PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
09.P.PM91: Technical Expertise and Support - Post
ACTIVITY CONTINUING UNDER PERFORMANCE PASS
ACTIVITY UNCHANGED FROM FY2008
From COP08:
This activity links with all activities under PMTCT. It covers the salaries and travel for the technical
HHS/CDC/BOTUSA staff in-country supporting PMTCT. Eight HHS/CDC/BOTUSA staff work in the PMTCT
section. Six of them are based in Francistown where they carry out operational research, while two are at
the BOTUSA headquarters in Gaborone. An example of the operational research is the successful pilot of
EID of HIV in infants using DBS and DNA PCR. The result of the pilot has led to the roll out of EID by the
MOH countrywide.
In 2008, USG funds will be used to hire additional dedicated staff (2 nurses) to visit each district, provide
detailed feedback on ART initiation rates in pregnant women and infants, organize troubleshooting
meetings, and provide ongoing feedback to every district. In addition, a medical officer will be hired to
provide ongoing technical support to the PMTCT program in the MOH and other related programs (SRH,
Family Planning Unit, and the Food & Nutrition Unit) on PMTCT related issues.
Support for printing technical materials and other costs related to working with the GOB are included. Costs
related to workshops and participation by the technical staff in domestic, regional, and occasional
international meetings are supported.
The PMTCT team in Francistown will conduct a demonstration project on Prevention with Positives (PwP),
by supporting the promotion of family planning and unintended pregnancy prevention among HIV positive
women and their partners. Activities will include community mobilization through local dramas and related
discussion forums, in addition to supporting implementation of the existing PMTCT protocols by health care
workers within clinical settings, which include active promotion of family planning to clients.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17341
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17341 10154.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $420,000
Disease Control & Disease Control
Prevention and Prevention
10154 10154.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $275,000
Table 3.3.01:
09.P.AB91: Technical Expertise and Support
This activity covers the salaries and other administrative costs for the technical staff in-country that support
the AB and C/OP program areas. These staff include 2 full-time CDC direct hire, 2 senior FSN, and 1 mid-
level FSN. The funds also support USG-sponsored meetings of prevention implementing partners,
professional development and training for staff persons, conference attendance, and travel for site visits and
other meetings in and out of Botswana that USG prevention officers may attend as part of their regular
duties.
All staff work across the AB and C/OP program areas, so the costs associated with these staff and activities
above are distributed proportionately (66%-33%, respectively).
Continuing Activity: 17342
17342 10159.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $193,000
10159 10159.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $231,812
Table 3.3.02:
09.P.OP91: Technical Expertise and Support C/OP
the AB and C/OP program areas. The staff includes one full time CDC direct hire, part time of a senior CDC
prevention lead, 2 senior FSN, and 1 mid-level FSN. The funds also support USG-sponsored meetings of
prevention implementing partners, professional development and training for staff persons, conference
attendance, and travel for site visits and other meetings in and out of Botswana that USG prevention
officers may attend as part of their regular duties.
Continuing Activity: 17344
17344 10150.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $114,000
10150 10150.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $215,695
Table 3.3.03:
09.P.BS91: Technical Assistance & support - Blood safety
This activity covers the salaries and travel for the technical staff in-country. The funds also support the
printing of technical materials and other costs associated with providing support for the programs and
projects, including work with the GOB. Also included are costs related to workshops and participation by
the technical staff in domestic, regional, and occasionally international meetings deemed necessary for their
work.
Continuing Activity: 17343
17343 10162.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $75,000
10162 10162.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $75,000
Table 3.3.04:
09.P.IS91: Technical Assistance and support - Injection Safety
This activity is intended to provide technical support to the Ministry of Health to strengthen the existing
injection safety systems and promote the safety of health care workers, patients and the community. It will
also support the scaling up of injection safety interventions, a multi-year advocacy and Behavior Change
and Communication strategy, and linkages with Supply Chain Management Systems (SCMS) in the areas
of procurement of injection safety-related commodities.
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $2,915,798
Table 3.3.07:
09.P.MC91: Technical Expertise and Support for Male Circumcision - Local
This activity links with all activities under Male Circumcision (MC). Botswana recently adopted MC as added
strategy for the prevention of HIV infection. It is intended to provide technical support to the Government of
Botswana's (GOB) effort in scaling up MC and intends to do the following: (1) increase the number of health
providers trained to perform safe MC; (2) increase the knowledge of health providers about risks and
benefits of MC; (3) augment equipment and supplies; (4) establish a referral system; (5) set standards and
quality assurance for MC; and (6) establish a monitoring and evaluation process to monitor MC demand and
use, as well as rates of adverse events. Since this is a new activity, it is currently being coordinated by the
Prevention of Mother to Child Transmission (PMTCT) Section Advisor as an additional activity over and
above PMTCT activities. Given the importance of MC as a new prevention strategy in Botswana, it is
necessary that a dedicated LES be recruited to coordinate MC activities.
In F2009, United States Government (USG) funds will be used to hire a dedicated LES to coordinate all MC
activities and to provide ongoing technical support to the GOB Ministry of Health (MOH) and the partners
involved in implementation of MC.
Additionally, the costs related to training, workshops, and participation by the technical staff in domestic,
regional and international meetings, the printing of training materials, and support for the MOH on MC will
be covered by the funds for this activity.
09.C.AC91: Technical Expertise and Support PC/Basic Services
projects, including work with the Government of Botswana. Also included are costs related to workshops
and participation by the technical staff in domestic, regional, and occasionally international meetings
deemed necessary for their work.
Continuing Activity: 17345
17345 10306.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $84,000
10306 10306.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $85,000
Table 3.3.08:
09.T.AT91: Technical expertise and Support ARV Services
CONTINUING ACTIVITY UNDER PERFORMANCE PASS
Continuing Activity: 17351
17351 10235.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $109,000
10235 10235.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $400,000
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $1,060,900
Program Area Narrative:
In response to the challenges that HIV and AIDS present to Botswana, efforts continue to be made to diversify approaches, fine
tune technical support, and plan for future program sustainability with the support of the Presidents' Emergency Plan for AIDS
Relief (PEPFAR). The national HIV prevalence rate is 23.9% among adults ages 15 to 49, according to recent UNAIDS data, and
an estimated 300,000 are living with HIV/AIDS. About 53.2% of Batswana know their HIV status up from 25% in 2004, 95% of
pregnant mothers gaining that information through the Prevention of Mother to Child Transmission program. The Botswana 2007
Sentinel Survey indicated that HIV prevalence among pregnant women (15-49 years) is 33.7%, though the overall trend appears
to be decreasing from 37.4% in 2003. Challenges remain, however, with prevention, particularly the issue of multiple concurrent
partnerships, alcohol abuse, nascent civil society, and human capacity development.
Infant and child mortality in Botswana continues to be dramatically affected by the HIV epidemic, and HIV continues to contribute
to an alarmingly high proportion of deaths of children younger than five years old, more than 50% by some estimates. Child
mortality for younger than five years old is high at 120 per 1000. Reasons for this high infant and child mortality are unclear and
may relate to intra uterine HIV infection, HIV drug exposure, formula use, or other factors related or unrelated to HIV epidemic.
Despite these challenges, Botswana has become a global leader in scaling pediatric HIV care and treatment. Anti-retroviral
therapy (ART) is currently provided free of charge to all qualifying HIV-infected citizens in Botswana through the national ART
program known as Masa (or "new dawn"), which was launched in January 2002 and already prescribes ART through 32 hospitals
and 62 clinics around the country (see Adult Care and Treatment narrative). In common with adult treatment services, there are
no partners directly providing treatment - all care is delivered through the Masa Program or Government of Botswana (GOB)
licensed private practitioners. Children receive care and support and highly active anti-retroviral therapy (HAART) through the 32
hospitals and as of April 2008 there were 6481 pediatric patients on ART in the public sector, which represents approximately 8%
of the total number of individuals receiving ART in the public sector. In recent months, with support from UNICEF, the Masa
Program hired a Pediatric Coordinator to oversee pediatric care and treatment in the country. As part of long-term human capacity
development, the President's Emergency Plan for AIDS Relief (PEPFAR)-supported national HIV training program—Knowledge,
Innovation, and Training Shall Overcome (KITSO)—continued regularly throughout FY2008 a substantive week long pediatric
HIV/AIDS management course in an effort to decentralize pediatric expertise and care to all parts of Botswana. This course
utilized trainers from the GOB and the United States Government (USG) partners, Baylor School of Medicine and University of
Pennsylvania School of Medicine, and will continue with USG support in FY2009. PEPFAR is also supporting the position of four
pediatricians to deliver services to the children in Princess Marina, Nyangabgwe Hospital and in surrounding districts through an
outreach program. These pediatricians are strengthening the capacity of GOB in pediatric care and treatment.
HIV-exposed infants are tested for HIV using polymerase chain reaction (PCR) testing of dried blood spots (DBS), at the age of
six weeks and breastfed infants are tested again six weeks after weaning (see PMTCT Program Narrative). 2007 data show that
nationwide, 78% of all HIV-exposed infants were tested before the age of six months. Cotrimoxazole (CTX) is provided for
exposed infants from age six weeks until they have a negative HIV test along with nutritional support. 2007 data show that among
infants older than 9 weeks old, more than 70% were already taking daily CTX at the time they arrived for their first HIV test. HIV-
infected infants are referred to the Masa Program, which provides pediatric ART at all sites which provide adult ART. FY2007
data show that only 24% of HIV-infected infants identified through routine PCR testing received treatment. Reasons for this low
percentage have been explored in other studies and relate to the slow return of results and lack of adequate outreach to follow
these children at their homes in a timely manner.
In FY2009, using USG funds, clinics will be supported to develop their own protocols to track and review appointment compliance,
to prioritize patients for follow up, and to find and engage the families in care. HIV-exposed infants who become sick will be
referred to the HIV care and treatment clinic as soon as possible so they can be evaluated for possible treatment, even if they
have not had an HIV test yet. Health workers will conduct a daily review of appointment schedules to identify patients who missed
appointments and, on a weekly basis, identify priority cases for follow-up. Family welfare educators, lay counselors and peer
educators will be engaged to track families in local communities. Where possible, staff will phone patients who missed visits on
mobile phones to give them another appointment date. All infants receiving care at the sites will benefit from the development of
follow-up systems and a shift from episodic to continuous care during childhood.
Project Concern International (PCI) will strengthen delivery of comprehensive services in the community and identify ways to
strengthen service linkages between civil society and government, and community and facility, in project districts. Provider
initiated counseling and testing and strengthened referral linkages between sites of HCT and treatment are part of this strategy
(see Adult Care and Treatment narrative).
The Catholic Relief Services-Vicariate of Francistown (CRS-VoF) project aims to provide as complete and holistic a package of
OVC care and support services as possible, by integrating activities and interventions across the PEPFAR domains of palliative
care. This project will directly provide psychological care in the form of psychosocial support (PSS) to OVCs and guardians,
spiritual care as part of home visits by trained community volunteers augmented by pastoral visits, social care comprising several
forms of prevention activities including OVC peer support groups (PSG) and broad-based community sensitization, as well as
assuring links to GOB-provided social services, food and education resources. The project will indirectly provide clinical care by
linking to the local health center in each project site for non-HIV health care, and its home-based care (HBC) outreach services for
HIV-related care and support.
Strategies to increase diagnostic coverage continue, and include routine health provider initiated testing and counselling (PITC)
for all children. With support from the Clinton Foundation, Masa recently completed an expert patient training pilot to improve
appropriate diagnosis and treatment for unidentified children beyond the reach of current clinics and referral centres. In FY2009
with the support from PEPFAR, the Ministry of Health (MOH) will continue to strengthen its pediatric activity and initiate through
Masa and the Botswana Harvard Project (BHP) the roll out of the Expert Patient support which will serve to identify children in
need of treatment and increase their access to care. The pediatric care and outreach will continue with a TBD partner. In addition,
both Baylor and a new partner in FY2008, the Children's Hospital of Philadelphia (CHOP), will pilot facility to community strategies
in selected sites to improve contact tracing for TB affected families, which will include introduction of facility-based sputum
induction to improve diagnosis, and community and referral strategies to improve follow up.
A Public Health Evaluation (PHE) will begin in FY2009 that will characterize stillbirth and early infant mortality rates in several
large sites in Botswana and determine factors associated with mortality in order to tease out the causes of the unacceptably high
infant mortality figures for Botswana. In addition, a Program Evaluation collaboration between the MOH and CDC-Botswana will
extract and analyze pediatric outcome data from the Masa Program in parallel with the routine evaluation carried out for the adult
program. It is hoped to strengthen this activity so that it becomes routine.
PEPFAR will also continue to support purchase of supplies for early infant diagnosis. In addition, through SCMS, training of health
workers will be conducted to strengthen infant formula supply chain management.
Table 3.3.10:
09.T.PT91: Technical Support Pediatric Treatment-Post
Table 3.3.11:
09.C.TB91: Technical Expertise and Support PC
This activity covers the salaries and travel for the technical staff in-country and TDY visits by colleagues
based in the US at HHS/CDC headquarters to provide support for the programs and activities, including
work with the Government of Botswana, at a total cost of $466,767. The cost of providing administrative
support (telephone, consumables, supplies and equipment) will be $5,000.
PEPFAR funds will be used to contract out the organization of a consensus workshop to finalize a national
medium-long term strategic plan for TB and TB/HIV control and of an annual conference of the BNTP, at a
combined cost of 30,000.
FY08 funds are requested to support contractual services to maintain and upgrade the electronic TB
register (ETR) and to develop a database for routine monitoring of anti-TB drug resistance, at a cost of
$90,000.
Continuing Activity: 17346
17346 10177.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $181,000
10177 10177.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $15,000
Table 3.3.12:
09.C.CT91: Technical Expertise and Support CT
activities, including work with the GOB. Also included are costs related to workshops and participation by
An additional staff member (locally employed) will be hired to provide technical and management support
for the counseling and testing program area. This position was approved in FY2007, but was has not yet
been filled. Position description is now being developed, and will be caged by the US Embassy Gaborone,
before advertising the position.
Continuing Activity: 17349
17349 10186.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $50,000
10186 10186.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $30,000
Table 3.3.14:
09.T.AD91: Technical Expertise and Support—ARV Drugs
CONTINUING ACTIVITY UNDER A PERFORMANCE PASS:
ONGOING ACTIVITY FOR WHICH NO ADDITIONAL FY2009 ARE REQUESTED
Continuing Activity: 17350
17350 10219.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $15,000
10219 10219.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $15,000
Table 3.3.15:
09.T.LS91 Technical Expertise and Support Post
Continuing Activity: 17352
17352 10264.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $100,000
10264 10264.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $100,000
Table 3.3.16:
09.X.SI91: Technical Expertise and Support - SI (Post)
This activity covers the salary of four experts including two additional staff members that will join the existing
team. One of the new staff will be an direct hire Full Time Equivalent and the other is a Locally employed
staff member. Costs cover salary, travel, and printing of technical materials to provide support for the
strategic information/ monitoring and evaluation activities including work with the GOB. Funding also covers
participation by staff in domestic and international conferences related to their work, contractual costs, and
TDY visits experts outside the USG agency.
Continuing Activity: 17353
17353 10321.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $100,000
10321 10321.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $207,000
Table 3.3.17:
09.X.SS91: Technical Expertise and Support
Continuing Activity: 17355
17355 10271.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $99,000
10271 10271.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $40,000
Table 3.3.18:
09.X.MS91: HHS/CDC Management and Support
This is a continuing activity from FY2008 and is supported with both GAP and GHCS (State) funds.
Funds requested between GHCS (State) and GAP accounts will support staff salaries/allowances and
related office support, including travel, communications, equipment, and miscellaneous procurement, etc.
Including all program area technical staff, PEPFAR supports 55 FTE positions. No new positions are being
requested for FY2009. Most of the operations staff is shared across three CDC Divisions working in
Botswana. An additional 22 individuals representing almost 7.0 full time equivalents provide some portion of
their time to support PEPFAR activities and are funded by either the Divisions of HIV/AIDS Prevention or
Tuberculosis Elimination. The following positions are currently supported with Management and Staffing
funding:
Country Director, USDH
Associate Director-Management and Operations, USDH
Associate Director, GAP, USDH
GAP Senior Administrator, USDH
Associate Director for Science, USDH
Communications Officer, contractor
Building and Design Coordinator, contractor
Program Specialist, contractor
Financial Chief, LES
Secretary, LES (3)
Receptionist, LES (2)
Administrative Assistant, LES (3)
Janitress/laborer (6)
Drivers, LES (3)
Program Assistant
CDC Management and administration (Headquarters)
In FY 2008 the Botswana estimates for administrative costs from Base Headquarters are $1,322,615.
These include salaries, benefits, travel, training and support for the Director, Deputy Director, Associate
Director for Global AIDS Program (GAP), GAP Senior Administrator, Associate Director for Science,
Informatics Specialist, the Informatics Section Chief, and communication officers. It also covers 30 days of
support to backstop the country Deputy Director during home leave/R & R by a staff person from CDC
headquarters and dollars for a Building and Design Contractor.
Support costs for the CDC Information Technology Services Office (ITSO) will be covered for 42
workstations in Botswana. ITSO has established a support cost of $3,250 per workstation and laptop for FY
2008 to cover the cost of information technology infrastructure services and support provided by ITSO. This
includes the funding to provide base level of connectivity for Gaborone and Francistown, connectivity to the
CDC global network, keeping the IT equipment refreshed and updated on a regular cycle, expanding the
ITSO Global Activities team in Atlanta and fully implementing the Regional Technology Services Executives
in the field. This is a structured cost model that represents what is considered as the "cost of doing
business" for this location. Also included are consumable IT supplies, equipment, maintenance and
repairs, telecommunications, international travel and training of IT staff not covered by ITSO.
CDC Management and administration (Post)
These funds support local management and staffing costs including local salaries, travel costs, training;
utilities and telecommunications for sites in Gaborone and Francistown; space, leases and warehousing;
security services; XTS500 handheld radios for Emergency Action Committee members; motor pool and
supplies, local printing, supplies and associated operational costs.
Local salaries this year will be higher than last year due to the anticipated transition to a pension plan. This
will require payout for employees formerly on the severance plan as well as a 15% employee annual
contribution to the pension plan.
Salaries are included for the requested new CDC FSN positions.
Continuing Activity: 17356
17356 10326.08 HHS/Centers for US Centers for 7732 5406.08 Local Base $1,420,385
10326 10326.07 HHS/Centers for US Centers for 5406 5406.07 Local Base $2,116,785
