OVC_HIVSTAT services flow Chart

1
 HIV risk assessment
continuum
1. Register • OVC may enter the project
OVC & without a known HIV status
obtain HIV
status • Before being referred for HIV
testing, each OVC should be
2. Conduct
assessed for HIV risk
HIV Risk
Assessment
3. Refer at-
risk
children to
testing
• If they are determined to be at risk, 4. Obtain
they must be referred for HIV testing test result
and
• OVC program must ensure the HIV document
referral is completed, provide family-
centered disclosure, and document
self-reported test results
2
 HIV negative
• When to conduct HIV risk assessment
Assess HIV
Suspected risk as soon
to be exposed to sexual violence as a change
in risk
profile is
suspected
Suspected refer for
to be sexually active HTS if
eligible

3
 HIV positive

• When to conduct ART assessment

Assess ART
adherence
status and
Child HIV positive and VL results
currently on ART at every
visit
Case plan
and serve
Child HIV positive and not to enhance
currently on ART / ART status adherence
unknown and
suppress
VL
4
 ART treatment status
For HIV-positive children, the child’s ART treatment
status at enrollment is recorded in case file.
A case management file is opened and adherence
support is provided.
The case worker must verify the child’s ART status
with the primary caregiver at each visit and assess
adherence to ART, current VL result status
(Current?, suppressed?, Known?)record in case
files, update/review Case plans, provide services
and report

5
 ART treatment status

For “HIV positive currently on ART” if there are ART

medications in the home (as verified by the
caseworker) that the HIV+ child/adolescent is currently
taking.

The caseworker should encourage linkage to care,

retention in care, and ART adherence, assess
availability and knowledge of current VL results

6
 ART treatment status
At enrollment, open Link to ART Provide services & adh.
case management file treatment support and record in file
and record in file

HIV+ not HIV+

currently currently
on ART on ART
Assess adherence
Support linkage to care, and current VL
retention in care,) results, if Adh. is low
and VL is high
HIV-positive children who were enrolled as “HIV positive not
currently on ART / ART status unknown” are provided
retention and adherence support.

Case plan is updated When the HIV-positive child is linked to

ART treatment, the case file is updated and information
reported in DATIM during the data entry period.
7
 ART treatment status
At enrollment, open Provide retention and adherence
case management file support and record in file

HIV+ HIV+
currently currently
on ART on ART

Report in Report in
DATIM (SAPR) DATIM (APR)
HIV-positive children who were enrolled as “HIV positive
currently on ART” are provided retention and adherence
support.

Even though the child’s ART status has not changed, this
information must be verified and reported in each
subsequent reporting period in DATIM with the goal of
supporting retention in care and adherence to ART. 8
 ART treatment status
At enrollment, open Provide adherence
case management file support and record in file

HIV+ HIV+ not

currently currently
on ART on ART

Report in Report in
DATIM (SAPR) DATIM (APR)
An HIV-positive child enrolled as “HIV positive on ART”
may self-report as “HIV positive not on ART” in a
subsequent reporting period.
Extra efforts should be made to ensure that ART
defaulters are detected by case workers, noted in the
case management file, and updated in DATIM.
9
• Caregiver
services

10
 “Caregiver and child”
services
Some caregiver services qualify both caregiver and child to
be counted as active, because there is direct benefit to the
child.
Mother and child
are active at APR
Mother joins Mother Mother Mother
OVC savings continues in continues in continues in
group savings savings savings
group group group

Q1 Q2 Q3 Q4
Child is Child Child is Child is
accompanied receives a assessed and assessed and
to clinic for school does not does not
HIV test but uniform require added require added
is negative services but services but 11
Avoiding double counting
OVC caregivers under age 18
Some OVC caregivers are younger than 18 years of
age. A child caregiver is considered active when
he/she:
• Received at least one service in each of the
preceding two quarters;
• Had a case plan updated within the past four
quarters
• Is monitored at least quarterly
The child caregiver may receive services either from
the child or caregiver list of eligible OVC services.

While OVC caregivers under the age of 18 may receive

services from either category, they may not be counted twice. 12
Caregiver-only services
Other caregiver services do not directly benefit a child, and
therefore do not qualify the child to be counted as active
unless the child is also receiving an eligible service.
Mother is Mother is
accompanied facilitated Mother is
to clinic for to obtain active at
HIV test and HIV
is HIV- treatment
SAPR
positive
Q1 Q2 Q3 Q4

Child completes Child has

Child is
referral for updated exited at
vaccination, has case plan SAPR
updated case and is
plan and is monitored 13
Module 3
Graduation

Orphans and Vulnerable Children

Monitoring, Evaluation and Reporting
(MER) Indicators
Implementing Partner Training
October 2018
Introduction
Learning objectives
1. Gain an introduction to the eight graduation
benchmarks
2. Understand which benchmarks are required for
different households based on household
composition
3. Identify which members of a household are eligible
to receive OVC services and be enrolled
4. Learn how the principle of family-centered
graduation applies to individual beneficiaries

15
Data definitions
Graduation definition

Graduation is a disaggregate
within OVC_SERV which is
assessed at the household level

Remember that OVC_SERV is assessed at the individual

level. 16
 Minimum required
benchmarks Beneficiaries
House-
Benchmarks hold
10-17 0-4 School
All ages HIV+
years years age
1. Known HIV status (or test not
✓
required)
2. Virally suppressed ✓

3. Knowledgeable about HIV prevention ✓

4. Not malnourished ✓

5. Improved financial stability ✓

6. No violence ✓

7. Not in a child-headed household ✓

8. Children in school ✓

The household composition will determine benchmarks. 17

Healthy
Known HIV status (or test not required)

1.1. Increase knowledge of HIV status

1.1.1. All children, adolescents, and

caregivers in the household have known
HIV status or a test is not required based
on risk assessment

Disclosure of HIV test results to

the IP is required to meet this 18
benchmark.
Healthy
Virally suppressed - Option (a)

1.2. Increase HIV treatment adherence, retention and

viral suppression

1.2.1.(a) All HIV+ children, adolescents and

caregivers in the household with a viral load
result documented in the medical record
and/or laboratory information systems (LIS)
have been virally suppressed for the last 12
months

Beneficiaries whose earliest viral load test result was

<12 months ago are ineligible to meet this benchmark. 19
Healthy
Knowledgeable about HIV prevention

1.3. Reduce risk of HIV infection

1.3.1. All adolescents 10-17 years of age in

the household have key knowledge about
preventing HIV infection

20
Healthy
Not malnourished

1.4. Improve development for children <5 years

– particularly HIV exposed and infected
infants/young children

1.4.1. No children <5 years in the

household are undernourished

A child’s mid-upper arm circumference (MUAC) and

bipedal edema will be checked by a case or health worker.
21
Stable
Improved financial stability
2.1. Increase caregiver’s ability to meet
important family needs

2.1.1. Caregivers are able to access

money to pay for school fees and medical
costs for children 0-17

Without selling productive assets (household

possessions which could generate income) 22
Safe
No violence
3.1. Reduce risk of physical, emotional and
psychological injury due to exposure to violence

3.1.1. No children, adolescents, and

caregivers in the household report
experiences of violence in the last six
months

Including physical violence, emotional violence,

sexual violence, gender based violence, and neglect 23
Safe
Not in a child-headed household

3.1. Reduce risk of physical, emotional and

psychological injury due to exposure to violence

3.1.2. All children and adolescents in the

household are under the care of a stable
adult caregiver

24
Schooled
Children in school

4.1. Increase school attendance and

promotion

4.1.1. All school-age children and

adolescents in the household regularly
attended school and progressed during
the last year

25
 Required
benchmarks
for family-centered
graduation

26
 Minimum required
benchmarks Beneficiaries
House-
Benchmarks hold
10-17 0-4 School
All ages HIV+
years years age
1. Known HIV status (or test not
✓
required)
2. Virally suppressed ✓

3. Knowledgeable about HIV prevention ✓

4. Not malnourished ✓

5. Improved financial stability ✓

6. No violence ✓

7. Not in a child-headed household ✓

8. Children in school ✓

The household composition will determine benchmarks. 27

Required benchmarks

All children and all caregiver beneficiaries in a

household must meet all applicable*
graduation benchmarks established by
PEPFAR for improving stability in the
household.

PEPFAR will be releasing a Graduation

Assessment Tool to use in assessing whether a
household has met these benchmarks.

*Benchmark requirements may vary according to

age and HIV status of beneficiaries in the household. 28
Family-centered
graduation
Children and primary caregivers in a
household move from active to graduated
status together when each has met the
minimum benchmarks.

This approach to graduation of the household

as a unit reflects the family-centered nature of
OVC programming.

29
Family-centered
graduation
In a small number of cases, a beneficiary may
have received all the services for which he or
she is eligible but may not be eligible to
graduate because all members of the
household have not met all the graduation
benchmarks.

Provided such a beneficiary continues to have

an updated case plan and a minimum of
quarterly assessment (if a child), he or she
may continue to be counted as active.
30
Family-centered
graduation
The all-or-nothing rule:

All children and primary

caregivers in a household
graduate TOGETHER
or no one graduates.

31