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.
Context
Started in 2002, the Masa Program is currently supporting more than 108,288 (Aug 09) ART patients at 32 ART sites and their 109 satellite clinics (Aug 09). There are currently 138 satellite clinics countrywide. Constraints that will continue to impede the Botswana Government's plans to provide treatment and care to an estimated 125,000 patients in 600 ART treatment sites by 2013 are: shortage, turnover, and attrition of qualified health professionals; lack of coordination among HIV/AIDS-related programs, limited capacity to conduct timely CD4 and viral load testing; and an inadequate system of tracking and monitoring ART patients.
Goals and Objectives
The goal of the project is to support the Masa program and its current 32 sites and their 138 satellite clinics and future ART sites by: 1) developing a sustainable capacity in clinical care and treatment of HIV/AIDS patients through training, on-site support, and roll out of facilities; 2) developing a sustainable capacity in CD4, viral load, and other lab testing, and supporting countrywide decentralization of laboratories; 3) establishing a Monitoring and Evaluation (M&E)Unit to track ART patients and monitor the progress and effectiveness of the Masa program; and 4) implementing and operationalizing a fully functional Botswana-based NGO, Botswana Harvard Project (BHP), whose governance is shared between the Botswana Ministry of Health and Harvard to ensure PEPFAR sustainability.
Major Activities
Activities prior to FY10
In FY06, the Clinical Master Trainers' pharmacists, physicians and nurse/midwives conducted needs and pharmacy assessments, training in ART care and treatment, Nurse Dispensing and Prescribing, on-site and/or telephone support at 29 ART sites and 95(by Sept 09) satellite clinics.
BHP set up treatment failure management registries and pilot of Universal Highly Active Antiretroviral Treatment (HAART) in 4 sites (hospital, supporting clinics and feeder health posts).
Quality Assurance Initiative (QAI) activities continued to be integrated into site support.
The Laboratory Master Trainers collaborated on production of a laboratory training manual and provided training and follow-up support for 23 laboratories in CD4 and 10 laboratories in viral load testing. Decentralized labs performed 55% and 29% CD4 and viral load tests respectively countrywide this year.
The Monitoring and Evaluation Unit of Masa provided consolidated monthly reports, conducted data training and data audits, upgraded, piloted,, and rolled out a SQL-server-based electronic application (PIMS II), and provided a data set QOL.
BHP was operationalized as a Limited Liability Corporation (LLC) in Botswana on September 1. 2009. BHP applied for and was awarded two PEPFAR Cooperative Agreements as well as other USG and non-USG awards.
Activities in FY10
The Clinical Master Trainers will continue to provide training and support in HIV/AIDS treatment and care to all ART sites and their satellite clinics with specific training and support for nurse prescribing and dispensing, QAI, and pediatric scale-up.
BHP will continue to develop training materials; and collaborate to integrate Prevention of Mother to Child Transmission (PMTCT), TB and other HIV/AIDS-related activities.
The Laboratory Master Trainers will continue to provide training and support in, CD4 and viral load testing at the decentralized labs; provide new training in hematology, chemistry, microbiology, lab data management, reagent logistics, and QAI; and provide Rapid HIV and Dry Blood Spot testing training for lay counselors.
The M&E Unit will complete deployment and training on PIMS II, to ARV sites; refine and expand indicators and management tools, especially for PMTCT; integrate functions of the national system, and establish IT support to the department.
BHP as an LLC will be fully operationalized.
By the end of FY10, all established ART sites will have received training and support through the Clinical Master Trainer, Lab Master Trainer, and Monitoring and Evaluation Unit programs.
Enhancing Sustainability
All activities of the Harvard Botswana PEPFAR grant will be fully transitioned to the BHP LLC and will continue to apply for future funding
Monitoring and Evaluation
The M&E Unit will develop systems to monitor the national ART program and provided reports and analyses to inform the Government of Botswana in HIV/AIDS care and treatment policies.
10.C.PC01: BHP - Pediatric Care and Outreach Support - 230,000.00
The PEPFAR team is involved in the expansion and decentralization of pediatric HIV care and training to peripheral ARV facilities. BHP-PEPFAR will continue to support capacity building in all segments of pediatric HIV/AIDS treatment and care through the updating of the knowledge of best practices, the provision of pediatric clinical training, and the mentoring and support of health care personnel to ensure that the minimum required standards of care are continually met.
Given the high rate of TB infection among HIV-infected patients, the PEPFAR team will train health care workers on routine HIV testing (RHT) services for children presenting in all facilities through awareness training to facilitate early identification of HIV/TB co-infection.
With HAART available, more HIV infected children are entering into adolescence and lately, issues relating to adolescent care have assumed prominence. Although there are no clearly defined adolescent care guidelines, currently limited adolescent-focused programs exist to address this emerging need. The PEPFAR team in collaboration with other stakeholders aims to:
a. develop a framework that comprehensively addresses adolescent HIV/AIDS care by empowering health care providers through training.
b. provide clinical mentoring and support of the adolescent ART program.
c. review existing services (psychosocial, nutritional, educational and medical) available for adolescents.
d. improve access to these services and other existing community-based resources and programs.
Consistent good nutrition for children requires support. The annual average malnutrition rate in the last three years is 5% with marginal improvement over this period. Addressing the challenges of malnutrition in the country requires:
a. a review of existing guidelines on pediatric nutrition.
b. increased awareness and training of care givers, health care workers, the community and other stakeholders, such as NGOs, in the guidelines and the indicators of malnutrition in HIV settings.
Another area of concern is care for orphans and vulnerable children which can be improved by:
a. strengthening the linkages in care within the medical, psychosocial, and nutritional realms.
BHP is committed to building partnerships and linkages. The MOH as primary coordinator and BHP as primary implementers of the program will ensure that the linkages with other relevant training partners avoid duplication of services and resources.
10.T.PT01: BHP - Pediatric ART treatment - 200,000.00
CONTINUING ACTIVITY UNDER PERFORMANCE PASS: ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: The TBD organization is expected to develop a sustainable training capacity in clinical care and treatment of HIV/AIDS patients, expand CD4 and viral load laboratory testing to decentralized laboratories, and strengthen the Ministry of Health's (MOH) Monitoring and Evaluation (M & E) capacity to assess the effectiveness of the national anti-retroviral (ARV) program, Masa. In FY07 and FY08, the Clinical Master Trainer (CMT) program trained a total of 492 health personnel on ART service delivery and 635 on palliative care service delivery. It also supported and mentored staff at 18 hospitals and 39 satellite clinics. The Laboratory Master Trainers have, so far, been able to train a total of 22 laboratory technicians and have supported and mentored staff at approximately 22 facilities, 15 of them were decentralized sites. The M & E results indicated that there were 32 sites reached, 59 data entry clerks (DEC) trained, a data warehouse developed with the ongoing integration of Masa and DHIS, and a data security and confidentiality system with encrypt and decrypt completed. The TBD organization is expected to have a three pronged approach to using the Master Trainer model, which will include Clinical Master Trainers, Laboratory Master Trainers, and M & E technical advisors. The Clinical Master Trainers will continue to: (1) do task shifting, in this case, the training of nurse dispensers and nurse prescribers; (2) train health care providers on QAI, implement QA activities at the ART site level, and provide QAI training for district/site leadership cadres; (3) provide CME at the district level and telephone site support; (4) continue the development of training materials, SOPs, guidelines, memos, checklists and other tools for care and treatment sites. B) The Laboratory Master Trainers will continue to: (1) support the established CD4 and VL decentralized laboratories and expand training to include hematology, chemistry and microbiology support; (2) formalize the training manuals on CD4, VL, hematology, chemistry and microbiology, including TB, in collaboration with the MOH and HHS/CDC/BOTUSA; (3) train staff on LIS issues, laboratory data management, reagent logistics and quality assurance at decentralized laboratories/sites. C) The M & E Unit within Masa will continue to: (1) refine and expand indicators and management tools; (2) replace PIMS (Masa) and roll out the new system to all PIMS locations; (3) integrate functions of, for example, PMTCT, and integrate into all other national systems, for example, DHIS; (4) train end users on the new systems; (5) establish a support desk and use DEC to perform vital roles; and 6) conduct a targeted patient evaluation study on medication adherence.
10.C.TB18: BHP pediatric HIV/TB management - 107,500.00
The diagnosis of tuberculosis in children has always been a challenge. To improve the management of children with TB and TB/HIV co-infections, the BHP will collaborate with the National TB Program (and other stakeholders) to: a. review and refine the existing screening algorithm for TB diagnosis in children, and review and provide current information, education and communication materials for adolescents and parents of children with TB/HIV co-infection. b. provide training for health care workers on routine HIV testing (RHT) services for children presenting with TB in all facilities through awareness training to facilitate early identification of HIV co-infections. c. provide training of health care workers on pediatric TB case management. d. undertake joint support supervisory visits for M & E. e. improve logistical support. f. decentralize pediatric training and care efforts, which have been concentrated mainly in hospitals, through the BHP Master Trainer Team who are currently involved in the expansion and devolving of pediatric training and support to peripheral facilities. g. facilitate training of laboratory personnel on TB microscopy at peripheral labs. h. integrate pediatric TB care with community support mechanisms.
