Expenditure Analyses

Since fiscal year 2012 (1 October, 2011 – 31 September, 2012), PEPFAR has begun tracking expenditures alongside planned funding in the COPs.

While structurally different from the COPs, EA data enable researchers and advocates to dig into the details of PEPFAR’s actual expenditures in each country or region. EA data are categorized across 19 Program Areas, 8 Major Categories, and 21 Minor Categories all detailed below.

While not directly comparable to COP data, EAs provide a different level of detailed data on the structure and design of PEPFAR’s programs. Importantly, when attempting to compare COP budgets and EA spending is that they are offset in terms of years. While the COPs budget funding provided during the identified financial year (e.g. COP2014 budgets fiscal year 2014 funds), the budget is actually spent in the following financial year (e.g. COP2014 budget is more tied to the fiscal year 2015 expenditures). Expenditures can also be significantly higher or lower than budgeted funds as both centrally funded programs from the Office of the Global AIDS Coordinator or unspent funds from a previous year's COP may extend into the next fiscal year.

EA Program Areas

The following descriptions are taken from PEPFAR's data dashboard glossary:

• Above site-level cross-cutting activities: Treated as both a program and major cost category. PM activities support administration of PEPFAR funding including grant management, human resources management, internal accounting and finance, host country support staff and offices, and indirect recovery rates.
• Blood Safety: Services and support for the collection and testing of blood units to ensure a safe and adequate blood supply.
• Community-based Care, Treatment, and Support: Care, support, and ART provided in a community setting, outside of a traditional health facility. This includes any clinical care provided outside health facilities, as well as nutrition support, psychological, social, or spiritual care, and economic strengthening activities. Effort related to supportive supervision and mentoring of healthcare workers providing care and treatment services in a community or home-based setting should be reported under this program area. This program area also includes linkage and retention activities and quality improvement measures that occur within a community or home-based setting.
• Facility-based Care, Treatment, and Support: Clinical care, support, and antiretroviral therapy (ART) provided in a health facility. Effort related to supportive supervision and mentoring of healthcare workers providing care and treatment services in a health facility as well as patient-directed TB services in a health facility should be reported under this program area. This program area also includes nutrition support, psychological and other supportive interventions, linkage and retention activities, and quality improvement measures that occur within a health facility.
• Health Systems Strengthening for Strategic Information: Treated as both a program area and major cost category. HSS activities are meant to build the capacity of local health systems to effectively respond to the HIV epidemic. Activities are widely varied and target different aspects of the health system. For EA, HSS has been further divided into functional areas that better describe the nature of HSS activities within PEPFAR. A list of these functional areas and descriptions can be found in the section on System-level Support below.
• HIV Testing and Counseling: Services providing HIV testing and results to individuals as well as counseling on how to remain negative for those who test negative and information on seeking care, treatment, and prevention services for those who test positive. HTC is further disaggregated by testing modality: provider-initiated (PITC), voluntary (VCT) and community-based (CBTC).
• Infection Control: Investments in renovating facilities and training health care workers to reduce the spread of infectious disease. This includes renovations and training for TB-HIV mitigation, however, patient-directed TB services should be recorded under FBCTS.
• Lab: Provision of diagnostic services related to HIV clinical interventions (e.g., CD4 counts and tuberculosis testing), early infant diagnosis, quality improvement/quality assurance, and site-level system development support to renovate, train, and otherwise expand laboratory capacity and quality.
• Medication Assisted Therapy: Provision of opiates such as methadone for PWIDs. Expenditures related to outreach mobilization, and other ancillary services provided to opioid substitution therapy (OST) clients should be estimated and reported under the SORP-PWID program area.
• Orphans and Vulnerable Children: Services that target OVC needs in the areas of medical care (not facility-based), educational support, spiritual care, psychological care, social care and food and nutrition.
• Other Biomedical Prevention: enumerations.Other Biomedical Preventionlong
• Other cross-cutting activities: enumerations.Other cross-cutting activitieslong
• Post-exposure Prophylaxis: Services providing prophylaxis for both occupational and non-occupational exposure to HIV.
• Preventing Mother-to-Child Transmission: Services for pregnant women and exposed infants which include HIV testing and results; access to care, ART and prophylaxis for those found positive; and information on ways to protect themselves if negative. Note that classifying expenditures reported for supporting Option B+ will depend on your country-specific implementation of Option B+. Specifically, effort expended to support women who are on treatment (currently pregnant or not) who are still counted as receiving Option B+ should be reported as PMTCT. When your organization continues to support those women on lifelong treatment beyond their being considered an Option B+ beneficiary, those expenditures should be classified as FBCTS.
• Sexual and Other Risk Prevention, Sex Worker: Behavioral prevention and structural prevention interventions targeted to female sex workers.
• Sexual and Other Risk Prevention, General Population: Behavioral prevention and structural prevention interventions targeted to the general population rather than specific key-populations or other vulnerable populations.
• Sexual and Other Risk Prevention, Injection Drug User: Behavioral prevention and structural prevention interventions targeted to persons who inject drugs including harm reduction services, needle exchange and condom distribution. Expenditures related to the provision of medication, such as methadone, to PWIDs should be estimated and reported under the Medication Assisted Therapy (MAT) program area.
• Sexual and Other Risk Prevention, Priority Populations: enumerations.Sexual and Other Risk Prevention, Priority Populationslong
• Sexual and Other Risk Prevention, Key Populations: Fiscal year 2012 only. After 2012 the key populations expenditures were separated into separate program areas for better tracking.
• Sexual and Other Risk Prevention, Key Populations Other: Behavioral prevention and structural prevention interventions targeted to other vulnerable populations which are not PWID, FSW, or MSMTG specifically. Depending on the country context, this may include but not be limited to: miners, migrant workers, truck drivers, fisher folks, mobile men with money, or enlisted military.
• Sexual and Other Risk Prevention, Men who have Sex with Men and Transgender: enumerations.Sexual and Other Risk Prevention, Men who have Sex with Men and Transgenderlong
• Surveillance: Treated as both a program area and major cost category. Surveillance is considered a subset of, but distinct from, SI. Surveillance activities are typically routinely implemented and will include objectives like measuring HIV prevalence, incidence and related disease burden, as well as quality and coverage of diagnostics, commodities and treatment services.
• Voluntary Medical Male Circumcision: The provision of surgical circumcision and support services. Expenditures related to the provision of HTC services which often accompany VMMC procedures should be reported under the VMMC program area rather than the HTC program area.

EA Major Cost Categories

Major cost categories are subdivisions of the EA Program Areas. These are general higher level classifications that exist in most program areas.

• Health Systems Strengthening
• Health Systems Strengthening to Strategic Information
• Investment
• Program Management
• Program Management to Health Systems Strengthening
• Program Management to Strategic Information
• Recurrent
• Strategic Information
• Strategic Information to Health Systems Strengthening
• Other Cross-cutting
• Above Site Total
• Investment and Recurrent

EA Minor Cost Categories

Minor cost categories are the most detailed expenditures with EAs. They are classified across 21 categories:

• Antiretroviral drugs
• Building rental and Utilities
• Condoms
• Construction and renovation
• External Consultants
• Equipment and furniture
• Food Supplements
• HIV Test Kits
• Non-ARV drugs and reagents
• Other
• Other cross-cutting
• Other General and Administrative
• Other investment expenditures
• Other site recurrent expenditures
• Other supplies
• Personnel
• Program Management for Health Systems Strengthening
• Program Management for Strategic Information
• Strategic Information for Health Systems Strengthening
• In-service training
• Transport and Travel
• Vehicles