Tracking coverage on the silk road: time to turn theory into practice.

Scaling up coverage of programs that effectively reduce the spread of HIV among vulnerable populations, including injecting drug users (IDUs), sex workers (SWs), and men who have sex with men (MSM), is a critically important issue for many countries today. However, in addition to the lack of a commonly accepted definition of coverage, there are currently no universally accepted standards, methodologies, or tools to track coverage among these groups. Globally, most programs working to prevent HIV among vulnerable populations are not using monitoring & evaluation (M&E) systems that accurately track numbers of clients and frequency of contact with those clients. Nor do most programs have targets on the frequency of contact needed to effectively promote healthy behaviours. This article presents a narrative of how one program in Central Asia developed a simple M&E system to track the extent and frequency of contacts among clients. The system uses a simple and anonymous "Unique Identifier Code" (UIC) that is assigned to each client and recorded into a simple database to track the client's interaction with the program. The system allows program managers to track numbers of clients served and at what frequency and to better monitor progress towards goals. The data produced by the UIC system, when compared against HIV and sexually transmitted infection (STI) sentinel surveillance data by site, allows programs to test theorized definitions of the quantity of coverage needed to reduce the risk behaviours that spread HIV among vulnerable populations. Such systems can then provide urgently needed data to help national HIV/AIDS programs understand current coverage levels and gaps in coverage that need to be filled in order to reduce the spread of HIV. Such a system provides valuable data to enable decision makers to make evidence-based decisions on how to allocate resources to reach sufficient coverage to reduce the spread of HIV among populations most at risk of HIV.