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
n/a
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $4,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,200
and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $4,000
Economic Strengthening
Education
Water
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The HIV/AIDS epidemic in China is concentrated in injection drug users (IDU), female sex workers (FSW), and men who have sex
with men (MSM). Sentinel surveillance data from 1995 to 2007 show that HIV infection rates among IDU, sex workers, and
pregnant women at the national level continue to increase, albeit at a slow rate. Although overall national HIV prevalence remains
low (0.04-0.07%), cases of HIV/AIDS in China increased by an average of 3,000 monthly between January 2006 and June 2007.
So far in 2008, 32,235 new HIV/AIDS cases have been reported, which represents an 8% increase over 2006. Sexual
transmission is now the primary mode for the spread of HIV. Among HIV/AIDS cases reported between January and October
2007, 37.9% were infected through heterosexual transmission, 29.4% via IDU, and 3.3% through MSM transmission. The 38% of
cases attributed to heterosexual contact were more than triple the 11% reported in 2005.
Prevalence among FSW nationwide is estimated to have risen from 1.1% in 2004 to 2.1% in 2005. Surveys of "hot spots" found
FSW HIV prevalence rates between 5-10%. Prevalence in FSW who also inject drugs is up to 30% with the highest rates in
Guangxi, Xinjiang, and Yunnan. HIV prevalence in FSW in Yunnan increased from 0.05% in the mid 1990s to 1.68% in 2006. In
Guangxi, a similar pattern of HIV transmission exists - IDU as the major transmission mode, followed by sexual transmission.
Rates of HIV infection vary from county to county. The highest HIV prevalence among FSW was seen in the counties where HIV
prevalence among IDU was already high. According to current estimates, there are approximately 100,000 FSW in Yunnan
province. In Guangxi, there are approximately 60,000 FSW.
Risk behaviors include low levels of consistent condom use and limited health seeking behavior, despite confidential anonymous
services through government STI clinics. According to behavioral surveillance data, 60% of sex workers reported not using
condoms at every sexual encounter. Although 85% of FSW report using condoms consistently with commercial partners, only
44% report using condoms consistently with regular partners, thereby increasing the risk of passing the virus to regular partners.
Although FSW condom usage appears to be increasing, high-risk sex remains an issue, particularly among low-end sex workers.
In studies conducted by Renmin University of China, 1 in 10 sexually active Chinese men have engaged in sex with a FSW at
least once.
There is growing evidence and concern that China's MSM epidemic is much larger and developing much faster than previously
acknowledged. The proportion of cases among MSM increased eight-fold from 0.4% in 2005 to 3.3% in 2007. Until recently, there
has been limited surveillance data on MSM. Beginning in early 2008, with support from the USG, NCAIDS has conducted a
national MSM epidemiological survey in 61 cities. The preliminary results from the first round survey show HIV prevalence at 4.8%
and syphilis prevalence at 11.4%. HIV prevalence in Kunming, the only city in Yunnan province covered in the first phase, was
14%. In a behavioral survey of MSM, 70% reported having had sex with more than one partner in the past six months, 50% used
condoms when they engaged in sex work, and only 30% reported using condoms for anal sex. Size estimates for MSM have not
been conducted.
In 2007, the State Council AIDS Working Group and UN Theme Group on AIDS in China reported that the proportion of women
infected had doubled over the past decade. As 90% of these women are of child-bearing age (15-44), this could translate into
increased potential for perinatal transmission. These data suggest that the HIV- 1 epidemic is maturing, and more effective
preventive measures targeted to FSW and MSM (and their clients and partners) are needed in order to address the epidemic.
Primary prevention remains a top priority for GoC as well as for the USG program. Although GoC has established HIV prevention
interventions with most at risk populations (MARPs) during the past several years, many of these efforts are of low or inconsistent
quality due to the different levels of resources and skills among implementers. There is a strong need to provide models of HIV
prevention that are evidence-based, highly targeted, and non-discriminatory. USG supports activities in 15 high-burden provinces,
with increased resources to support replicable models in two provinces, Guangxi and Yunnan.
To prevent HIV transmission through commercial sex, GoC has set up "high-risk intervention teams" throughout the country to
insure implementation of the 100% Condom Use Program (CUP). Shortcomings of the 100% CUP include poor implementation
due to low capacity of staff, low coverage, and reliance on the stand-alone intervention of condom distribution without concurrent
efforts placed on voluntary counseling and testing (VCT), behavior change, and STI service provision. In FY 2009, USG will
provide technical support to GoC to improve the quality of CUP by revising the national guidelines on CUP, strengthening the
capacity of implementing staff, and linking CUP with STI treatment, HIV testing, counseling, care, and treatment. USG will also
support field testing of interventions for street-based FSW.
In FY 2008, USG supported the STI Clinic-Based Peer-Driven Behavioral Intervention Model, in which community-based
organizations (CBOs) in Beijing, Heilongjiang, and Shandong conducted testing and counseling, behavioral change interventions,
MSM-friendly STI clinics, and linked MSM PLHA to CBOs and ART providers for positive prevention services. In FY 2009, USG
will continue to support the national MSM epidemiological survey and comprehensive intervention program in 61 cities. The
popular opinion leaders (POL) behavior change model supported by USG has become a standard intervention model for all 61
pilot sites. USG will support the improvement and revision of the POL model, together with a compilation of best practices. USG
will also support counties funded under GFATM Rounds 4, 5, and 6 with scale-up of the model.
The Minimum Package of Services (MPS) model will focus on establishing high quality, targeted prevention interventions that are
linked with care and treatment services provided by other USG partners, local government, and CBOs for low-fee FSW, MSM who
have multiple concurrent male sexual partners, and low-income clients of FSW. The MPS model for FSW and MSM includes peer
education, drop-in centers, targeted interpersonal community outreach activities, community events, access to condoms and
lubricants, voluntary counseling and rapid testing, support groups, STI management, and health service referrals.
From 2005 to 2008, USG has supported implementation of MPS in nine "hot spots" in Guangxi and Yunnan provinces as mutually
agreed upon between USG and GoC: Gejiu, Kaiyuan, Kunming, Luzhai, Mengzi, Nanning, Ningming, and Pingxiang. In FY 2009,
USG support for an additional site at Hekou will be continued as requested by the Yunnan government and approved by USG.
USG partners and relevant GoC authorities will work together to transition this program site by September 2010.
FY 2009 planned activities will fill gaps in the MPS sites by providing: 1) social marketing of highly-targeted HIV risk reduction
products including male and female condoms and lubricants; 2) targeted behavior change communications (BCC), particularly
peer outreach, through drop-in centers and outreach; 3) drop-in centers that provide a ‘safe space' for FSW and MSM; 4) referrals
and linkages to allow MARPs to access a full range of prevention, care, and treatment services; 5) mid- and mass media
communications for general HIV knowledge and reduction of stigma and discrimination towards MARPs; and 6) capacity building
of local partners, grassroots non-governmental organizations (NGOs), and GFATM project sites for replication of successful
interventions.
Outreach teams engage MARPs where they work, socialize, or engage in risk contact. The drop-in center approach is a
cornerstone of the outreach strategy, as drop-in centers provide a safe space for MARPs to congregate and provide a base of
operations for the outreach teams. In addition to the core delivery of basic prevention messages, all programs aggressively
promote the importance of knowing one's sero-status and understanding the need for regular STI check-ups, even in the absence
of overt symptoms. Outreach teams provide referral support to any MARP who decides to seek VCT and STI screening. Most
VCT services are currently provided by the local China CDC. Some agencies will have MARP-friendly VCT and STI services as
part of their funded activities. For instance, Kunming CDC provides on-site STI and VCT services to FSW and STI mobile services
and VCT referral to MSM; in Gejiu, on-site STI services for FSW are provided by Gejiu Red Cross with referral to Gejiu Red
Cross' Maternal and Children Hospital; and on-site VCT and STI services for MSM in Nanning are provided by Nanning CDC.
To date, HIV programs targeting FSW are reasonably well-covered by GFATM, local CDCs, and USG partners. However, there is
a lack of emphasis on lower-income and harder to reach FSW. For example, it is more difficult for outreach teams to engage with
street-standing FSW who normally charge low fees for sex. Efforts to reach these most vulnerable women will be emphasized in
FY 2009.
MSM still suffer from social persecution and isolation. The internet is becoming an increasingly popular medium for exchange of
information (as well as sexual contact). However, the internet is most likely restricted to higher-income and better-educated MSM.
USG programs in FY 2009 will concentrate on lower-income MSM to balance the prevention effort. USG partners will assist local
MSM organizations to create linkages with the Yunnan MSM network. Barriers to VCT will be addressed by creating a demand for
MSM-friendly VCT services, with an emphasis on the way government VCT providers deliver VCT services to MSM. A toolkit for
MSM condom promotion will be developed, and training sessions will be offered to local and international organizations working
with MSM. USG will also support local MSM groups in exploring the option of registering under Yunnan's newly instituted NGO
registration policy.
USG will continue to support mid-media efforts including targeted billboard messages in the "hot spots" of Gejiu and Mengzi, as
well as public events in MPS sites. USG partners will continue to assess communities on the periphery of the MPS sites,
recognizing the spread of potential risk to outlying areas. When pockets of risk are detected, USG will support local partners or
other agencies to cover these pockets with essential prevention services.
During FY 2009, USG partners will support capacity building of local partners by training local sub-partners, including local CDCs
and other grassroots NGOs, in behavior change interventions, HIV prevention, and working with MARPs. Partners will work
closely with sub-partners to build their expertise in FSW, client, and MSM interventions, and to ensure the quality of their
programs.
Condom availability in China is high, with over 1,000 brands available, many of which are low-cost. While low-cost condoms are
readily available and there are numerous brands, many are of low quality and not easily accessible for populations at highest risk
of HIV transmission. Rather than developing its own brand, the USG-funded social marketing program in Guangxi and Yunnan
promotes existing high-quality, low-cost brands that are available in China to help increase access and use by MARPs. USG will
provide free male and female condoms and lubricants in FY 2009. These supplies can be used by the hardest to reach FSW (e.g.,
street- based FSW). USG will also assist its local partners in leveraging condoms from family planning programs supported by the
Family Planning Commission. Condoms are also available through other local government-supported HIV programs.
In FY 2009, USG will develop successful pilot model sites of behavior change interventions with clients of sex workers, which can
be replicated by GFATM project sites. In Anhui, Guangdong, and Yunnan provinces, the US Department of Labor (DoL)-funded
International Labor Organization (ILO) project will promote "abstinence, be faithful, and use condoms" (ABC) messages in the
workplace, with a specific focus on behavior change among high-risk workers. These new programs will be coordinated with
ongoing programs in these provinces.
Based on the relatively low HIV prevalence rate in the general population and among youth, coupled with the need to scale-up
coverage and unmet prevention needs for MARPs, USG will not invest its limited resources on AB prevention activities for youth
and the general population. The bulk of its sexual transmission prevention funding will be directed towards creating replicable
demonstration projects for FSW, their clients and partners, and MSM.
USG programs leverage funding from GFATM, Australian Agency for International Development (AusAID), and other donors. In
FY 2009, USG partners will provide technical assistance to GFATM and 25 demonstration project sites in Guangxi and Yunnan.
As part of the MPS approach, USG will support GFATM project sites to replicate successful models of targeted prevention
interventions, including MSM and FSW drop-in centers and peer outreach for FSW and MSM. USG-supported programs will share
methods, materials, and tools on strategic behavior change and prevention interventions targeting MARPs. As part of its
commitment to build sustainable models, USG will discontinue its support of FSW MPS projects in Ningming and Pingxiang, as
both are now well covered by provincial and GFATM resources. These projects now serve as Centers of Excellence and provide
technical assistance on the MPS model through site visits and consultations. USG has supported its partners in developing low-
cost outcome monitoring systems for FSW and MSM. Data from these systems will be collected on a regular basis and used as a
proxy measure for effectiveness of the projects.
Program Budget Code: 03 - HVOP Sexual Prevention: Other sexual prevention
Total Planned Funding for Program Budget Code: $1,601,426
Table 3.3.03:
Estimated amount of funding that is planned for Human Capacity Development $60,000
Estimated amount of funding that is planned for Education $60,000
N/A
New/Continuing Activity: Continuing Activity
Continuing Activity: 18010
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18010 11436.08 HHS/Centers for Chinese Center for 7911 5777.08 C-CDC COAG $40,000
Disease Control & Disease
Prevention Prevention and
Control
11436 11436.07 HHS/Centers for Chinese Center for 5777 5777.07 C-CDC COAG $33,000
Estimated amount of funding that is planned for Human Capacity Development $63,600
Estimated amount of funding that is planned for Education $106,000
Table 3.3.06:
Estimated amount of funding that is planned for Human Capacity Development $154,800
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $12,900
Estimated amount of funding that is planned for Education $51,600
Table 3.3.08:
Estimated amount of funding that is planned for Human Capacity Development $128,500
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $12,850
Estimated amount of funding that is planned for Education $51,400
Table 3.3.09:
Estimated amount of funding that is planned for Human Capacity Development $14,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $7,000
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $145,000
Table 3.3.11:
Estimated amount of funding that is planned for Human Capacity Development $25,500
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $8,500
Estimated amount of funding that is planned for Food and Nutrition: Commodities $17,000
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $66,000
China accounts for nearly 17% of the world's TB burden, which includes an estimated 1.5 million new cases and 270,000 deaths
each year, 80% of which are in rural areas where public health systems are not optimally functioning. There is a significant
increase in the incidence of multidrug-resistant TB (MDR-TB) (up to 8.9% of new cases), particularly in regions of the country
without a DOTS program. The State Council created the National TB Control Program (2001-2010) with an annual disbursement
of 400 million RMB by the central government. Since 2005, the Global Fund has also provided significant support for TB control in
China, leading to the expansion of DOTS coverage from 68% to 90% of the population, an increase in the detection rate of new
smear-positive cases from 29% to 70%, and maintenance of a cure rate of at least 85% for smear-positive cases treated in the
DOTS program. Financing from the Global Fund will ensure that eight provincial governments working in 536 counties can deliver
diagnostic services to detect TB and offer DOTS free of charge for infectious cases. Within three years, China anticipates that an
additional 930,000 infectious TB cases will be detected and treated. National data in 2006 showed that the prevalence of
isoniazide (INH) drug resistance was about 19% in China. As a result, Chinese policy makers have been reluctant to implement
intermittent preventive therapy (IPT) using INH for TB prophylaxis among HIV- positive patients.
The prevalence of active TB among HIV-positive patients is geographically heterogeneous in China. Based on 2006 data from
Guangxi and Yunnan field tests by USG-supported China CDC TB/HIV co-infection programs, the prevalence of active TB among
HIV-positive patients is between 10% and 20% while the prevalence of HIV among TB patients nationwide is only 1.3% -2.2%.
At the national level, the separation of TB and HIV/AIDS health systems poses a major barrier to improving TB service coverage
for HIV/AIDS patients. Much assistance is needed to improve the collaboration between these two systems. USG assisted GoC in
developing national guidelines for TB/HIV co-infection, and will work closely with the National AIDS Treatment Taskforce to
improve linkages between the TB and HIV systems and enhance the current national diagnosis and treatment guidelines for TB in
PLHA. The implementation of these national guidelines is conducted through GFATM Round 5. USG supported the field testing
and scaling-up of TB/HIV co-infection programs in 134 GFATM Round 5 counties. These programs focus on HIV testing and
counseling for clients in TB clinics through opt-out strategies, referral mechanisms for HIV-positive TB patients to HIV/AIDS
prevention, care, and treatment programs (including ART and cotrimoxazole prophylaxis), TB screening of PLHA, and referral of
HIV-positive patients diagnosed with TB to clinics for treatment through DOTS.
To assist GoC in better implementation of the national TB program, including the TB/HIV co- infection program, China CDC has
requested USG to recruit a senior TB clinical scientist under the umbrella of the USG Emerging and Re-emerging Infectious
Disease Program in China. If fully agreed upon during the CDC Directors' meeting in Beijing later this year between US CDC and
China CDC, this person will provide daily technical assistance and support to the National TB Center as well as NCAIDS on
TB/HIV-related policy.
In FY 2009, USG will continue to work with GoC to promote PITC programs at TB clinics located in high HIV endemic provinces
such as Anhui, Guangdong, Guangxi, Guizhou, Henan, Xinjiang, and Yunnan. In response to the IDU-driven epidemic in the
southwest and northwest of China, USG will work on an operations manual with GoC that includes the development and field
testing of optimal HIV care and treatment models for TB/HIV co-infected IDU (with first implementation in Hunan province).
Table 3.3.12:
Estimated amount of funding that is planned for Human Capacity Development $5,000
Program Budget Code: 13 - HKID Care: OVC
Not applicable
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $793,000
Counseling, testing, and knowing one's HIV status is one critical element in behavior change and the main entry point for care,
support, and treatment. Of the estimated 700,000 PLHA as of 2007, about 30% know their current HIV status. GoC has positioned
counseling and testing as one of the major components of its national comprehensive AIDS program and, as a result, more than
5,000 stand-alone VCT sites have been set-up nationwide. Approximately 1,000 of these are special counseling and testing clinics
in hospitals. However, uptake of the service is still low, especially by MARPs. The current stand-alone VCT is sub-optimal
because it emphasizes the number of VCT sites rather than the quantity and quality of services delivered. Testing at VCT sites
and routine health facilities is hampered due to the national testing algorithms, reflective of GoC's commitment to expensive
confirmatory Western Blot testing which limits MARPs' access to VCT and "confirmed" results and, therefore, severely restricts the
proportion of PLHA who receive free government ART. The result is a 2-to-6 week waiting period before test results can be given
to patients, which translates into many MARPs being lost-to-follow-up. Instead of the stand-alone VCT clinic model, USG is
advocating for linking HIV counseling and testing with other program components such as surveillance, health education, peer
education, STI services, care, outreach, and behavior change interventions, including, where feasible, within NGO facilities
targeting MARPs. Currently, USG supports the establishment of linkage mechanisms to bridge VCT sites with local CDCs, which
provide counselor training and quality assurance/quality improvement (QA/QI) guidance.
USG is advocating for making HIV testing routine and simple through rapid HIV testing models and USG participation in the
Revision of the National HIV Laboratory Testing Guidance. For instance, USG is improving the rate of status-learning by field
testing rapid tests. In an IDU peer-driven VCT site, the percentage of people tested who know their status increased from 35% to
74% with the application of rapid tests. In Shandong, the reach-in method is being field tested to bring counseling and testing
services to facilities commonly visited by MSM through a local CBO (Jinan)-CDC partnership. By advocating for the use of rapid
tests in Shandong, the proportion of clients who know their status on-site reached 100% in 2008. USG has successfully used data
from these models to advocate for the use of rapid tests at the national level. At present, however, the Chinese central
government is providing direct financial support for only 10% of the rapid test kits used in the provinces. Based on these results,
USG will assist in scaling-up the outreach-based and reach-in models in the 15 USG-supported provinces targeting IDU, FSW,
and MSM through partnerships between local CDCs, MMTs, STI clinics, CBOs, and other local organizations, and will continue to
advocate for the use of rapid tests at the provincial level to improve status learning rates. This will address the existing lack of
linkages between testing and knowing one's HIV status, and also allow for better linkages to care, treatment, and support services
through local CDC involvement.
Some provinces have introduced policies and regulations that reduce demand for VCT, which could also be addressed with the
introduction of rapid testing. For example, the Yunnan government and a number of other provinces introduced new regulations
that require state- issued identification be shown by persons seeking HIV confirmatory testing, ostensibly to improve follow-up for
those who test positive. However, once a person knows they are HIV-positive, they have to provide their "real name" to access
free government services. For many MARPs, this requirement to reveal their full name and address for confirmatory tests causes
them to doubt the confidentiality of their results as well as whether they will not be discriminated against if they test HIV-positive.
For some MARPs, such as IDU and FSW, there is a corresponding fear of arrest and detention linked to this "real name" policy. In
Yunnan, to influence VCT policies and operations, USG will support the operational cost of a Counseling and Testing technical
working group (TWG) under the auspices of Yunnan CDC to actively review related issues and establish measures to counter the
"counseling and testing bottleneck" at both policy and operation levels, as well as work with all partners to increase demand for
VCT through effective promotional strategies and activities. The success of efforts to scale-up VCT for MARPs and OI
prophylaxis, OI treatment, and ART for PLHA in China will depend, in large part, on whether senior health officials can be
influenced to break through this "bottleneck" by exempting MARPs from the Western Blot confirmatory requirement, and phasing-
in confirmatory rapid testing (using a second and/or tie-breaker rapid test algorithm) beginning with MARP-targeted VCT sites.
This will reduce costs, ensure more people tested actually leave VCT services knowing their HIV status, and incidentally eliminate
MARPs' concerns about "real name" testing at VCT sites. USG will continue to persistently promote the importance and
responsibility of knowing one's sero-status as a consequence of engaging in high risk behaviors. With ART becoming more widely
available, and some prefectures turning to rapid tests or ELISA for confirmation, some of the barriers to VCT service utilization
should weaken. Through a renewed emphasis on VCT, USG support will help to significantly accelerate the transition to greater
sero-awareness and reduced risk.
To better target MARPs, USG is promoting outreach-based, confidential HIV VCT with peer educators or specially trained health
professionals as outreach staff in 15 provinces. USG is also providing assistance to NCAIDS to pilot VCT and follow-up services
provided by MSM CBOs in two sites in Sichuan province in which MSM counselors are trained by and work in cooperation with
local CDCs, especially in HIV testing and case reporting. In addition, USG is providing assistance to GoC in better targeting IDU,
FSW, and MSM through the MPS model targeting MARPs in Guangxi and Yunnan. USG will work with GoC to provide VCT, as
appropriate, within the MARP drop-in centers in the MPS sites, and strengthen government testing linked to MARP outreach at
the sites. In Guangxi, USG will continue to play a leading role in provision of province-wide VCT training through the USG-
supported Center of Excellence on Counseling and Testing. In addition, USG will provide direct technical assistance and quality
assurance for VCT sites supported by USG partners in Guangxi. The MSM VCT clinic located in the MPS drop-in center and
managed by a sub-grant to the Nanning CDC in Guangxi province was nominated in 2008 as one of the best MSM-friendly VCT
sites in China by the UN TWG on Counseling and Testing.
In detoxification facilities, all attendees are tested for HIV upon entry. In Guizhou, USG has facilitated partnerships between CDC,
MMT, and PSB (which runs the detoxification facilities) to allow CDC staff to enter into the facilities and conduct counseling
sessions. This has lead to better follow-up of HIV-positive attendees after they exit the facilities. Detoxification facilities are also
linked with MMTs through pre-registration for services of willing detoxification attendees. USG will scale-up this model in Xinjiang
and Yunnan provinces with a large IDU- driven epidemic.
To better target MARPs through the routine health system, USG is assisting GoC in drafting PITC guidelines to be included in the
revised national HIV testing and counseling guidelines. PITC guidelines will encourage VCT in routine health facilities in areas
with high HIV prevalence among MARPs, hospital departments commonly visited by MARP patients (such as STI, Ob/gyn,
urology, infectious disease), and TB institutes. The draft guidelines are being field tested in Guangdong, Liaoning, and Shandong
provinces, and USG will provide direct support to sites in these provinces through NCAIDS. In FY 2009, together with the local
CDC and hospital authorities, USG will develop a PITC pilot for children hospitalized in Luzhai County, Guangxi province (an area
with particularly high HIV prevalence).
A current barrier in the hospital system is the lack of incentives for doctors to counsel HIV- positive patients and their lack of
capacity and time to conduct counseling. USG has addressed this issue by developing the Clinical-setting-CDC-Connection (C3)
Model to create linkage mechanisms through a hotline for hospital staff to call the city CDC to come to the hospital to counsel HIV-
positive patients and provide follow-up services. Field testing of the model in Guangdong City in 2007 showed that knowing one's
HIV status increased from 11% to 34%. Field testing will expand to three provinces in FY 2009 to improve status disclosure of
PLHA in clinical settings.
USG will support GoC in building counseling and testing capacity at all levels, providing training to improve counseling skills,
providing training to local CDC, hospital, and detoxification facility staff, and assisting GFATM Rounds 3, 4, 5, and 6 to better
target MARPs for VCT at the national, provincial, and local levels.
Table 3.3.14:
Estimated amount of funding that is planned for Human Capacity Development $95,400
Estimated amount of funding that is planned for Education $31,800
Estimated amount of funding that is planned for Human Capacity Development $72,000
Table 3.3.16:
Estimated amount of funding that is planned for Human Capacity Development $225,000
Estimated amount of funding that is planned for Education $22,500
Table 3.3.17:
Estimated amount of funding that is planned for Human Capacity Development $171,500
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $1,088,986
The USG management and staffing plan is designed to work ourselves out of a job, and to ensure that China's HIV/AIDS program
has the technical and management competence to successfully contain and control the epidemic. USG will accomplish this goal
by providing technical assistance to public and private sector partners to carry out innovative and replicable demonstration
projects; jointly collect and analyze data to demonstrate effectiveness; facilitate the policy process, both formally and informally;
and integrate and provide incentives for the Chinese health system to adopt effective HIV control strategies based on cost-
effective and "best practice" evidence. To achieve this goal, the USG HIV/AIDS program incorporates the strengths and
comparative advantages of all USG agencies working in HIV/AIDS in China.
The Embassy AIDS Committee (EAC), headed by the Deputy Chief of Mission (DCM), plays a coordinating role for the USG
agencies working on HIV/AIDS in China. Under DCM's direction, the Science Counselor and Health Attache serve as the official
liaisons with the Chinese MoH and other implementing agencies to ensure proper follow-through on the "One USG" policy. As a
member agency, HHS/CDC works closely with China CDC and NCAIDS, the Chinese government agency that coordinates the
national response to HIV/AIDS. HHS/CDC has direct relationships at the national and provincial levels, with eight Divisions of
NCAIDS (Behavioral Intervention, Data Integration and Evaluation, Epidemiology, Laboratory, Policy and Information, Treatment
and Care, International Cooperation, ChinaCARES, and the Center Office for Training), the National Center for Women and
Children's Health (NCWCH), and 15 provincial CDCs. HHS/CDC has technical and management staff that provide timely and
strategic direct technical assistance to China CDC and its partners to help China adopt comprehensive and cost-effective control
strategies and facilitate adoption at the national and provincial levels. Through its involvement in the planning process for each
round of GFATM, NCAIDS division, and annual national planning processes, HHS/CDC has effectively influenced national policy
with minimal resources.
USAID works closely with NGOs and the provincial and the local MoH, focusing its efforts primarily in two provinces. Providing
technical expertise and oversight, it funds international and local non-governmental organizations to implement programs focused
on community-based support, follow-up, and care for people most affected by HIV/AIDS. Currently, USAID partners also
implement activities aimed at strengthening the capacity of local governments and civil society to implement client-friendly
supportive services and outreach activities which link to available government services. USAID's goal is to develop effective, non-
duplicative, cost-effective, and sustainable models for adoption by GoC.
The majority of the USG team is located in Beijing with three at the US Embassy, 13 current and four vacant CDC staff, one
USAID technical advisor and two planned USAID local staff co- located at the HHS/CDC GAP office in the Dongwai Diplomatic
Office Building, a CDC GAP office located at NCAIDS of China CDC, and another office located at the UNAIDS office to facilitate
USG program planning within the multilateral community. Four additional staff members are located at the USAID Bangkok-based
Regional Development Mission Asia (RDM/A). The regional platform at RDM/A continues to exercise overall management
responsibility, budgeting and financial management, procurement, and technical assistance to China since it does not have a
bilateral USAID Mission. Except for the two persons highlighted in the staffing chart and the one USAID technical advisor in the
GAP office, all other persons at RDM/A dedicate less than 20% of their time on the China program.
The USG China HIV/AIDS program is supported by 45 persons. Of those 45 persons, 24 are dedicating 100% of their time to the
program, and the others dedicate anywhere from 20% to 50%. This equates to 33.8 Full-Time Equivalents (FTEs). Many staff are
responsible for providing assistance and oversight in more than one technical area. Currently, 0.8 FTEs on PMTCT, 1.3 FTEs on
Other Sexual Prevention, 2.5 FTEs on Injecting and Non-Injecting Drug Use, 1.5 FTEs on Adult Care and Support, 1.0 FTEs on
Adult Treatment, 1.0 FTEs on Pediatric Care and Support, 1.0 FTEs on Pediatric Treatment, 0.8 FTEs on TB/HIV, 3.0 FTEs on
Counseling and Testing, 2.5 FTEs on Laboratory Infrastructure, 5.6 FTEs on Strategic Information, 2.0 FTEs on Health Systems
Strengthening, and 10.6 FTEs on Management and Staffing. Of the 10.6 FTEs, three are related to management and the rest are
support staff. During the next planned retreat in June 2009, one of the tasks will be to revisit the current staffing pattern and
propose revisions if deemed necessary. It is envisioned that some support from RDM/A will decrease next year as the Beijing staff
acquire the experience needed to manage the program.
Processes have begun over the last two years to improve coordination, and the agencies will continue to set up more effective
mechanisms for information sharing, facilitating interagency communication, and managing the overall program. This is the first
year where USAID and HHS/CDC are co-located in China. This strategy of co-location has already assisted USG in improving
communication, coordination, and overall management of the program.
In addition to co-location, HHS/CDC and USAID will continue several co-management mechanisms and strategies to reinforce the
one USG HIV/AIDS control program and draw upon each agency's relative strengths. These include: team input on government
and non- government contract and cooperative agreement development and implementation (including joint reporting and
technical monitoring trips), sharing quarterly and annual partner reports, and joint meetings with key counterparts; conducting all-
team meetings every quarter; orienting new staff to PEPFAR in an interagency approach; involving counterparts and partners,
when appropriate, in strategic planning meetings; instituting joint site visits and partner work plan meetings; conducting joint
evaluations; and holding joint meetings with key counterparts.
In FY 2009, the USG team plans to form TWGs around the key areas of USG intervention. This will substantially enhance our
ability to provide technical support as well as monitor progress and fine tune our supported interventions, as needed. The four
planned TWGs are: Prevention (sexual and IDU), Counseling and Testing, Treatment and Care, and Strategic Information. These
groups will be made up of representatives from GoC, HHS/CDC, USAID, and partners.
The USG HIV/AIDS team seeks permission to hire three persons during the FY 2009 implementation year. Currently, the team
lacks adequate personnel to provide quality assistance to the GoC in prevention, counseling and testing, and care and treatment.
We propose to fill these positions with junior project officers who will work under two seasoned CDC GAP employees already on
staff. In addition, the USG team proposes to hire two locally employed staff (LES) through a USAID mechanism. There are
currently only 1.5 FTE administrative assistants funded by CDC GAP and available to assist all the USG HIV/AIDS staff located in
Beijing. This is not adequate given the number of persons requesting these types of services. It is of growing importance to have
strategically placed, highly adaptable, and qualified staff throughout the Chinese health system as USG continues provision of
timely advice to GoC counterparts. The continued expansion of technical assistance provided by USG in China has led to a
greater need for more strategically placed staff.
Table 3.3.19:
