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
Transitioned from BOTUSA into a local Non-governmental organization (NGO) in 2004, Tebelopele's goal is to make a critical difference in HIV prevention in Botswana by expanding the coverage and accessibility of high quality, same-day, confidential and Voluntary Counseling and Testing (VCT) services. TVCT's goals and objectives are aligned with the Botswana National Strategic Framework (NSF).
Goals and Objectives
- To prevent HIV infection among Youth
- To position VCT as a key public health goal and an entry point for a healthy life
- To position Tebelopele as a reliable, high-quality option for VCT services
- Ensuring the sustainability of TVCT services
Major Activities
- Building on its success in providing quality VCT services over the years, TVCT will use PEPFAR 2010 funds to support salary of 240 staff to continue delivering Voluntary Counseling and Testing (VCT) services in partnership with the Ministry of Health (MOH) and others.
- Funds will support outreach services, community mobilization and social marketing activities. Procurement of essential backup HIV test kits and supplies will to support expanded coverage and accessibility of services to children and adolescents, the deaf, Most-At-Risk Populations (MARPS), couples and men.
- Funds will be used to provide supportive counseling, Post Test Clubs (PTCs), TB screening of VCT clients, and strengthening referral linkages will also be supported. HIV prevention messages, counseling and referral will be provided for Safe Male Circumcision (SMC), prevention for discordant couples, reduction of multiple concurrent partnerships (MCP), and other risk reduction strategies.
- The TVCT HIV Training Initiative, accredited in 2009, will provide in-service courses in peer education, lay counseling and Couples Counseling and Testing (CHCT).
- Funds will support 2 sub-partners (Humana People to People and Botswana Christian AIDS Intervention Program) to provide youth VCT and conduct training of traditional healers on HIV/AIDS and referral strategies.
Geographic Coverage
TVCT centers are distributed countrywide, with 16 free standing and 26 satellite sites, and cover all the 28 health districts. TVCT covers more than 90% of villages and more than 60% of all the settlements in the country. Sites are situated in such a way that over 80% of the population is within a 50km radius.
Target population
The general population (below and above 15 years of age), males and females; couples, men, youth, children, MARPS, the deaf and pregnant mothers referred for Prevention of Mother to Child Transmission of HIV (PMTCT) services. TVCT will reach 120,000 individuals with VCT. Of these, 16,000 will be in couples, 7000 individuals will be reached with supportive counseling, 90,000 individuals will reached with prevention messages with at least 50% of these being men.
Making the Most of HIV Resources
GoB provides most of TVCT's HIV test kits, condoms and Information Education and Communication materials. TVCT will capacity build 6 CBOs in VCT service provision thus expanding reach to remote areas and reducing outreach cost.
TVCT will form and consolidate partnerships with the private sector and the District Multi Sectoral AIDS Committee (DMSACs) to leverage outreach resources while strengthening linkages.
TVCT will work with the following partners
Twinning program with American International Health Alliance (AIHA) in NGO capacity-building Community Based Organizations (CB)s).
Zebras4Life, Test4Life Project for mobilizing men to test
Involving Youth Against AIDS (YAA) volunteers with support from the Ministry of Sports Youth and Culture
DMSACs to make combined outreach trips, thus reducing transport costs
TVCT will leverage funds
Some staff time will be compensated with funds from projects for construction of Dikgathong dam and Tlokweng road.
Internal efficiencies will be improved
All vehicles will be equipped with tracking devices to enhance controls and efficient usage.
Supply Chain Management System (SMC) strategies will be implemented in the tracking and controls of HIV test kits
Multitasking (e.g. redeploying receptionists to provide counseling) will be introduced, thus lowering the use of part-time counselors
Community and Youth Against AIDS (YAA) volunteers and Post Test Club members will be utilized for mobilization
Partnering with local clinics for combined mobile outreach
Disposal of aged and high maintenance vehicles
Implementing fee-for-service for specific services to private organizations
Training more counselors on issues of MCP, SMC, Anti Retroviral Therapy adherence, TB screening, child counseling and PMTCT.
Conducting fund-raising for the YAA program
Pursuing opportunities for supplying specialized M&E and medical information services together with Satelife.
Cross-Cutting Areas
TVCT will support activities for increasing women's equity and addressing male norms and behaviors in VCT and PMTCT, intensified verbal TB screening and referral for assessment and treatment.
Twenty-five sex workers in the Kasane will be assisted to start sustainable income-generating activities in collaboration with RTI International.
Through the Zebras4Life project, more men will be reached with MCP messages and SMC counseling and referral.
TVCT will continue collaboration with its partners to provide workplace VCT services in the mines, construction sites and other workplaces.
Monitoring and Evaluation
TVCT implements a well established M&E system, and will capture the PEPFAR NGIs and the country-level indicators.
TVCT has data-collection tools which have been approved by CDC and has successfully introduced the use of PDAs to capture data accurately and report in a timely manner.
TVCT has been trained in SCMS logistics-monitoring tools and systems to tract HIV test kits and supplies.
TVCT will work with prevention and palliative-care programs to report on their respective indicators for which TVCT provides services and collects information.
M&E tools are designed to allow session-type specific information and the incorporation of emerging issues (such as those involving disabled persons and Most-At-Risk Populations.)
Site visits will be undertaken to ensure data systems function, and to address data issues at collection points.
10.C.AC10: Tebelopele - Prevention with Positives - 600,000.00
Tebelopele has a wide reach with 16 standalone sites throughout the country. We are placed such that 80% of the population is within a 50km radius from a Tebelopele site. This geographic proximity makes it easier for a pool of people to access services. Although our counseling focus has been in HIV counseling and testing, the number of clients visiting the centers presenting with a combination of factors has been increasing as such we have put measures in place to accommodate general psychosocial support in a more systematic manner. We offer targeted counseling and supportive counseling services to couples, men and women and children/adolescents. 75% of TVCTC clients test HIV negative the few that test positive have an opportunity to come back for supportive counseling. It is however worth mentioning that HIV negative clients are given an opportunity to come back for supportive services: these are mainly clients who although tested HIV negative have risk factors that put them at a greater susceptibility for HIV infection. Supportive counseling clients are identified during post test counseling by counselors and lay counselors though services that are provided by qualified counselors. As for lay counselors they identify clients who will benefit from such a service and make referrals to the more qualified counselors. Post test clubs keep communities mobilized.
POST TEST CLUBS Post Test Clubs are an initiative whereby people who have tested for HIV, whether positive or negative, meet together regularly to share experiences, information and insights, and to support one another regarding challenges that some maybe facing. The PTCs are semi formal facilitated meetings that are aimed at addressing issues and topics that are of interest to the members with the overall objective of enhancing prevention of HIV transmission, as well as to promote utilization/access to the available relevant post test services including treatment, care and or supportive services. PTCs also serve to provide information and support for those who have tested and are still dealing with issues of disclosure to partner and/or family and adherence to personal risk reduction plan. Ultimately PTCs are an extension of the gateway to prevention, treatment, care and support through which the members may be referred for services like ongoing supportive counseling and clinical assessment for treatment.
YAA The YAA Lay counselors are deployed in various secondary schools where they assist to reach adolescents and youth with timely guidance into supportive counseling services where need arises. This strategy is effective in that troubled young people especially those living with HIV/AIDS have fundamental distrust of adults and thus more comfortable with younger individuals to confide in.YAA volunteers are widely accepted by the school counseling and guidance unit as an invaluable resource.
DISTRICT MULTI-SECTORAL AIDS COMMITTEES Tebelopele has engaged the District Multi-Sectoral AIDS Committees (DMSACs) in building strong referral linkages at all their center locations in the country. They continued use of the referral form, track of referrals, and hold regular referral network meetings with service providers in each district. Screening of all clients for TB using a questionnaire was introduced in 2007. Any clients reporting any of the TB symptoms were referred to government clinics for evaluation. In addition, post-test clubs and supportive counseling were introduced.
FY10 plans Referrals and linkages will be augmented by using Post-Test Clubs and the Youth Against Aids (YAA) Volunteers to track clients tested at Tebelopele and referred for services. Tebelopele will work with HPP to create community-based referral linkages, and to continue the involvement of traditional and spiritual healers in prevention and referrals. Pregnant women will be referred to the Cervical Cancer Unit and to the PMTCT program.
The Tebelopele VCT centers will continue to rollout the Supportive Counseling program initiated in FY2007, by providing Post Test and Supportive Counseling Services to those who test negative and positive, both at Tebelopele VCT sites, as well as Provider Initiated Sites. Tebelopele now provides supportive counseling at its fixed sites, with a package of services that includes TB suspect screening, testing of family members, disclosure, discordant couples, education and prevention for positives.
To strengthen capacity and improve quality of services, Tebelopele will train its counselors and VCT site managers in various aspects of supportive counseling and, in particular, couples counseling.
10.C.CT01: Tebelopele - VCT Network - 6,000,000.00
Tebelopele (TVCT), a local NGO, provides high quality, same-day, confidential HIV testing and counseling services through 46 service points nationwide. TVCT uses a HIV testing algorithm that consists of two rapid test kits running simultaneously, with Ora-quick HIV 1/2 for indeterminate results. When the results are clear, the testing process takes 15-20 minutes. The ACTS (Assess, Consent, Test, and Support) counseling protocol has been adapted for use at all sites. To take advantage of client waiting times before seeing a counselor, pre-counseling group education sessions are offered. For clients that receive this information, the counseling session is shortened.
While all TVCT tests are client-initiated, nearly 40% of tests come as a result of a campaign or special event, mostly through youth activities and soccer matches. TVCT performs about 50% of all HIV tests in the country annually. Outreach services are provided in hard-to-reach areas. Couples counseling and testing services are provided in collaboration with the Ministry of Health and the office of the District Commissioner, which conducts marriages every Thursday. TVCT's post-test services include on-going supportive counseling, post-test clubs and TB screening (through the use of a questionnaire). In FY08 and FY09, TVCT introduced counseling supervision, with mentorship from Liverpool VCT, and in FY10, this activity will be rolled out to other CBOs. Six community-based organizations will also be supported to expand VCT services in remote areas as a more cost-effective intervention than sending TVCT staff to these locations.
Even though TVCT services are open to anyone, specific target populations include couples, adolescents and youth (ages 15-29), men, and most at-risk populations, specifically sex workers and truck drivers in high construction and tourist areas. TVCT also reaches these groups with prevention messages through radio and sports activities. In FY10, TVCT will: (a) provide VCT to 120,000 individuals, including 16,000 couples; (b) reach 90,000 individuals with prevention messages; and (c) offer on-going supportive counseling to 7,000 people.
Recognizing the need to strengthen the referral process, TVCT will make efforts to bolster this aspect of their program in FY10. Referral buddies, who accompany a referred client to government sites, have been introduced and will be rolled out nationwide. Referral slips will continue to be used and mechanisms have been put in place to collect them from various partners for cross-matching to monitoring successful referrals. TVCT centers provide confidential VCT services, a change that enables follow-up of clients between the test and clinical sites. Most clients provide their names and national identification number (omang). The omang is a unique identifier that allows for data interlink with other providers. Traditional healers in Kweneng West district have been trained to refer their clients for VCT and other HIV/AIDS services. Referral cards are used to track and monitor the performance of this activity.
To improve on data quality, personal digital assistants (PDAs) are currently used in all TVCT centers and are utilized during outreach activities to ensure data accuracy and security. TVCT also participates in internal/external quality assurance mechanisms as per national standards.
