for each reporting year, the number of countries/total number of United Nations member states is given in parenthesis
The percent of countries reporting on the indicators that address knowledge about HIV prevention (GARPR indicator 1.1), sex workers: condom use (GARPR indicator 1.8), men who have sex with men: condom use (GARPR indicator 1.12), people who inject drugs: prevention programmes (GARPR indicator 2.1), prevention of mother to child transmission (GARPR indicator 3.1), antiretroviral therapy (GARPR indicator 4.1), and the National Commitments and Policy Instrument (NCPI) are presented in Fig. 4a–g.Fig. 4Reporting rates for key indicators in the Global AIDS Reporting 2006–2015 reporting rounds: a knowledge about HIV prevention (GARPR indicator 1.1), b sex workers: condom use (GARPR indicator 1.8), c men who have sex with men: condom use (GARPR indicator 1.12), d people who inject drugs: prevention programmes (GARPR indicator 2.1), e prevention of mother to child transmission (GARPR indicator 3.1), f antiretroviral therapy (GARPR indicator 4.1), and g the National Commitments and Policy Instrument (NCPI), Global reporting was every 2 years until the 2012 reporting round, except for the NCPI which has continued to be reported biennially, 2006–2015
The Global AIDS reporting system has substantially improved over time and has provided key trend data on responses to the AIDS epidemic at global, regional and country level, serving as the global accountability mechanism and reference data for the global AIDS response.
The AIDS epidemic and the response are changing rapidly and the monitoring system must evolve with the changing context and environment.
The Global AIDS reporting system will be critical in supporting the post-2015 monitoring of the AIDS response through the Sustainable Development Goals in view of ending the AIDS epidemic as a public health threat by 2030. Many of the challenges, obstacles and biases that arose during the evolution of the monitoring systems for the AIDS response were not unique to the AIDS epidemic. However, it was among the first monitoring frameworks in health to showcase how political, social, financial, behavioral, and service delivery indicators can complement each other. While governments often may resist external pressures for implementing such mechanisms, the Global AIDS Response Progress Reporting has demonstrated that the information that is produced can remain of high quality, even with decreasing external support, once it has proven its added value in accountability. Such mechanisms may arise in new areas of health delivery, driven by current crises, (such as Ebola, Zika and others), and as the global community moves into new areas of health services, including Universal Health Coverage, Non Communicable Diseases, antibiotic resistance, etc. AIDS progress reporting can help in understanding the need for integration between different monitoring systems, data sources, and the ongoing dialogue that must be generated between different sector experts.