Reach and results

This checklist works like the other checklists in this toolkit: the more yellow (‘partly’) and red (‘no’) answers you give in each row, the higher the need to discuss this aspect in more detail and decide on actions for improvement. If you contribute data to the COBATEST network, you can base your discussions on its reporting format. If you find that your are lacking the necessary information to discuss a topic, actions for quality improvement can include collecting more information during the next cycle (e.g. some form of needs assessment, improved data collection, literature review, consulting experts, research projects etc.).

Topic	Does your CBVCT have objectives, targets, indicators and data on this topic?	Do the collected data* suggest that your CBVCT’s performance reaches more than 70% of this target?	Does your CBVCT respond to local needs and conditions in this area?	Are you satisfied that there is nothing else that needs to be improved in this area?	Action
Number of clients overall More details Number of clients overall This is the number of clients you provide services to in a given period (e.g. per month or per year). It is useful to look at the number of individual clients and the number of instances of service provision. Depending on the data you collect, you may be able to analyse which clients return to the service and for what purpose. Consider what these statistics can tell you about the performance of your CBVCT when you takelocal conditionsinto account, such as the role of other service providers, the size of the target group etc.					→ Copy to action plan
Number of tests More details Number of tests The numbers of the different tests you offer not only show how much work you do, they can also indicate client preferences, responses to promotion, special events (e.g. European Testing Week) and other influences. Can you describe what your targets are based on (e.g. local epidemiology – estimates of undetected infections, funders/donor’s expectations etc.)? This will help interpret the data and you can review your targets so that they become more meaningful. However, the number of tests performed only becomes meaningful in conjunction with other data, especially the number of new infections found.					→ Copy to action plan
Number of new infections found More details Number of new infections found This statistic is important because the strength of CBVCT services is to focus on and access thepopulation groups most at risk of infection. Your success is most clearly represented by the percentage of new infections that are found by your service compared to those found overall in your city/region/country (taking into account estimates of undiagnosed infections and the overall number of tests performed). If your CBVCT detects a significant percentage of the (estimated)number ofundiagnosed infections, especially considering the overall number of tests conducted, your services are well targeted.					→ Copy to action plan
Proportion of clients successfully linked to care More details Proportion successfully linked to care The proportion of clients successfully linked to care is an important indication of the trust your clients have in your service, and of your ability to cooperate and network with other parts of the health system. It is another important indicator for the particular strengths of CBVCTservices. Consider not only how well clients with reactive/positive results are linked to further testing and treatment services, but also how well you are linking clients to other social, health and support services according to individual needs.					→ Copy to action plan
Other numerical targets More details Other numerical targets Insert and discuss other numerical (expressed in numbers) targets that are specific to your particular service or organisation and are not listed here. You may want to differentiate between different infections (e.g. HIV and Syphilis), and also count Hepatitis A/B vaccinations.Or you may have had a particular short-term target during the period being reviewed (e.g. clients using the service during newly introduced opening hours, a new outreach service or testing location).					→ Copy to action plan
Reaching MSM who face age-related barriers More details Reaching MSM who face age-related barriers Which MSM face additional barriers to accessing CBVCT services because of their age? Are theyyoung MSM because of legislation or lack of peer support, or MSM of working age because of opening hours? Consider any data you collect, as well as the observations of staff and volunteers. Always discuss your CBVCT’s strengths, weaknesses and possible improvements in reaching a particular subgroup of MSM in the context of need (epidemiology, other health and social needs) and local conditions (e.g. population mix, contributions of other service providers etc.).					→ Copy to action plan
Reaching MSM who face cultural and linguistic barriers More details Reaching MSM who face cultural and linguistic barriers Which MSM face cultural barriers (religion, ethnic origin, MSM subcultures etc.) in accessing your CBVCT? Which MSM face language barriers? Always discuss your CBVCT’s strengths, weaknesses and possible improvements in reaching a particular subgroup of MSM in the context of need (epidemiology, other health and social needs) and local conditions (e.g. population mix, contributions of other service providers etc.). Improvements may include recruiting more culturally diverse peers, incorporating interpreting services, targeted promotion etc.					→ Copy to action plan
Reaching trans* MSM More details Reaching trans* MSM Ignorance of or misconceptions about the presence of trans* MSM in the community and their health needs are common. It is important not to make assumptions based on the observations and experiences of staff and other stakeholders who are not trans* MSM themselves. The most important step for improving your reach of trans* MSM is to involve them in the process. There may not (yet) be a trans* community group or organisation to collaborate with in your area, buta focus group held by your CBVCT can not only give you the information you need, but also generate activist initiatives.					→ Copy to action plan
Reaching MSM who use drugs More details Reaching MSM who use drugs Sexual health and (harmful) drug use are both health issues that influence each other in different ways. It is important not to reduce this topic to the risk of transmission of infectious diseases through sexual activity orto thedrug use specifically associated withit (‘ChemSex’). Drug use is a health issue related todiscrimination and disadvantage, and therefore more common among MSM than it is in the general population. How does your CBVCT respond to the different forms of drug use among MSM? Are there attitudes or messages that may stigmatise any form of drug use or limit access of MSM who use drugs to your CBVCT? May it be useful to actively and directly bring up this topic in all counselling sessions, provided it is done in a low-threshold manner? Could your CBVCT offer ChemSex services?					→ Copy to action plan
Reaching MSM who face other health or disability-related barriers More details Reaching MSM who face other health or disability-related barriers These barriers can result from mental health issues, disabilities (e.g. sensory, mobility or intellectual impairments) or chronic illnesses such as diabetes or chronic hepatitis. General discrimination in society on the basis of these characteristics may be intensified by internalised homonegativity and discrimination inside MSM communities. Do youtake practical accessibility issues (e.g.wheelchair access, sign language interpretation) into account? Do you have goals and targets for outreach and inclusion? Do you act against prejudice and discrimination on these topics?					→ Copy to action plan
Reaching MSM who face socio- economic barriers More details Reaching MSM who face socio-economic barriers Education and economic status are strong predictors for health in all populations. Facing homonegativity can heighten the impact of these factors for subgroups of MSM: higher levels of education and income can be more prevalent in MSM communities than the general community (this may be a result of MSM overcompensating for disadvantage by striving even harder for recognition by the society). These men are often overrepresented in MSM survey samples and CBVCT statistics. However, homonegativity can also makeeducational and economic disadvantageworse, and result in multiple discrimination. MSM in this group are often underrepresented and face additional barriers in accessing services. If you charge clients for tests and other services, would it be an option to provide them free of charge to those who those who can‘t afford the charges? Lowering the threshold to accessing services is very important, especially for this target group. This may also include the language you use and other aspects of your operations.					→ Copy to action plan
Reaching MSM who face geographic barriers More details Reaching MSM who face geographic barriers Geographic barriers are very specific to the local context. They depend on population densities and the general economic situation. Barriers may be the distance from larger population centres (e.g. cities), availability of affordable transport, differences in personal safety when travelling in different areas etc. How do these factors impact on your work considering the geographical region your are aiming to cover? Adjusting your opening hours (e.g. weekends, evenings) and offering outreach services can be helpful responses.					→ Copy to action plan
Providing an accessible, safe and welcoming space for a diverse range of clients More details Providing an accessible, safe and welcoming space for a diverse range of clients CBVCTs cangenerallybemore flexible in how they design their premises and how they interact with their clients than mainstream health services. Factors include confidential access (neutral entrances and signage), a friendly,homely atmosphere, reflectingthelivesof MSMin decoration, music etc., open and diversity-affirming staff attitudes, and reinforcing non-discriminatory interactions (e.g. through codes of conduct regarding racism, sexism, transphobia etc.).					→ Copy to action plan
Providing the level of anonymity/confidentiality that clients want More details Providing the level of anonymity/ confidentiality that clients want One of the main strengths of CBVCTs is their ability to offer levels of confidentiality or even anonymity that mainstream services struggle to provide. The level of confidentiality or anonymity that different subgroups of MSM want can vary. Some may be happy to share personal information for statistical and research purposes, others prefer complete anonymity, even among their peers. These preferences can also change along the life course, as MSM go through different stages of ‘coming out’. They depend on individual circumstances, as well as on changes in the society around them. How does your CBVCT take into account these different preferences and changes? How obvious is it to others that your service is associated with MSM? Can clients enter your premises without others noticing what they are there for? This may be a very important to some clients. On the other hand, it can reinforce stigma and must be considered with care.					→ Copy to action plan

Print Checklist

*(statistics (e.g. COBATEST reporting), evaluation forms, client feedback, staff observations)

Part 1 of the quality improvement plan lists the actions you wrote in the ‘Action’ column while working through the checklist.

Quality Improvement Plan Part 1

Reach and results
Reach and results

Item	What will be done?	Who will do it?	When?	How will we monitor it?
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Print Action Plan

Number of clients overall

Number of tests

Number of new infections found

Proportion successfully linked to care

Other numerical targets

Reaching MSM who face age-related barriers

Reaching MSM who face cultural and linguistic barriers

Reaching trans* MSM

Reaching MSM who use drugs

Reaching MSM who face other health or disability-related barriers

Reaching MSM who face socio-economic barriers

Reaching MSM who face geographic barriers

Providing an accessible, safe and welcoming space for a diverse range of clients

Providing the level of anonymity/ confidentiality that clients want

Quality Improvement Plan Part 1

Reach and resultsReach and results

Reach and results
Reach and results