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: 2008 2009
09.X.SI02: Qualitative Behavioral Study in Adults
ONGOING ACTIVITY FOR WHICH NO NEW FY2009 FUNDS ARE REQUESTED - LARGE PIPELINE
From COP08:
PHE: Qualitative behavioral study among adults to investigate the causes of decline of HIV prevalence
among youth in Botswana.
1.Title: Qualitative behavioral study among adults to investigate the causes of decline of HIV prevalence
among youth in Botswana
2.Summary: This is proposed as a 1-year formative research, with a total projected budget of $125,000.
3.Investigators: Stephane Bodika, MD, MPH (BOTUSA); Negussie Taffa MD, MPH , PhD(BOTUSA);
George W. Rutherford MD, MPH & Sandy Schwarcz MD (UCSF); others to be determined.
4.Project Description: for the past few years, a significant decline in HIV prevalence among youth has been
observed in Botswana. In an attempt to understand the causes of this prevalence decline, USG supported
MOH's DHAPC to conduct a qualitative behavioral study among youth initially. There are evidence that
intergenerational sex and multiple and concurrent sexual partnership in Botswana. This activity intends to
assess how adults' sexual behavior interferes in this declining HIV prevalence to allow holistic approach in
the designing or reinforcing effective prevention interventions in the communities. Between May 2008 and
August 2008, a to be determined partner (TBD) will assist BOTUSA and the MOH to implement this study
among a convenient sample of adult males and females in different districts with declining, stable and
increasing HIV prevalence. The study will consist of focus group discussions and in-depth interviews with a
sample of adults and will cover various topics including risk sexual behavior, multiple and concurrent sexual
partnership, condom use, transactional sex and intergeneration sex. It will cover also discussion with
discordant couples to unveil their sexual behavior and the potential risk this behavior represent to the youth.
Between December 2008 and March 2009, the TBD partner will assist with data analysis, report
preparation, and dissemination of results and recommendations.
5.Primary Research Question: What are the risk sexual behaviors adults indulge in which potentially affect
youth HIV infection? What is the dynamic of the intergenerational sex and its trends in districts with different
HIV prevalence? What is amplitude of transactional sex involving youth and its reasons? What are the
configuration of adults' sexual network and the importance of youth in this network?
6.Programmatic Importance: Understanding the adults' sexual behavior and the level of their involvement of
the youth in these behaviors is essential in order to develop and target effective prevention strategies.
Youth are a key group in which to assess basic knowledge of HIV transmission and related risk behaviors
because they are a vulnerable group, risk behaviors are often established during adolescence, and
prevention and educational efforts, if implemented prior to sexual debut can effectively prevent acquisition
of HIV. Studies have shown that girls enter into sexual relationships with older men (who are more likely
than younger men/boys to be HIV-infected) and the result is higher HIV prevalence in adolescent girls than
boys. Determining the prevalence of such behavior as well as the factors that contribute to this behavior
(such as the desire for having sex with virgins in exchange with items of monetary value from their older
sexual partners) can form the basis for intervention. Furthermore, prevention interventions targeting youth
will be enhanced by these targeting adults who have intergeneration sex with young people. By conducting
such study in different districts with different trends of HIV prevalence, the MOH will learn lessons about the
effectiveness of different interventions implemented in these districts targeting adults. This survey will inform
national quantitative surveys to really quantity the magnitude of the findings.
7.Methods: Focus group discussions will be organized with adults from different social strata (by
profession, education, gender…) in districts with declining, stable and increasing HIV prevalence among the
youth. The groups will be homogenous to facilitate full participation of all the members.
8.There will be an in-depth interview with a sample of community members selected by convenience. The
interview will help to closely follow up on the major themes with will emerge during the focus group
discussions.
9.Population of Interest: A convenient sample of adults from different social strata (by profession,
education, gender…) in districts with declining, stable and increasing HIV prevalence among the youth.
These districts will be the same like where the qualitative behavioral study among youth would have been
conducted through FY 07 funding.
10.Information Dissemination Plan: Between December 2008 and March 2009, the TBD partner will assist
with data analysis, report preparation, and dissemination of results and recommendations. The selected
partner will conduct a 1-day Data Use and Results Dissemination Workshop with key stakeholders in order
to disseminate result of this survey.
11.Budget Justification: Funds are required to support staff effort and travel to review and revise protocol
and data collection tools, obtain necessary ethical approvals from HRDC, and CDC, and to assist with
implementation of this PHE as follows:
Salaries/fringe benefits: $40.000
Equipment: $20,000
Supplies: $10,000
Travel: $20,000
Other: $35,000
Year 01 Total: $125,000 USD
New/Continuing Activity: Continuing Activity
Continuing Activity: 17901
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17901 17901.08 HHS/Centers for University of 8748 8748.08 UTAP $125,000
Disease Control & California at San
Prevention Francisco
Table 3.3.17:
09.X.SI04: HIV-Related Mortality Validation
ONGOING ACTIVITY FOR WHICH NO NEW FY2009 FUNDS ARE REQUESTED
The team has changed the funding mechanism for this activity to be UTAP from New CoAg, and the prime
partner from TBD to UCSF. (April 08 Reprogramming)
1.Title: Updating of HIV-Related Mortality Statistics & Validation of Cause of Death Data.
2.Summary: In order to clarify the accuracy of reported AIDS related mortality data in Botswana we propose
to conduct an assessment and validation of causes of child and adult mortality in Botswana in which we will
estimate the extent of over-or under-reporting or misclassification of mortality due to HIV/AIDS by
comparing death certificate coded cause of death with medical chart diagnoses. Through this work, we will
advise on improving the accuracy of mortality reporting and utilization of mortality statistics to improve public
health surveillance and policy decision making in Botswana. This project is expected to end in FY08 and
the two year cost is estimated at $150,000.
3.Investigators: UCSF Investigators: George W. Rutherford MD MPH, Rand Stoneburner MD, Sandy
Schwarcz MD, Gail Kennedy MPH; Tracy Creek MD (CDC/GAP-Atlanta). Local co-Investigators: Negussie
Taffa MD, PhD; Stephane Bodika MD, MPH (BOTUSA); Anna Majalantle & Diemo Motlapele (CSO),
Florindo Gomez MD (Botswana Ministry of Health).
4.Status of study/progress to date: In 2007, UCSF assisted team Botswana with the development of a
research protocol to update and collect all available HIV-related institutional mortality statistics, as well as
ART and PMTCT programmatic data from 1993 through 2006, in order to assess changes in HIV-related
mortality following scale up of ART and PMTCT programs, and estimate the degree of potential under-
reporting of HIV-related mortality in Botswana. A protocol to update, collect, and analyze mortality and
program through 2006 was approved by ethical review committees at UCSF, CDC, and HRDC in Botswana.
Further technical assistance to assist the MOH Central Statistics Office in coding, entering, and publishing
this data occurred. An amended research protocol for conducting de-identified patient chart review to
validate mortality data and describe the extent of potential misclassification of AIDS-related mortality was
drafted, reviewed by key stakeholders in Botswana and submitted for review and approval by respective
ethical review committees at UCSF, CDC, and HRDC in Botswana.
5.Lessons Learned: It's difficult to give full picture of lessons learned on this project as the progress so was
is limited to protocol development and preparing the background work of coding cause of death using ICD-
10. The later took quite some time in order to clear backlog of patient chart coding dating back from 2004 to
2006.
6.Information Dissemination Plan: Early in FY08, findings from the updated mortality and programmatic
datasets including overall trends, and correlations between infant mortality and PMTCT program uptake,
and adult mortality and ART program uptake will be shared with key stakeholders in a Dissemination
Meeting. This information is expected to update our understanding on the impact of HIV/AIDS on adult
mortality and the extent to which large scale ART can help curb this. Likewise the impact of high PMTCT
program uptake on infant and child mortality over time will be assessed.
7.Planned FY08 activities: Detailed analyses of updated mortality datasets on trends, and correlations
between infant mortality and PMTCT program uptake, and adult mortality and ART program uptake;
8.Findings from these analyses will be shared with key stakeholders during a Dissemination Workshop
9.Following the Dissemination Workshop, abstracts will be developed for presentation at local and
international meetings;
10.Data collection for the Cause of Death Validation Study will be completed, and preliminary results will be
reviewed with all Investigative staff.
.
11.Budget Justification: In the second year of this 2-year effort, funds will be required to support staff effort
and travel to conduct final analyses on updated mortality data as described, attend a Dissemination Meeting
in-country to present findings, and plan for the development of abstracts and manuscripts; to assist with
data collection and analysis of the Mortality Validation Study as outlined for this PHE as follows:
Salaries/fringe benefits:$26,000
Equipment: $14,000
Supplies: $20,000
Tavel: $25,000
Contractual Costs: $15,000
Other:$50,000
Year 01 Total: $150,000 USD
Continuing Activity: 17903
17903 17903.08 HHS/Centers for University of 8748 8748.08 UTAP $150,000
09.X.SI03: Behavioral Survey among High School Students
ONGOING ACTIVITY FOR WHICH NO NEW FY2009 FUNDS ARE REQUESTED - DELAYED
IMPLEMENTATION
We have changed the funding mechanism for this activity to be UTAP from New CoAg, and the prime
1.Title: Baseline behavioral surveillance survey among high-school students in Botswana.
2.Summary: This is proposed as a 2-year PHE effort, with a total projected budget of $350,000 and a year 1
budget of $200,000.
others to be determined.
4.Project Description: In 2007, the MOE in Botswana conducted a consensus building workshop to plan for
a national surveillance study of HIV-related knowledge and behaviors among high school students.
Consensus meetings were convened in-country, and draft protocols, procedures, and survey instruments
were prepared. Between April 2008 and March 2009, a yet to be dermined partner will assist BOTUSA and
the MOE to implement a baseline cross-sectional survey of HIV-related behaviors among a sample of male
and female high-school students enrolled in 9-12th grades in Botswana. Between April 2009 and March
2010, the partner will assist with data analysis, report preparation, and dissemination of baseline results and
recommendations for continued annual administration of this surveillance exercise so that national
behavioral trends among youth in Botswana can be observed prospectively.
5.Primary Research Question: What are the baseline levels of knowledge of HIV transmission and the
baseline sexual and other risk behavioral patterns among currently enrolled high school students in
Botswana?
6.Programmatic Importance: Understanding the prevalence of HIV risk behaviors in populations at risk for
HIV is essential in order to develop and target effective prevention strategies. Youth are a key group in
which to assess basic knowledge of HIV transmission and related risk behaviors because they are a
vulnerable group, risk behaviors are often established during adolescence, and prevention and educational
efforts, if implemented prior to sexual debut can effectively prevent acquisition of HIV. Studies have shown
that girls enter into sexual relationships with older men (who are more likely than younger men/boys to be
HIV-infected) and the result is higher HIV prevalence in adolescent girls than boys. Determining the
prevalence of such behavior as well as the factors that contribute to this behavior (such as the desire for
obtaining items of monetary value from their older sexual partners) can form the basis for intervention.
Furthermore, risk behaviors serve as an early marker of HIV incidence, that is, the risk behaviors precede
HIV acquisition. In addition, this activity will assist the MOE to follow trends in risk behaviors, which is a
method of predicting HIV incidence and to assess the impact of different HIV prevention programs targeting
youth implemented in school in Botswana. Thus, providing information on the required modifications in the
design of current prevention programs or mandating the design of new ones.
7.Methods: A three stage multi-cluster sampling strategy will be used to obtain a representative sample of
high school students. The first stage will be identifying primary sampling units which will consist of provinces
(cities, or other reasonable unit) that will be categorized into X strata based on degree of urbanicity (and any
other meaningful measures so that all areas are represented in the sample). A sample of X schools within
each strata will be sampled using probability proportionate to size. Within each school, X classrooms will be
randomly selected and all students within these classrooms will be asked to complete a written anonymous
survey. The classrooms should be selected to ensure that they are required courses. The analysis will be
weighted based upon demographics (e.g. sex) and applied to each record. The weights will be scaled so
the weighted count of students will equal the proportions of students in each grade to match national
population proportions.
8.Population of Interest: A representative sample of X high school students selected from X districts in
Botswana.
9.Information Dissemination Plan: Between April 2009 and June 2009 (year 2 of this PHE) a 10-day Data
Use and Results Dissemination Workshop will be conducted with key stakeholders in order to disseminate
baseline results, and to review recommendations for continued annual administration of this surveillance
exercise to support future surveillance activities among High School student on an annual basis.
10.Budget Justification: In Year 1 of this 2 year effort, funds will be required to support staff effort and travel
to review and revise protocol and data collection tools, obtain necessary ethical approvals from HRDC, and
CDC, and to assist with implementation of this PHE as follows:
Salaries/fringe benefits: $80,000
Equipment: $15,000
Travel: $30,000
Other: $65,000
Year 01 Total: $200,000 USD
Continuing Activity: 17902
17902 17902.08 HHS/Centers for University of 8748 8748.08 UTAP $200,000
