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.
Background: Botswana began implementation of its national ARV program, called "Masa" or New Dawn, in
2002, available free of charge to all Batswana. As of December 2004 it had rolled out to a total of 32 sites
nationwide with more than 32,000 people initiated on ARV. Masa, which is the largest ARV program in
Africa, is largely funded by the government of Botswana, with key infusions of financial and technical
support from ACHAP (Merck and Gates Foundations). Pregnant women and their families also receive care
from these sites. There is no freestanding PMTCT+ program. In FY 2004 the Emergency Plan provided
largely indirect support through referral from USG-support voluntary HIV counseling and testing facilities,
guidelines development, training, and laboratory support.
There are approximately 110,000 HIV infected individuals in Botswana whose immune status makes them
eligible for immediate initiation of antiretroviral therapy. Since the launch of the Botswana ART Program in
2001, the Government has provided free antiretroviral drugs to eligible patients at the expense of other
national development priorities. By December 2004, 30,600 patients were enrolled in the ARV program
managed by public health facilities. The target for December 2005 is 50,000 enrollees at an estimated cost
of Pula 313 million ($68 million). If this target is achieved, 45% of eligible individuals will be enrolled in ART.
The Government has already spent well over Pula 154 million ($34 million) on the 30,600 patients. An
additional Pula 121 million ($ 26 million) will be needed to treat the 19,400 new enrollees and keep the older
patients on continuous medication. The $6.5 million requested from the Emergency Fund will assist the
Government to treat 6,000 patients, at a cost per client of $1,083. These 6,000 individuals represent 31%
of the Government's target of reaching an additional 19,400 patients in 2005. The Government will allocate
funds to treat the remaining 13,400 patients. This proposal will enable the U.S. Mission to substantially
contribute to the Botswana government's aggressive goal of reaching the 110,000 PLWHA who need ART.
Women seek testing and treatment more readily than men. This proposal is likely, therefore, to have a
greater impact on women.
Proposed activity: In 2005, the Masa program aims to increase enrollment to 50,000 patients. Funds are
requested for procurement of ARVs for 12,000 patients, of whom 90% are adults identified as HIV infected
with a CD4 count <200 and 10% are HIV-infected infants. The budget indicates the required drugs
according to the current program experience.
Procurement will be done by the Ministry of Health's Central Medical Stores through the Public Procurement
and Asset Disposal Board (tender board) under the Ministry of Finance and Development Planning. This
will ensure sustainability of this support through an efficient and transparent procurement system. The
funding will be provided through a cooperative agreement between HHS/CDC and the government of
Botswana with the Ministry of Finance and Development Planning. Funds have already been approved in
the FY 2005 COP to strengthen and support the security and supply chain management of Central Medical
Stores. Funding has also been approved to support the Botswana Drug Regulatory Unit to improve quality
assurance capability. The government of Botswana will ensure cost-effectiveness in the procurement of
ARV drugs, laboratory reagents and test kits. The USG will also work with the government of Botswana to
explore the feasibility of approval and use of U.S. FDA-approved generic drugs in the Botswana ARV
program.
This will contribute substantially and directly to the Botswana national goal of treating 50,000 persons in
2005 and to the Emergency Plan Botswana goal of supporting treatment of 40,500 persons in FY2005.
This direct support will be an important complement to the largely indirect support already approved in the
FY2005 COP. This concentration of funding on ARV treatment is also important to bring Botswana closer to
the recommendations of the Office of the Global AIDS Coordinator on funding percentages by Emergency
Plan goal. This is also part of broader, comprehensive strategic plans for prevention, treatment, and care
according to the Botswana National Strategic Framework and National Operational Plan, the Emergency
Plan Five-Year Strategy, and specifically for children, the results of a National Consultative Meeting on HIV
Prevention, Access to Treatment, Care and Support for Children Living with HIV/AIDS, 25-26 November
2005.
By providing this funding to the Botswana national program and not creating parallel or competing
structures, sustainability and coordination will be maximized.
HIV Testing Commodities
HIV testing is important in the fight against the global HIV/AIDS epidemic. It is the key to the diagnosis,
prevention, treatment and care of persons infected by the HIV virus. The current practice in Botswana is to
encourage as much voluntary testing as possible. HIV testing has been integrated as a routine test in the
public health care system in Botswana since January 2004. Testing has been expanded to all clinics and
hospitals. Enzyme Immunoassays (EIAs) are the most widely used diagnostic tests in Botswana because
of their suitability for analyzing a large number of specimens, particularly in blood screening centers. With
the introduction of a routine HIV testing policy in Botswana, use of rapid screening tests (Determine, Uni-
Gold, and OraQuick) has dramatically increased, mainly in VCT centers and PMTCT clinics.
About 50,000 HIV screening tests are expected to be performed in public health facilities in 2005 as a result
of the introduction of routine testing, excluding tests done through the PMTCT program. In addition, some
60,000 or more people are expected to be tested in 2005 through the Tebelopele VCT program, which is
funded by the Emergency Plan. In total, 7,000 HIV positive people who require immediate treatment with
ARVs are expected to be identified through both testing mechanisms. Emergency Plan funds from the USG
will be used to cover the cost of testing the 50,000 new clients in 2005. The cost of screening these
samples using standard rapid test mechanisms in Botswana is estimated at $233,000. The Government of
Botswana will cover the cost of parallel testing the 50,000 samples using ELISA.
CD4 Cell Count and Viral Load Monitoring Equipment
Currently there are only three laboratories with capacity to do CD4 cell counts and viral load measurements
in Botswana. The requested Emergency Plan funds will provide capacity for 14 additional laboratories to do
CD4 cell counts and viral load measurements, which will assist in running viral load counts for 19,400 new
patients who are expected to be put on ARV during 2005. Four Facs Calibur CD4 cell count machines at a
cost of $700,000 will be provided to key district hospital laboratories. Seven smaller and easy to transport
CD4 count machines (e.g. Facs Count) will also be purchased for use in more rural hospitals at a cost of
$245,000 ($35,000 each). Three more viral load measurement machines (two Amplicors and one
Ampliprep) will be purchased to provide sufficient patient monitoring service for the 19,400 PLWHA at a
total cost of $322,000. The Government of Botswana will absorb the cost of reagents for CD4 cell counts
and viral load monitoring during 2005.
In 2005, the Masa program aims to increase enrollment to 50,000 patients. The requested funds will
support the required HIV diagnostic testing, both adult and pediatric, and CD4 laboratory screening. While
25-30% of Batswana know their HIV-infection status, the great majority have not tested. Substantial
increases in testing will be necessary to strengthen prevention and care activities, and to refer additional
persons for ARV treatment. Rapid testing has been promoted by HHS/CDC because it is preferable in most
setting where there are relatively few patients per day and to ensure same-day delivery of test results. With
the requested funds 440,000 rapid test kits will be procured for dual parallel testing during 220,000 patient
visits. This is a substantial increase from the estimated 120,000 tested in 2004, but should be feasible with
the highly innovative and successful routine testing policy and very active social marketing of HIV testing
that is taking place. Of these, an estimated 88,000 infected persons will be identified (estimated using 2004
national routine testing prevalence data).
Funds are also requested for CD4 screening of those identified as HIV positive. It is assumed that 90% of
them (80,000) will be successfully referred for CD4 testing. Of those projected 80,000 PLWHAs, it is
estimated that 40,000 will have a CD4 count <200 or an AIDS-defining illness, thus qualifying for treatment
according to national guidelines.
Funds are also requested for infant diagnosis using PCR. Serodiagnosis is not reliable for children age <18
months, but it is important to diagnose HIV infection early in exposed infants in order to be able to initiate
antiretroviral therapy in a timely manner and monitor PMTCT program efficacy. A total of 40,000 children
are born in Botswana annually. An estimated 15,000 are born to HIV-infected women. Some 2,000 of them
may be HIV infected, depending upon the efficacy of the PMTCT program.
Activity Narrative: The included laboratory costs per person for testing are $9.10 for adults (two rapid tests), and $32.50 for
infant PCR. There are minimal overhead costs in this cooperative agreement between HHS/CDC. Even
with this substantial USG support, the great majority of the program costs, including drug costs, will be
borne by the government of Botswana.
Note on Targets: There are currently 28 laboratories capable of conducting lymphocytes testing, including
the three laboratories that can also do CD4 cell counts and viral load measurements. This funding will
increase the number of facilities able to do CD4 cell counts and viral load measurements from 3 to 17.
However, due to the nature of the measurement in the next section, we have listed the number of
laboratories with the capacity to perform HIV test and CD4 test and/or lymphocytes test as 28.
