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
This activity is part of a broad four-year project launched in FY05 to build a local response to HIV/AIDS in
underserved rural areas, where 60% of Côte d'Ivoire's population lives, much of it functionally illiterate. The
project is expanding access to HIV/AIDS prevention, care, and treatment and improving links to health,
social, and education services, accompanying expansion of these services as national programs scale up.
The implementing consortium brings together and applies the expertise of:
- The National Agency for Support to Rural Development (ANADER) for rural community mobilization and
HIV prevention based on participatory risk-mapping and village HIV/AIDS action committees
- The Network of Media Professionals and Artists Fighting Against HIV/AIDS (REPMASCI) for BCC,
including local outreach and radio, training, and use of its lexicon to communicate about HIV/AIDS in 16
local languages
- PSI-CI for HIV counseling and testing activities, including training and CT promotion, and procurement for
palliative care
- ACONDA-VS CI for health-provider training in CT, PMTCT, and PLWHA support, as well as palliative-care
provision and referral to ARV treatment
MSD Interpharma and the HIV/AIDS Alliance are providing technical assistance.
In the program area of AB, FY08 funds will be used to continue and strengthen FY07 activities in six
departments (Dabou, San Pedro, Abengourou, Tanda, and, starting in FY07, Soubre and Daloa). These
activities, implemented through village HIV/AIDS action committees in 24 village sites per region, draw on
ANADER's risk-mapping approach, which includes segmenting village populations to allow young women,
young men, older women, and older men to discuss sexuality and HIV-related risks and risk-reduction
strategies separately and together. Local HIV/AIDS action committees and community counselors will be
supported, with the help of JHU/CCP, in applying culturally appropriate BCC strategies, curricula, and
educational materials with abstinence, faithfulness, and gender-based violence-prevention messages.
Specific programs will be developed for and with youth groups, with an emphasis on vulnerable girls and
young women. Within the ANADER project, community counselors will also link HIV prevention with
promotion of HIV counseling and testing (through the project's mobile CT units and fixed-site CT services at
rural health centers) and with provision of palliative care services and OVC care and support.
Activities include coordinated BCC campaigns mediated by influential figures and peers and designed to a)
delay sexual debut among youth, b) decrease number of sexual partners and c) promote mutual fidelity with
knowledge of one's own and one's partners' serostatus. Use of methods of proximity (debates, sketches,
videos, peer education, traditional events, etc.) in the community, schools, sporting fields, mosques, and
churches are reinforced by radio in local languages. Traditional and religious leaders are empowered
through tools such as the HIV/AIDS lexicon and use of participatory approaches to lead communities to
address HIV/AIDS in their socio-cultural context, including addressing issues of negative gender attitudes
and HIV-related stigma and discrimination. ANADER works with teachers to reach youth in primary and
secondary schools, drawing on Ministry of Education (MEN) life-skills materials and approaches.
Project activities complement and build on other initiatives, including PEPFAR-funded efforts, such as
Ministry of AIDS and JHU/CCP activities to develop effective BCC approaches and mobilize faith-based
communities and opinion leaders; MEN and Ministry of Family and Social Affairs activities in support of
youth and OVC; CARE International and Alliance Cote d'Ivoire support for CBO/FBOs and PLWHA; and
MOH and EGPAF/ACONDA support for expanded PMTCT, CT, and treatment. Activities are coordinated
through relevant village, district, regional, and national forums.
Activities conducted with FY05, FY06, and FY07 funds include:
- Identification of 144 village sites (each serving multiple surrounding villages) for intervention
- Baseline needs assessments in the six departments
- Training of 130 ANADER staff in AB-targeted prevention
- Training of 30 ANADER workers/facilitators (five per department) and 432 community counselors (three
per village site) in use of the local-language HIV/AIDS lexicon and AB-targeted prevention
- Training of 144 schoolteachers (one per village site) in AB-oriented prevention
- Training of 12 local radio announcers (two per department) in AB prevention, with REPMASCI providing
the training and drawing on IRIN/JHU/CCP materials
- Delivery of video campaigns with community mobilization (at least one per village) and prevention
campaigns on local radio (at least two per village)
- Creation of linkages among village action committees and agricultural cooperatives by involving members
of cooperatives in village action committees
- Broadcast of radio spots and radio programs with AB prevention messages in all six departments
- Training for schoolteachers and development, with technical assistance from JHU/CCP, of the Sports for
Life program with youth organizations in all six departments
In FY08, AB activities will be guided by quantitative and qualitative assessments conducted in FY06 and the
2005 national AIDS Indicator Survey. To expand AB and other prevention and care activities, ANADER will
expand the number of community counselors per village site from three to five. ANADER will continue to
work with schoolteachers and youth associations and will work to build REPMASCI's sustainable
organizational capacity and ability to identify and creatively meet the needs of rural families, particularly
women and youth without access to mass media, for HIV and other health-related information.
Activities supported by FY08 funding will reach 150,000 people (including 90,000 youth (60%) with A-only
messages) through community outreach that promotes AB-oriented prevention and will train 158 people to
promote AB-oriented prevention.
Specific activities with FY08 funds will include:
1. Training of 10 ANADER facilitators (five per department beginning activities in FY07) and 288 community
counselors (two new CC per village site in the 144 villages to increase the number of CC to five per village
site) in use of the local-language HIV/AIDS lexicon, AB-targeted prevention, and stigma reduction
2. Training of 144 schoolteachers (one per village site in all six departments) in AB-oriented prevention
3. Training of 720 village community counselors in their functions
4. Training of four local radio announcers (two per new department) in AB prevention; REPMASCI will
provide the training, drawing on IRIN/JHU-CCP materials
Activity Narrative: 5. Delivery of at least 48 video campaigns (one per new village) and at least 96 prevention campaigns (two
per new village) on local radio
6. Creating linkages among village action committees and agricultural cooperatives by involving one or two
members of cooperatives in village action committees
7. Broadcast of AB prevention spots (1,920 emissions in the six departments) and educational programs
(156 emissions) on local radio
9. At least one video campaign in each village (a total of 144 video film projections in the six departments)
10. Piloting of using HIV-positive mothers as counselors and "accompagnateurs" for pregnant women and
new mothers identified as HIV-positive
11. Production of educational materials on AB prevention (targeting rural cultural practices) and drug use
among youth, with assistance from JHU/CCP.
Activities will strive to build capacity among CBOs and village and district HIV/AIDS action committees to
achieve local ownership and sustainability. Training of community counselors (members of village HIV/AIDS
action committees) and rural health center staff and initiation of income-generating activities are designed to
enable communities to carry on palliative-care activities after PEPFAR funding for the project has ceased.
- ANADER for community mobilization and HIV prevention based on participatory risk-mapping and village
HIV/AIDS action committees
including training, local radio and community outreach, and use of its lexicon to communicate about
HIV/AIDS in 16 local languages
- ACONDA-VS CI for health-provider training in CT, and PLWHA support, as well as palliative-care
In Condoms and Other Prevention, FY08 funds will be used to continue and strengthen FY07 activities in
six districts (Dabou, San Pedro, Abengourou, Bondoukou, and, starting in FY07, Soubre and Daloa). These
ANADER's risk-mapping approach. Traditional and religious leaders will be empowered through tools such
as the HIV/AIDS lexicon in local languages and use of participatory approaches to lead their communities to
address HIV/AIDS, including addressing intergenerational sex, gender inequity, and HIV-related stigma and
discrimination. Local HIV/AIDS action committees and community counselors will be supported in applying
culturally appropriate BCC strategies and materials with messages about abstinence, faithfulness, and
prevention of infection through other safe practices.
Activities include coordinated BCC campaigns mediated by influential figures and peers. Use of methods of
proximity (debates, sketches, videos, peer education, traditional events, etc.) in the community, schools,
sporting fields, mosques, and churches are reinforced by radio in local languages. Traditional and religious
leaders are empowered through tools such as the HIV/AIDS lexicon and use of participatory approaches to
lead communities to address HIV/AIDS in their socio-cultural context, including addressing issues of
negative gender attitudes and HIV-related stigma and discrimination. ANADER works with teachers to reach
youth in primary and secondary schools, drawing on Ministry of Education (MEN) life-skills materials and
approaches.
Activities complement and build on other PEPFAR-funded initiatives, such as Ministry of the Fight Against
AIDS and JHU/CCP activities to develop effective BCC approaches; Ministry of Education and Ministry of
Family and Social Affairs activities in support of youth and OVC; CARE International and Alliance Cote
d'Ivoire support for CBO/FBOs and PLWHA; and Ministry of Health and EGPAF/ACONDA support for
expanded PMTCT, CT, and treatment. Activities are coordinated through village, district, regional, and
national forums.
The project trains action committee members and community counselors to provide information to adults
about the correct and consistent use of male and female condoms as part of a comprehensive HIV/AIDS
prevention package that also includes behavior-change communication promoting delay of sexual debut
among youth, partner reduction, and mutual fidelity with knowledge of one's own and one's partners'
serostatus. The project supports or helps establish condom vending points at sites selected by the village
action committees. An initial supply of male condoms is provided free of charge, and a restocking structure
ensures that the adult community has a continuous supply of condoms.
Other Prevention linkages with the project's CT services (at rural health centers and through mobile CT
units) emphasize testing for couples. HIV-positive people are provided counseling and access to support
groups of PLWHA, which focus on secondary prevention messages and healthy lifestyles, drawing on RIP+
(network of PLWHA organizations) expertise and materials. Community counselors work with support
groups to facilitate PLWHA disclosure of their status to optimize protection of HIV-free partners and
encourage psychological support through the family. Community outreach events (e.g. video projections
with community discussion) address barriers to CT and disclosure, including stigma. Existing tools such as
films on PLWHA testimonials support communication activities to promote acceptance and minimize stigma.
Discordant couples are a target population for prevention counseling, CT promotion, and free condoms; it is
estimated that 20,740 male condoms will be distributed in FY08 to discordant couples. Community
awareness sessions will deal with reducing other risk factors for HIV infection, often revealed during risk-
mapping sessions, such as sharing knifes and razors for male circumcision, female genital mutilation, and
scarification. Whenever possible, traditional "doctors" and midwives will be trained, based on materials
developed by JHU/CCP, to reduce the risk of HIV infection through unsafe practices. The project will work
to build REPMASCI's sustainable organizational capacity and ability to identify and creatively meet the HIV-
information needs of rural families, particularly women and youth without access to mass media.
Within the ANADER project, community counselors will also link HIV prevention with promotion of HIV
counseling and testing (through the project's mobile CT units and fixed-site CT services) and with provision
of palliative care services, OVC care and support, and ART adherence support.
Activities conducted with FY07 funds include:
1. Identification of 48 more village sites (each with multiple surrounding villages) in Soubre and Daloa for
intervention
2. A situation analysis in three departments
3. Training of 60 ANADER staff in ABC-targeted prevention
4. Training of 10 trainers and 144 community counselors in use of the local-language HIV/AIDS lexicon and
ABC-targeted prevention
5. Community outreach reaching at least 52,292 people with Other Prevention messages
6. Broadcast of 922 spots and 248 educational programs with ABC prevention messages on local radio
7. 144 video campaigns (one village site)
8. Initiation of at least one support group for PLWHA in each village
9. Training of four local radio announcers (two per new departments) in ABC prevention, with REPMASCI
and using IRIN/JHU/CCP materials
10. Distribution of 71,720 male condoms
Activity Narrative: 11. Strengthening of linkages between village action committees and agricultural cooperatives by involving
one to two members of cooperatives in each action committee
The project is also piloting income-generating activities for community counselors and village committee
members to help support their HIV/AIDS prevention work (including transport and lodging when they work in
distant villages), motivate them to continue working, and help ensure the sustainable functioning of the
action committees, IGAs will be selected by community members and implemented with ANADER
agricultural technical assistance.
FY08 OP activities will be informed by assessments in FY06 and the 2005 AIDS Indicator Survey. The
project will reach 40,550 people through community outreach that promotes HIV prevention through
condoms and other prevention methods beyond AB and will train 720 people (five community leaders per
village) to promote such prevention.
Activities with FY08 funds will include:
1. Community-wide, small-group, and individual outreach promoting condom use and other HIV prevention
methods, as well as HIV counseling and testing, including at least 288 theatrical presentations
2. Delivery of at least 144 video campaigns with community mobilization and discussion (one per village)
3. Broadcast of 612 ABC prevention spots on local radio
4. Broadcast of 156 radio programs with ABC prevention messages
5. Competition (e.g. on local radio) with an HIV prevention theme to generate attention and interest
6. Strengthening of linkages between village action committees and agricultural cooperatives
7. Expand income-generating activities to 48 villages in Soubre and Daloa
The project will continue to implement an M&E plan based on national and USG requirements. ANADER
will report to the USG strategic information team quarterly program results and ad hoc requested program
data. To participate in the building and strengthening of a single national M&E system, ANADER will
participate in quarterly SI meetings and will implement decisions taken during these meetings.
Project activities will strive to mobilize and build capacity among CBOs and village and district HIV/AIDS
action committees to achieve local ownership and sustainability. Training of community counselors and peer
educators, creation of support groups, and involvement of agricultural cooperatives are designed to
enhance sustainability.
Noted April 16, 2008:
This funding represents a percentage of Alliance CI 's palliative care funds reprogrammed to ANADER to
conduct needed training and supervision activities in support of palliative care services in rural areas.
This activity is part of a four-year project launched in FY05 to build a local response to HIV/AIDS in
- ANADER for rural community mobilization and HIV prevention based on participatory risk-mapping and
village HIV/AIDS action committees
including training, local radio, and use of its lexicon to communicate about HIV/AIDS in 16 local languages
- PSI-CI for HIV counseling and testing (CT) activities, including training and CT promotion, and
procurement for palliative care
- ACONDA-VS CI for health-provider training in CT and PLWHA support, as well as palliative-care provision
and referral to ARV treatment
In the program area of Basic Health Care and Support, FY08 funds will be used to continue and strengthen
FY07 palliative-care activities in six districts (San Pedro, Dabou, Tanda, Abengourou, and, starting in FY07,
Soubre and Daloa). Palliative-care activities are led by ACONDA at rural health centers and by ANADER at
the community level. Building on ANADER's structure of HIV/AIDS action committees in 24 village sites per
region, the project uses nationally approved approaches and materials to train actors at the village level -
community counselors, ANADER rural development agents, and rural health center and mobile CT unit staff
- to provide facility- and home-based palliative-care services, including psychosocial support, prevention-for
-positives counseling (including referral to partner/family testing, "ABC" behavior-change communication,
and counseling for sero-discordant couples), ARV-adherence monitoring, and referral and counter-referral
to medical (including TB) and social services for children and adults identified as HIV-positive through CT at
rural health centers and the project's mobile CT units.
These community actors distribute palliative-care kits containing a 20-liter jerry can, two long-duration
pesticide-impregnated bed nets, and products replenished on a monthly basis, including male condoms
(20), rehydration salt, water-purification solution, and cotrimoxazole tablets. They also promote the creation
of peer support groups for PLWHA and their families and work to ensure linkages between palliative-care
services and other health care (including HIV, TB, and STI treatment), CT, HIV prevention, and OVC
services.
Project activities complement and build on other PEPFAR-funded efforts, including palliative-care policy and
guidelines for clinic- and home-based care as part of a continuum of care as well as HIV prevention, care,
and treatment activities by ministries (AIDS, Health, Education, Social Affairs) and other PEPFAR partners
(CARE International, Alliance CI, EGPAF). Activities are coordinated through local, national, and district
forums, with involvement of the district health management teams to maximize capacity-building and
coordination with the MOH.
In 2007, ANADER has a target of providing palliative care for 5,574 PLWHA. Activities include:
1. Identification of 48 new village sites in the districts of Soubre and Daloa for intervention, bringing the
project total to 144 villages (each serving multiple surrounding villages) in six districts
2. Identification of 10 additional rural health centers (five in each new district) where palliative-care activities
are aligned with fixed-site CT services
3. Training of 54 ANADER agents to provide palliative-care services
4. Supply of palliative-care services and kits for identified PLWHA
FY08-funded activities will support 147 service outlets (one per rural health center or village, plus three
mobile CT units) and provide HIV-related palliative care services for at least 6,000 PLWHA.
Emphasis will be placed on strengthening linkages among CT, health care, palliative care, and OVC care
services. To improve effectiveness and efficiency, community counselors will be cross-trained to provide
both palliative care and OVC care at the home level.
1. Provision of home-based palliative care, including kits, psychosocial support, and referral to district health
centers, social services, and OVC services
2. Supply of palliative-care services and kits for identified PLWHA
3. Support for the establishment and operation of 30 PLWHA support groups
4. Income-generating activities for 30 PLWHA groups (five per district) established around rural health
centers. The activities will be designed by the groups, with technical assistance and training from ANADER,
and will take into account lessons learned in the FY07 pilot. Part of the income will help fund operations of
the support group.
5. Distribution of 1,000 posters and 20,000 brochures with messages designed to reduce stigma and
discrimination against PLWHA.
ANADER will continue to implement an M&E plan based on national and USG requirements and tools. Data
will be collected by village action committees using simple tools and will be transmitted to district, regional,
and central units. Project reporting will occur monthly at the regional level and quarterly at the central level.
ANADER will report to the USG strategic information team quarterly program results and ad hoc requested
program data. To participate in the building and strengthening of a single national M&E system, ANADER
will participate in quarterly SI meetings and will implement decisions taken during these meetings.
Sustainability and project effectiveness are enhanced by consortium members' past and current
collaborations with multiple ministries (Health, National Education, Family and Social Affairs, and others) as
well as RIP+ (Network of Organizations of Persons Living with HIV/AIDS), Lumière Action (an NGO of
PLWHA), youth NGOs, and faith-based communities. Project partners have been successful in mobilizing
internal resources and attracting Global Fund, MSD, and other funds/partners to support their activities.
Activity Narrative: ANADER has a broad rural development mandate with initiatives to address poverty, gender inequities, and
food insecurity and seeks to maximize opportunities for wraparound activities. The World Bank, UNICEF,
WFP, AfriJapan and others have offered or do offer ANADER such opportunities.
enable communities to continue palliative-care activities after PEPFAR funding for the project has ceased.
This activity is part of a broad four-year project launched in FY 2005 to build a local response to HIV/AIDS
in underserved rural areas, where 60% of Côte d'Ivoire's population lives, with high levels of youth not in
school, and adult illiteracy. The project is expanding access to HIV/AIDS prevention, care, and treatment
and improving links to health, social, and education services, accompanying expansion of these services as
national programs scale up. The implementing consortium brings together and applies the expertise of:
village HIV/AIDS action committees;
including training, local radio, and use of its lexicon to communicate about HIV/AIDS in 16 local languages;
palliative care;
- ACONDA-VS CI for health-provider training in CT, palliative care and PLWHA support, plus referral to
ARV treatment.
In the program area of orphans and vulnerable children (OVC), activities conducted with PEPFAR support
in FY07 includes training 436 people (52 rural development agents, 96 community counselors, 144 school
teachers, and 144 rural health center workers) in OVC identification, needs assessment, and care. Direct
care is provided to 7,000 children in hard-to-reach areas, including psychosocial care and support for
schooling and vocational training, legal aid, and referral and counter-referral to social services. This
provides a key complement to the work of other PEPFAR partners to ensure geographic coverage in a
national strategy to scale up services across the country.
FY08 funds will be used to continue and strengthen FY07 activities in six departments (San Pedro, Dabou,
Abengourou, Tanda, Soubre, and Daloa) in five regions of the country. OVC activities in 2008 will be
informed by baseline assessments conducted in FY07 and results of the 2005 national AIDS Indicator
Survey. They will continue to complement and build on other PEPFAR-funded efforts, including Ministry of
Education (MEN), Ministry of the Fight Against AIDS (MLS), Ministry of Family and Social Affairs, ANS-CI,
CARE International, and Hope Worldwide activities in support of AB and Other Prevention activities for
youth and OVC. The project will operate in consultation with the National OVC Program (PNOEV) and will
participate in the national OVC committee (CEROS-EV).
ANADER will continue to work through HIV/AIDS action committees in 24 village sites (each with several
surrounding villages) per department, which help implement and coordinate its OVC, HIV prevention, CT,
and care activities in collaboration with other actors and relevant ministries. The project's OVC strategy
involves establishing or reinforcing a four-member OVC team (1 community counselor, 1 rural health
worker, 1 schoolteacher, and 1 ANADER rural development agent) in each village. Team members are
trained to educate and mobilize communities around the need for OVC identification and support; to identify
vulnerable children and their families through CT at rural health centers, PMTCT at rural maternity centers,
and the project's mobile CT units; and ensure that OVC needs are identified and met with the minimum
package of care, including psychosocial support and monitoring, educational and legal assistance (school
fees, vocational training with an emphasis on providing opportunities for girls, birth certificates), support
packages (school kits, basic health-care supplies, impregnated bed nets, safe-water products, nutritional
and food items, hygienic products), HIV prevention messages, and referral to needed health (including HIV
and TB) and social services. Follow-up at the household level by social workers and community counselors
trained in OVC and palliative care will identify and address needs of different OVC groups, including HIV-
infected children and their families, children of HIV-infected parents, adolescent girls, orphans requiring grief
support, and different age groups. This process will be improved in 2008 with introduction of the Child
Status Index to simplify and standardize the monitoring of the child's well-being and the effectiveness of
services delivered.
Based on FY07 experience, ANADER will add training in OVC support and care for community leaders (four
per village site). ANADER will also extend income-generating activities (started in 24 villages in FY07) to 12
more villages to build self-sufficiency among OVC families, with links to school feeding programs in
collaboration with the Ministry of Education and with WFP wraparound programming for OVC and host
families identified as needing nutritional support. In addition, ANADER will provide incentives to ensure that
community counselors are able to sustain their OVC work.
FY08 expanded funds will provide OVC services to at least 2,000 newly identified OVC (for a total of 9,000
children receiving direct support) and to build capacity of at least 1,214 people, including 588 people to be
trained in the use of harmonized OVC data-collection tools (144 ANADER rural development agents, 12
ANADER district head office workers, 144 rural health workers, 144 schoolteachers, and 144 community
counselors). Training in OVC care and support will be provided for at least 50 replacements for reassigned,
deceased, retired, and inactive members of the village OVC teams and for 576 community leaders (four per
village site). In addition, community counselors providing OVC services will be cross-trained to provide
home-based palliative care services.
Specific activities conducted with FY08 funds will include:
1. Community sensitization by community counselors about the importance of community-based support for
OVC and HIV-affected families, including information about and referral to existing sources of care and
support, including educational support. This will include efforts to engage religious leaders and other
influential community members in creating a supportive environment for OVC.
2. Training replacements and encourage partnering to compensate for deceased and transferred village
committee members.
3. Stigma reduction through local radio and community outreach. Collaboration with JHU/CCP, the Ministry
of Education, and other partners will ensure synergy and avoid duplication with other BCC and IEC media
and outreach activities.
4. Provision of support to ensure a minimum standard of OVC care for at least 9,000 children, including at
least 2,000 newly identified in FY08.
5. Procurement and distribution of inputs for support packages to meet needs of at least 9,000 OVC, with
renewed efforts to engage other donors/partners (UNICEF, UNDP, WFP) and local contributions to ensure
that other children in OVC families receive support.
6. Support for adaptation and use of the Child Status Index.
7. Training for village committee members to improve monitoring, linkages with other service-delivery
organizations, and direct care support.
Activity Narrative: 8. Monitoring and technical support for income-generating agriculture/school canteen activities in 24 village
sites begun in FY07.
ANADER will implement a project-specific monitoring and evaluation (M&E) plan based on national and
USG requirements and tools. Data will be collected by rural health center personnel, community counselors,
ANADER rural development agent and village schoolteachers and will be transmitted to ANADER's district,
regional, and project central units. Project reporting will occur monthly, quarterly and yearly. The project will
contribute to the implementation of an integrated M&E system in collaboration with national and
international stakeholders, including the ministries of AIDS, Health, and Family and Social Affairs.
Both sustainability and project effectiveness are enhanced by consortium members' past and current
well as RIP+ (Network of Organizations of Persons Living with HIV/AIDS), Lumière Action (a PLWHA
organization), youth NGOs, faith-based communities, and community leaders. Project partners have been
successful in mobilizing internal resources and attracting PEPFAR, Global Fund, MSD, and other
funds/partners to support their activities. ANADER has a broad rural development mandate with initiatives to
address poverty, gender inequities, and food insecurity and seeks to maximize opportunities for wraparound
activities. The World Bank, UNICEF, WFP, AfriJapan and others have offered or do offer ANADER such
opportunities.
These activities strive to build capacity among CBOs and village and district HIV/AIDS action committees to
action committees), rural health center staff, village schoolteachers, and community leaders and initiation of
income-generating activities are designed to enable communities to carry on OVC identification and care
activities after PEPFAR funding for the project has ceased.
The implementing consortium brings together the expertise of:
• The National Agency for Support to Rural Development (ANADER) for rural community mobilization and
• The Network of Media Professionals and Artists Fighting Against HIV/AIDS (REPMASCI) for BCC,
• PSI-CI for HIV counseling and testing activities, including training and CT promotion, and procurement for
• ACONDA-VS CI for health-provider training in CT, PMTCT, and PLWHA support, as well as palliative-care
• Provision and referral to ARV treatment
ANADER's CT activities complement the integrated and free-standing CT services provided by PEPFAR-
funded partners ACONDA, EGPAF, Alliance Cote d'Ivoire, PSI, and FHI by extending mobile and fixed-site
CT services and promotion to rural areas while strengthening a referral network linking CT services to HIV
prevention, PMTCT, palliative care, OVC care, and treatment services.
Overall project strategies rely on village HIV/AIDS action committees in 24 villages in each of six
departments and draw on ANADER's risk-mapping approach, which includes segmenting village
populations to allow young women, young men, older women, and older men to discuss sexuality and HIV-
related risks and risk-reduction strategies separately and together. Local HIV/AIDS action committees and
community counselors are trained and supported in applying culturally appropriate BCC strategies,
curricula, and educational materials with ABC prevention and CT promotion messages. Activities include
coordinated BCC campaigns mediated by influential figures and peers and using methods of proximity
(debates, sketches, videos, peer education, traditional events, etc.) in the community, schools, sporting
fields, mosques, and churches, reinforced by radio in local languages. Traditional and religious leaders are
empowered through tools such as the HIV/AIDS lexicon and use of participatory approaches to lead
communities to address HIV/AIDS in their socio-cultural context, including addressing issues of negative
gender attitudes and HIV-related stigma and discrimination.
Trained community counselors (three per village site, increasing to five in FY08) and ANADER rural
development conduct community-mobilization, CT uptake-promotion, and stigma-reduction activities (using
existing tools, such as a documentary film on PLWHA testimonials). They join the mobile-unit staff in
providing counseling and testing, TB screening, HIV prevention education, and referrals for ART and care.
They also provide psychosocial support for PLWHA and follow up with home-based palliative care, OVC
care, and ART adherence support.
With FY06 and FY07 funds, the project initiated and is providing mobile-outreach CT and basic health and
support services at 144 village sites in the departments of San Pedro, Dabou, Abengourou, Tanda and,
starting in FY07, Soubre and Daloa, covering five regions. Two mobile CT units serving four districts were
installed in FY06, with training for 291 community counselors and other community members, and a third
mobile CT unit is being added in FY07. Each mobile unit covers two departments.
In addition, CT services are provided at rural health centers supported by ACONDA. ACONDA has trained
20 health providers from rural health centers in CT screening and 40 health workers in counseling, and 28
rural health centers have been equipped for CT services.
HIV/AIDS action committees have been strengthened in all 144 villages through training and provision of
one sensitization kit per committee. REPMASCI developed and broadcast 18 radio spots in six local
languages using its HIV/AIDS lexicon, as well as preparing and delivering video/film projections with
community discussion. Communication campaigns were conducted in 2006 and 2007 to promote CT in the
144 rural sites.
At the end of June 07, 9,005 people in the villages had received HIV counseling and testing with receipt of
test results, including 7,632 through mobile CT service delivery. The project's target is to test 15,360 in
FY07. In addition, ANADER expects to make up for a slow start of CT activities in FY06 to reach its
combined FY06-07 target of 42,280.
CT quality assurance is provided through supervisory visits with regional and local health district teams.
Quality assurance for HIV tests is provided by the RETRO-CI laboratory in collaboration with the National
HIV/AIDS Care and Treatment Program (PNPEC) and local health authorities. Project activities were
coordinated through village, district, regional, and national fora, in consultation with relevant ministries and
other PEPFAR partners.
FY08 funds will be used to continue and strengthen FY07 activities in the six departments. Activities will
incorporate lessons learned and sustainability strategies identified during the first two project years,
including the importance of retraining community counselors; of conducting regular supervision of these
counselors to ensure quality service provision; of repeated exposure to health messages (particularly in
small-group or individual settings) to achieve behavior change; of communication and coordination with
partners at the local, regional and national levels; and of finding ways to motivate community counselors.
The project will seek to take advantage of a simplified national testing algorithm (expected within the year)
permitting the use of finger-prick, whole-blood rapid tests by lay personnel. Once rapid tests are available,
ANADER will work with the USG team to devise and implement a strategy for their introduction and use in
coordinated, carefully monitored approaches that may include community- and home-based testing, with the
mobile units switched to a supervisory function.
The project expects to test at least 31,130 people in FY08, including 27,330 via the mobile CT units and
3,800 at the rural health centers. Activities with FY08 funds will include:
1. Refresher and/or updated training in CT (including training in the new algorithm and rapid tests, if
Activity Narrative: approved) for 432 community counselors
2. Training for 56 health workers (two per center) for CT at rural health centers with integrated CT and for
56 health workers (two per center) in counseling.
3. Training for six CT supervisors for Bas Sassandra and Haut Sassandra regions according to the national
supervision tools
4. Mobile CT services to 27,330 clients in 144 villages.
5. CT services to 3,800 clients at 28 rural health centers with integrated CT.
6. Supervision by PSI and ACONDA, in collaboration with health district and ANADER staff, of all CT
activities.
7. Ensuring CT service quality using dried blood spot techniques.
8. Reinforcing referral systems among CT services, facility-based care and treatment, and community- and
home-based palliative care and OVC services.
ANADER will continue to implement an M&E plan based on national and USG requirements and tools and
will contribute to implementation of an integrated M&E system in collaboration with national and
international stakeholders, including the ministries of AIDS, Health, and Social Affairs.
Activities will strive to strengthen capacity among CBOs and village and district AIDS action committees to
action committees) and rural health center staff are designed to enable communities to carry on CT
underserved rural areas, where 60% of Côte d'Ivoire's population lives and most are illiterate. The project is
expanding access to HIV/AIDS prevention, care, and treatment and improving links to health, social, and
education services, accompanying expansion of these services as national programs scale up. The
implementing consortium brings together and applies the expertise of:
• PSI-CI for HIV counselling and testing activities, including training and CT promotion, and procurement for
• MSD Interpharma and the HIV/AIDS Alliance are providing technical assistance.
Funds in the ARV Services program area are used to promote treatment literacy, facilitate access to ART,
and provide treatment monitoring and support in rural areas in six departments. This includes development
and promotion of linkages between the comprehensive clinical care for PLWHA delivered at EGPAF- and
ACONDA-supported health facilities at district and village levels and community-based HIV counseling and
testing, palliative care, OVC care, and HIV prevention activities conducted by ANADER in surrounding rural
areas.
Referrals are made to district general hospitals and other public and private health-care centers that are
adequately equipped to provide HIV/AIDS care, including ART. Clients who test HIV-positive at rural health
centers are referred to the nearest accredited care and treatment site. Clients who test HIV-positive through
ANADER's mobile CT units are referred to the nearest rural health center and then to an appropriate care
and treatment site as needed. Nurses at rural health centers that have integrated CT are trained to monitor
the follow-up of ARV treatment at community health centers and to provide psychological support to
PLWHA under the supervision of the district health team. Community counselors are trained to provide
psychological support and to monitor and support patients on ART, as well as to provide home-based
palliative care and OVC care and support. Community counselors and peer-support groups monitor
adherence to treatment, contribute to referral activities, and promote treatment literacy. The project works to
establish linkages between services provided by PEPFAR-funded NGOs and FBOs, the Global Fund,
EGPAF, ACONDA, AIBEF, and other partners.
FY08 funds will be used to continue and strengthen FY07-funded activities, which include:
i) Assessment of stigma and treatment literacy in the initial four departments and prioritization of needs and
available support, with involvement of PLWHA
ii) Training of 196 health workers in rural health centers in ART referral, monitoring, and support
iii) Training of 192 community counselors to provide counseling and education on treatment, positive living,
and prevention for positives using local languages
iv) Promotion of adherence to treatment and secondary prevention with linkages to ART services
v) Referral of 5,574 PLWHA for care and treatment services, including ART if eligible.
FY08 funds will complement and build on other PEPFAR-funded efforts, including Ministry of the Fight
Against AIDS (MLS) and JHU-CCP activities to develop effective BCC materials and approaches and
mobilize faith-based communities and opinion leaders; Alliance Cote d'Ivoire support for CBO/FBOs and
PLWHA; and Ministry of Health (MOH) and EGPAF/ACONDA support for expanded ART, palliative care,
and CT.
Key activities and approaches during FY08 will include:
1. Assessment of stigma and treatment literacy in the two departments added in FY07, with prioritization of
needs and available support. These will be conducted in partnership with the national network of PLWHA
organizations (RIP+), and results will complement other available sources of data, including the 2005 AIDS
Indicator Survey;
2. Training of 116 health workers in the two new departments, including 40 in rural health centers, in ART
referral, monitoring, and support ;
3. Training of 96 community counselors to provide counseling and education on treatment, positive living,
and prevention for positives using local languages, in partnership with REPMASCI;
4. Promotion of awareness and adherence to treatment and secondary prevention with establishment of
linkages between community-based and ART services;
5. Referral of newly identified PLWHA to care and treatment, including ART if eligible.
ANADER will continue to support and strengthen a community-based M&E system to track implementation
of activities using national and USG tools in order to improve the quality of service provision and to provide
data on management of care and treatment for PLWHA at the community level. These data will be collected
by the village action committees using simple tools and will be transmitted to district, regional, and central
units. The reporting will occur monthly at the regional level and quarterly at the central level.
Planned activities will be coordinated through village, district, regional, and national forums and will strive to
build capacity among CBOs and village and district AIDS committees to achieve local ownership and
sustainability.
