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
Since 2002, the Ivorian NGO ACONDA has provided innovative, comprehensive, family-based care
services in support of Ministry of Health PMTCT and HIV treatment programs. ACONDA defines a holistic
approach to care and seeks to provide a complete and integrated package of quality services that includes
prevention (CT, PMTCT, secondary sexual prevention); adult, child, and family care (with provision of ART,
OI prevention and treatment, and promotion of "positive living"); and psychosocial support and a continuum
of care through links with local PLWHA and community organizations. After working as a treatment sub-
partner to EGPAF (Project HEART), ACONDA in September 2006 graduated to become a PEPFAR prime
partner providing comprehensive family care and PMTCT services.
As of June 2007, with PEPFAR funds, ACONDA had trained 328 health providers at 36 sites and provided
5,981 pregnant women with HIV counseling and testing with receipt of test results. Of these, 2,857 were
HIV-infected, 498 were provided with ARV prophylaxis, and 65 were initiated on ART. By March 2008,
ACONDA expects to support 72 PMTCT sites (out of 74 comprehensive HIV care and treatment sites)
testing 50,000 pregnant women and providing 3,570 women with ARV prophylaxis.
In FY08, ACONDA will continue its PMTCT activities while contributing to the scale-up and decentralization
of PMTCT and linked HIV care and treatment services. ACONDA aims to improve access to underserved
and rural populations, enhance uptake of services, improve population coverage, promote quality and
evidence-based practices, and integrate PMTCT and HIV care into routine health services with district
health team involvement. ACONDA will adhere to national standards, will remain an active member of the
PMTCT and other technical consultative forums, and will provide input to improve national policies
according to evidence-based practices. ACONDA will also remain an active member of the national
commodities coordination committee for HIV-related commodities.
ACONDA will coordinate with EGPAF as the ACONDA program splits off to become an independent prime
partner under PEPFAR, and they will coordinate the scale-up of their programs in strategic geographic
areas with ICAP-Columbia University, the MOH, the Global Fund, and other stakeholders.
With FY08 funds, ACONDA will expand PMTCT activities to 16 new sites. At its 88 PMTCT sites, ACONDA
will reach at least 67,250 pregnant women with HIV counseling and testing results and will provide ARV
prophylaxis to at least 4,700 HIV-infected pregnant women. To support its sites, ACONDA will train 80
health providers involved in preventing mother-to-child transmission of HIV, using previously developed
national PMTCT training materials. To meet human-resource needs in areas that lack laboratory
technicians, ACONDA will also train 50 nurses and midwives from rural areas to perform HIV testing using
approved methods and will monitor their performance. To ensure that all sites adhere to national standards,
ACONDA will conduct site assessments, onsite training, supportive supervision, and laboratory quality
assurance, and will provide ongoing technical support. PMTCT commodities will be monitored but will be
procured through the Partnership for Supply Chain Management (SCMS) and the Public Health Pharmacy
(PSP).
ACONDA and its partners will link HIV care and treatment services with systematic referrals to enable all
identified HIV-infected pregnant women to access clinical and home-based services. Women eligible for
ART will start treatment according to national guidelines and receive ongoing care through HIV treatment
clinics or community-based sites. ACONDA will provide joint care for HIV-infected women and their babies
during postnatal care, as well as infant follow-up with early infant diagnosis and clinical monitoring. It will
subsequently link mothers and children to community-based care services. The program will also
encourage HIV-positive women to bring their family members in for CT.
ACONDA will support MOH staff in each district to integrate PMTCT with other services, such as family
planning and nutritional support. MOH staff will also provide training, supportive supervision, and M&E
assistance to aid the progressive transfer of capacity to the district health team. ACONDA will support
health districts with equipment, rehabilitation, and technical assistance for the management of data.
ACONDA will improve the quality of data gathered at sites through supervision and ongoing participatory
training for data managers. ACONDA will help each site develop and implement a comprehensive M&E plan
that will also identify collaborations with key partners. ACONDA will report to the USG strategic information
team quarterly program results and ad hoc requested program data. To help build a unified national M&E
system, ACONDA will participate in quarterly SI meetings and will implement decisions taken during these
meetings.
At all sites, ACONDA will provide - either through direct hire or by contracting with individuals or local
organizations - counselors dedicated to providing a comprehensive package of HIV prevention
interventions for all clients and effective referrals for persons living with HIV/AIDS and their children.
ACONDA will engage enough counselors (funded in part through AB, Condoms and Other Prevention,
OVC, and palliative care funds) to allow every site to provide this prevention and referral package to all
clients.
All clients who test HIV-negative will be referred (on an opt-out basis) to a counselor for behavior-change
communication interventions, delivered individually or in small groups, focusing on risk reduction through
abstinence and fidelity, with correct and consistent condom use for those engaged in high-risk behavior, as
well as partner testing and STI prevention and care.
HIV-positive clients will be referred (on an opt-out basis) to a counselor for individual counseling that will
include HIV prevention interventions and referral to community-based OVC and palliative care services to
address family and individual care needs. Targeted HIV prevention counseling will focus on risk reduction
through abstinence, fidelity, correct and consistent condom use, disclosure, testing of partners and children,
and STI prevention and care. Where possible, family-planning counseling and services will be provided to
patients and their partners through wraparound programming by other non-PEPFAR funded partners, and
condoms will be provided free of charge.
In addition, all HIV-positive clients will be offered information about and referrals to specific community-
based OVC care and palliative care services tailored to their needs. With assistance from the National OVC
Care Program (PNOEV) and the PEPFAR in-country team, ACONDA will ensure that community-based
services capable of meeting these needs are identified, and ACONDA will be responsible for monitoring and
reporting on referrals according to a nationally standardized referral system.
Activity Narrative: Since 2002, the Ivorian NGO ACONDA has provided innovative, comprehensive, family-based care service
Facility-based health services represent a critical opportunity to impact client behavior through clear,
authoritative health messages delivered in one-on-one or small-group settings, as well as to connect clients
effectively with community-based care services. To use the opportunity to reduce risk behavior and thus
HIV transmission, all PEPFAR Cote d'Ivoire ART and PMTCT service providers will ensure that their
package of services includes HIV prevention behavior-change communication promoting risk reduction
through abstinence, fidelity, correct and consistent condom use, status disclosure, partner testing, and STI
prevention and care targeting both HIV-positive and HIV-negative clients. In addition, they will ensure that
all HIV-positive clients are offered effective, monitored referrals to community-based OVC and palliative-
care services.
HIV-negative clients at PMTCT and CT sites:
All clients who test HIV-negative will be referred (on an opt-out basis) to a counselor for behavior change
HIV-positive clients at PMTCT and ART sites:
Addressing prevention with HIV-positive patients is an important part of a comprehensive prevention
strategy. Through healthy living and reduction of risk behaviors, these prevention interventions can
substantially improve quality of life and reduce rates of HIV transmission. The goal of these interventions is
to prevent the spread of HIV to partners and infants born to HIV-infected mothers and protect the health of
infected individuals.
At all clinical visits, clients who are HIV-positive will be referred (on an opt-out basis) to a counselor for
individual counseling that will include HIV prevention interventions and referral to community-based OVC
and palliative care services. Targeted HIV prevention counseling will focus on risk reduction through
abstinence, fidelity, correct and consistent condom use, disclosure, testing of partners and children, and STI
prevention and care. Family-planning counseling and services will be provided to patients and their partners
through wraparound programming by other non- PEPFAR funded partners. Condoms will be provided free
of charge.
based OVC care and palliative care services tailored to their individual needs. ACONDA will ensure that
community-based services capable of meeting these needs are identified and will be responsible for
monitoring and reporting on referrals.
ACONDA will engage enough counselors to allow every site to provide this prevention and referral package
to all clients. Funding to support staffing and training of these counselors; training of physicians and nurses
to refer clients to the counselors; and adaptation and reproduction of job aids and prevention materials will
be split at approximately 50% Abstinence/Being faithful, 10% Condoms/Other Prevention, 10% Palliative
Care, and 30% Orphans and Vulnerable Children. The reason for dividing the funding is to allow the
program to address an array of HIV prevention needs for HIV-positive and HIV-negative persons as well as
to provide effective linkages to OVC and palliative-care services.
This entry represents the Abstinence and Being Faithful portion of the comprehensive prevention package.
This programmatic area is addressed in several components of the intervention. Counselors will be trained
to assess and address sexual risk behavior and to deliver tailored AB messages using culturally appropriate
visual aids. In each of these interventions, patients are encouraged to remain abstinent to protect their own
health and avoid transmission to partners. Patients who are sexually active are also encouraged to remain
faithful to one partner. Abstinence is also promoted in the family planning and STI trainings as a method of
preventing pregnancy and STI transmission.
ACONDA will report to the USG strategic information team quarterly program results and ad hoc requested
program data. To help build and strengthen a unified national M&E system, ACONDA will participate in
quarterly SI meetings and will implement decisions taken during these meetings.
All clients who test HIV-negative will be referred (on an opt-out basis) to a community counselor for
behavior change communication interventions, delivered individually or in small groups, focusing on risk
reduction through abstinence and fidelity, with correct and consistent condom use for those engaged in high
-risk behavior, as well as partner testing and STI prevention and care.
At all clinical visits, clients who are HIV-positive will be referred (on an opt-out basis) to a community
counselor for individual counseling that will include HIV prevention interventions and referral to community-
based OVC and palliative care services. Targeted HIV prevention counseling will focus on risk reduction
and STI prevention and care. Family-planning counseling and services will be provided to patients and their
partners through wraparound programming by other non- PEPFAR funded partners. Condoms will be
provided free of charge.
to all clients. A rule of thumb is that per day, one counselor might provide HIV prevention interventions in
small-group sessions for up to 80 HIV-negative clients or HIV prevention and OVC and palliative care
referral services in individual sessions for up to 10 HIV-positive clients.
Funding to support staffing and training of these counselors; training of physicians and nurses to refer
clients to the counselors; and adaptation and reproduction of job aids and prevention materials will be split
at approximately 50% Abstinence/Being faithful, 10% Condoms/Other Prevention, 10% Palliative Care, and
30% Orphans and Vulnerable Children. The reason for dividing the funding is to allow the program to
address an array of HIV prevention needs for HIV-positive and HIV-negative persons as well as to provide
effective linkages to OVC and palliative-care services.
This entry represents the Other Prevention portion of the comprehensive prevention package. This
programmatic area is addressed in several components of the intervention. Counselors will be trained to
assess and address sexual risk behavior and to deliver tailored OP messages using culturally appropriate
faithful to one partner. Furthermore, the prevention approach, "positive prevention," aims to protect the
health of HIV-infected individuals and prevent the spread of HIV to sex partners and infants. Because an
HIV-positive person is involved in the transmission of each new infection, prevention interventions aimed at
people infected with HIV can have a larger effect on disease spread than comparable efforts aimed at
people who are not infected. This makes positive prevention an essential part of a comprehensive
prevention approach. Key prevention steps at each clinic visit will be the delivery of behavioral prevention
messages (including addressing issues relevant to discordant couples), STI management, discussing family
planning needs, and assessment for heavy alcohol use and ARV adherence.
Noted April 16, 2008:
This funding represents a percentage of Alliance CI 's palliative care funds reprogrammed to ACONDA to
provide financial, programmatic, technical and overall capacity building support to subpartners who received
grants in FY 07 to continue providing uninterrupted palliative care services in the zones ACONDA is
working. ACONDA will also provide subgrant funding and technical assistance to several subpartners
formerly supported through Alliance National Contre le SIDA.
Since its creation in 2002, the Ivorian NGO of health professionals ACONDA has provided innovative,
comprehensive, family-based care services in support of the Ministry of Health PMTCT and HIV treatment
programs. ACONDA defines a holistic approach to care and seeks to provide a complete and integrated
package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention); adult,
child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive
living"); and psychosocial support and a continuum of care through links with local PLWHA and community
organizations. After working as a sub-partner to EGPAF (Project HEART) starting in 2004, ACONDA in
September 2006 graduated to become a PEPFAR prime partner providing comprehensive family care and
PMTCT services. ACONDA is rapidly expanding its family-based model and will provide ART to about
20,000 patients, including at least 2,000 children, by March 2009.
With FY08 funding, ACONDA will provide and support palliative-care services at the health facility and
community levels.
Clinic-based care:
ACONDA provides palliative care at its 74 ART sites and at community-level service points around each
site. With PEPFAR support, ACONDA has provided palliative-care services for 49,310 people. In FY08,
ACONDA will support 75 sites (excluding TB/HIV sites) providing palliative care to at least 50,000 patients
(including about 7,500 (15%) children). ACONDA will train 397 physicians, paramedics, social workers, and
community advisers in prevention and treatment of OIs, adherence to ARVT, and provision of psychosocial
support.
ACONDA ensures that people who test HIV-positive undergo clinical and biological assessments (CD4
count) to determine clinical staging and eligibility for ART initiation. Patients who are eligible are put on ART
according to national guidelines. They are followed up after three months and then every six months to
monitor side-effects and assess adherence and efficiency of treatment (based on CD4 count increase).
Symptomatic patients are cared for according to symptom type: Pain is treated with opiates or non-opiates
(according to WHO guidelines); patients with fever, diarrhea, or anemia are managed using pre-defined
algorithms with specific and appropriate drugs (anti-diarrhea, antipyretic, blood transfusion, and intravenous
solutions). Asymptomatic patients are assessed every six months for clinical staging and ART eligibility. All
patients with a CD4 count <500 (symptomatic or not, on ART or not) receive cotrimoxazole free.
Cotrimoxazole (20mg/kg daily) is given to all HIV-exposed children (born to HIV-infected mother) from 2
weeks to 18 months (or until the confirmation of non-infection) and to all HIV-infected children with
CD4<25%.
Infants diagnosed with HIV infection are assessed for ART initiation and are provided with a complete
package of care. ACONDA works to identify local foods that can be substituted in the diets of pediatric
patients who are being weaned off breast milk, and counselors provide information to patients on diet
changes.
Nutritional support is provided through non-USG support, wrapping around ACONDA's efforts to provide
HIV-infected families with cooking kits (containing rice, milk, flour, oil, etc,) and cooking classes geared
toward proper nutrition for PLWHA. These cooking kits are distributed by counselors at the health centers
and during home visits. ACONDA provides malnourished patients with targeted nutritional support. A series
of trainings on this care will be given to care providers and will comply with OGAC policy.
At all sites, ACONDA will provide - either by hiring or by contracting with individuals or local organizations -
counselors dedicated to providing a comprehensive package of HIV prevention interventions for all clients
and effective referrals for persons living with HIV/AIDS and their children. ACONDA will ensure enough
counselors (funded in part through AB, Condoms and Other Prevention, OVC, and palliative care funds) to
allow every site to provide this prevention and referral package to all clients.
address family and individual care needs. Counselors will provide adherence support, prevention-for-
positives counseling, and advice and help for disclosure of HIV status to partners and family, with a specific
focus on sero-discordant couples. Patients will also undergo a systematic psychosocial assessment to
identify barriers and obstacles to adherence and will then be referred to support groups. Targeted HIV
prevention counseling will focus on risk reduction through abstinence, fidelity, correct and consistent
condom use, disclosure, testing of partners and children, and STI prevention and care. Where possible,
family-planning counseling and services will be provided to patients and their partners through wraparound
programming by other non-PEPFAR funded partners, and condoms will be provided free of charge.
Community-based care:
In addition to counselors based at all facilities, CBOs and other organizations providing specific
Activity Narrative: interventions will be identified and given sub-grants, in conjunction with Alliance CI, to help ACONDA
support patients in their communities. Sub-grantees will make home visits to provide palliative care,
psychological support, adherence support, nutritional counseling, bed nets, and even some micro financial
support through income-generating activities. Sub-partner organizations will help develop community-
mobilization activities, work to promote CT and to reduce HIV-related stigma and discrimination, and
network with health-center teams to provide linkages among clinical HIV care, community support, and
wraparound services.
ACONDA will train these community counselors and supervise their activities in the community. Monthly
meetings will be organized by the district team, and monthly reports will be required from sub-partners.
ACONDA, the CBO/NGOs, and the district team will quarterly meetings to evaluate community-based
activities.
ACONDA's district approach involves the district team in each health district (the operational unit of the
country's health system) in the global care of PLWHA to support integration of HIV/AIDS care in the routine
activity of the health center. In collaboration with the district director, ACONDA will train and support all
members of the district team to supervise all health center activities, with timely evaluation missions. This
strategy aims to facilitate effective integration and sustainability of HIV/AIDS activities in the districts.
program data. To participate in the building and strengthening of a single national M&E system, ACONDA
will participate in quarterly SI meetings and will implement decisions taken during these meetings. ACONDA
will adhere to national palliative-care standards and contribute to the national dialogue on policy issues,
drug lists, and a minimum package of palliative-care services as part of the palliative-care and other
technical consultative forums. All activities will be planned with the National HIV/AIDS Care and Treatment
Program (PNPEC), and trainings will use nationally approved trainers and materials. Monthly reports will be
sent to the PNPEC and shared with all other actors in HIV/AIDS care. ACONDA will remain an active
member of the national coordination committee for HIV-related commodities.
Cotrimoxazole (adult and pediatric formulation), condoms, and other strategic inputs will be provided by
SCMS and the Public Health Pharmacy (PSP). ACONDA will provide some medical equipment and
supplies.
Since its creation in 2002, the Ivorian NGO of health professionals called ACONDA has provided innovative,
programs. ACONDA's personnel have more than a decade of experience in HIV clinical and applied
research, with a sustained focus on antiretroviral treatment. In addition, ACONDA defines a holistic
of care through links with local PLWHA and community organizations. ACONDA is also committed to
ongoing applied research to improve service delivery and promote sustainable quality services to reduce
HIV-related morbidity and mortality in Cote d'Ivoire.
ACONDA has been successful in mobilizing resources and developing its own organization to support
expanded service delivery and research activities. ACONDA has created numerous technical and financial
partnerships (with the MOH, ISPED/University of Bordeaux, GIP-ESTHER, Columbia University,
GlaxoSmithKline Foundation, NGO Sidaction, and the Clinton Foundation). Since 2004, ACONDA has been
a sub-partner under the five-year EP cooperative agreement called Project HEART, led by the Elisabeth
Glaser Pediatric AIDS Foundation (EGPAF) and the University of Bordeaux/ISPED.
In September 2006, ACONDA graduated to become an EP prime partner by winning a competitive EP/CDC
award to provide comprehensive family care and PMTCT services.
ACONDA is rapidly expanding its comprehensive family-based model and will provide ART to approximately
20,000 active patients, including 2,200 children (11%), by September 2009.
Integrated HIV/AIDS care and treatment at TB sites:
Despite the politico-military crisis in Cote d'Ivoire, the National TB Program has continued to decentralize its
services to 92 sites. ACONDA in collaboration with PNLT will train all the Tb staff in TB HIV co-management
and program implementation. ACONDA will strive for 100% (around 2,000) testing among TB suspects at
these sites using provider initiated counseling and testing approach. Cotrimozxazole prophylaxis will be
offered to all the co-infected TB patients at these sites. In line with its holistic approach, ACONDA has
linked HIV care and treatment services at its 20 ART prescription and 56 refill sites with TB services. As the
National TB Program decentralizes further, ACONDA will provide HIV/AIDS care and treatment services
linked to TB services at the 16 new sites it will open in FY08. ACONDA will strive for 100% coverage of HIV
testing among TB suspects. Following national recommendations, ACONDA will provide TB diagnosis and
treatment services to children aged < 5 years.
Integrated TB care and treatment at HIV/AIDS sites:
In line with its holistic approach, ACONDA has linked HIV care and treatment services at its 20 ART
prescription and 56 refill sites with TB services and proposes to link the new 16 sites as well. In FY08,
providers at ACONDA's 90 HIV/AIDS sites will systematically screen HIV/AIDS patients for TB based on
their clinical symptoms. TB suspects will be referred for sputum smear microscopy and chest x-ray and
active TB cases will be treated according to the national guidelines. During FY08, ACONDA expects to
increase the coverage of TB diagnosis and treatment services to 2000 patients in HIV clinics (an estimated
5% of all HIV patients at each clinic). To accomplish this, ACONDA will ensure that health professionals at
the new sites are trained to clinically manage HIV and common opportunistic infections, including TB. In
addition, professionals from TB clinics will attend training on the holistic case management of TB/HIV co-
infected patients, using materials validated by the national TB program (PNLT). ACONDA will also provide
INH prophylaxis to eligible HIV-infected patients as per the national guidelines.
ACONDA in collaboration with the national TB program will conduct facility assessments for TB infection
control and will implement corrective action as per the national guidelines. ACONDA plans to strengthen the
existing referral system between HIV and TB in coordination with the national TB Program. A system of
reference and linkage between TB centers and ARV service sites will be strengthened.
A total of 144 staff members from both existing and new sites will be trained on-site to diagnose TB in HIV-
positive patients using specific guidelines from the National TB program. Other professionals (75) will attend
training in holistic case management of TB/HIV co-infected patients (the same training listed above for TB
clinic staff). About 50 paramedics from the various sites will receive refresher training in TB care.
Patients co-infected with TB/HIV will be linked to community services at both the TB clinic and the HIV/AIDS
clinic. CBOs and NGOs will receive sub-grants, in conjunction with Alliance CI, to guarantee DOTS
adherence and to retrieve patients lost to follow-up. ACONDA will improve referral forms and counter-
referral forms to establish stronger links between clinics, to improve the ability of clinics and CBO/NGOs to
follow up with patients, and to improve monitoring and data analysis.
ACONDA will work to strengthen its monitoring and evaluation system and to support an integrated national
M&E system.
Noted April 17, 2008: ACONDA will also provide subgrant funding and technical assistance to several
subpartners formerly supported through Alliance National Contre le SIDA.
organizations. After working as a treatment sub partner to EGPAF (Project HEART) starting in 2004,
ACONDA in September 2006 graduated to become a PEPFAR prime partner by winning a competitive
award to provide comprehensive family care and PMTCT services. ACONDA is rapidly expanding its
comprehensive family-based model and will provide ART to approximately 25,000 patients, including 3,000
children, by March 2009.
In addition to providing medical care and treatment, facility-based health services represent a critical
opportunity to impact client behavior through clear, authoritative health messages delivered in one-on-one
or small-group settings, as well as to connect clients effectively with community-based care services. To
use the opportunity to reduce risk behavior and thus HIV transmission, all PEPFAR Cote d'Ivoire ART and
PMTCT service providers will ensure that their package of services includes HIV prevention behavior-
change communication promoting risk reduction through abstinence, fidelity, correct and consistent condom
use, status disclosure, partner testing, and STI prevention and care targeting both HIV-positive and HIV-
negative clients. In addition, they will ensure that all HIV-positive clients are offered effective, monitored
referrals to community-based OVC and palliative-care services.
At all its PMTCT and ART sites, ACONDA will provide - through direct hire or, more commonly, by
contracting with individuals or local organizations - counselors dedicated to providing a comprehensive
package of HIV prevention interventions for all clients and effective referrals for persons living with
HIV/AIDS and their children.
HIV-negative clients at PMTCT, CT, and TB sites:
HIV-positive clients at PMTCT, ART, TB, and CT sites:
and palliative care services to address family and individual care needs now and in the future. Targeted HIV
programming by other non- PEPFAR funded partners, and condoms will be provided free of charge.
based OVC care and palliative care services tailored to their individual needs. In these individual sessions,
the counselor will seek to obtain contact information (e.g. address, telephone number) for the client and
briefly assess the client's needs and resources. The counselor will provide the client with a brochure or
other illustrated materials showing what the palliative care and OVC care services might include, such as
clean water and bed nets for palliative care and educational, medical, nutritional, legal, and psychosocial
support for OVC. The counselor will then ask the client whether she or he would like to provide the names
of people in the household who might need referral to such services.
With assistance from the National OVC Care Program (PNOEV) and the PEPFAR in-country team,
ACONDA will ensure that community-based services capable of meeting these needs are identified, and
ACONDA will be responsible for monitoring and reporting on referrals according to a nationally standardized
referral system.
effective linkages to OVC and palliative-care services for persons living with HIV. The program's effort will
reflect the funding and proportions noted here.
comprehensive family-based model and will provide ART to approximately 20,000 patients, including at
least 2,000 children, by March 2009.
Counseling and testing services are the doorway for HIV-infected individuals into ACONDA's
comprehensive service program. In FY07, ACONDA is integrating CT services at 74 clinics and has a target
of providing counseling and testing for 128,048 people.
In FY08, ACONDA will equip and provide CT services at 16 additional sites (for a total of 90 sites), and
testing will be provider-initiated based on the national testing algorithm, which is expected to be simplified
within the year to allow rapid tests using whole blood and finger-prick techniques. New sites will include 12
district hospitals and four urban health centers or antenatal/maternity sites. All CT personnel will be trained
on the new algorithm after it is approved.
All HIV-positive adults will be counseled and asked whether their families, including children, can also be
tested. When a child tests positive, the parents will be asked to be tested and to have tests done for all
siblings. In collaboration with the rural development agency ANADER, ACONDA will also pilot community-
based counseling services that are delivered via mobile testing units in rural areas. In all, ACONDA expects
to provide counseling and test results for at least 50,000 people with direct PEPFAR support and will direct
all those who are seropositive to the appropriate services within its comprehensive program, as well as to
community-based palliative care and OVC services. ACONDA will emphasize strategies for couples testing
and for prevention and support services for discordant couples.
ACONDA's activities will be linked with stand-alone CT services operated by other organizations or the
government. ACONDA will accept all referrals for counseling, psychosocial support, clinical prevention,
prevention education, care, and treatment services.
clients. A rule of thumb is that per day, one counselor might provide HIV prevention interventions in small-
group sessions for up to 80 HIV-negative clients or HIV prevention and OVC and palliative care referral
services in individual sessions for up to 10 HIV-positive clients.
ACONDA will also provide training in CT according to the national algorithm to 100 community advisers and
health providers within the community and will work closely with CBOs and NGOs to provide them with
technical assistance. Local organizations will be given sub-grants, in conjunction with Alliance CI, to provide
psychosocial support and community-based CT. This will generate innovative ways of reaching out to
greater numbers of people with CT services in communities. These organizations also help ACONDA
leverage additional funding, because the reach that ACONDA has through these partnerships is attractive to
many donors. In terms of community-based services, activities performed by the community advisers will
include counseling for testing (including family testing) and ART adherence, home visits, establishment of
support groups, and sensitization designed to fight against stigmatization in the community.
The community advisers are integrated in the health-care system and work in collaboration with the district
team. They are the links between health centers and the community for counseling, testing, ARV services,
M&E, and all care provided for PLWHA. They participate in all the meetings organized by ACONDA and the
district team and produce a monthly report of their activities.
New sites will be provided with tools for record-keeping, and the staff will receive training to use these tools.
Staff at the new sites, and new staff at existing sites, will be brought up to speed on national guidelines.
M&E system. It will adhere to national standards, will remain an active member of the CT and other
technical consultative forums, and will provide input to improve national policies according to evidence-
based practices. ACONDA will also remain an active member of the national commodities coordination
Activity Narrative: committee for HIV-related commodities. ACONDA will involve the district team in all CT activities. In
collaboration with ACONDA, the district team will support and supervise activities by ACONDA-supported
NGO/CBOs.
Other FY08 activities will include:
1) Training providers in new rapid-testing approaches to provide community- and family-based CT (in
accordance with the new algorithm).
2) Strengthening the referral system, with the involvement of other stakeholders, to HIV prevention, PMTCT,
palliative care, OVC services, and treatment services,
3) Targeting 100% of patients in clinical settings (including TB and PMTCT services) for counseling and
testing.
4) Strengthening the district approach through consistent involvement of the health district team in planning,
supervision, and coordination.
5) Strengthening the continuum of care, especially for orphans and vulnerable children, and supporting
implementation of a "risk reduction plan" for HIV-negative people.
Noted April 21, 2008: ACONDA will also provide subgrant funding and technical assistance to several
subpartners formerly supported through Alliance National Contre la SIDA.
In FY08, ACONDA will initiate about 5,000 people on ART to reach a total of 20,000 patients, including at
least 2,000 (10%) children, at 90 sites, including 16 sites to be added in FY08.
Adult ARV Services
In FY08, ACONDA will continue to support sites to provide high-quality ART services following national
guidelines. The focus will be on treating families - not just the individual - to better meet patient needs and
to assure better adherence and clinical outcomes. Sites will be supported to shift the organization of their
facility from a traditional episodic model of care to a chronic model of care for HIV patients, using a multi-
disciplinary team of providers. ACONDA will emphasize the involvement of PLWHA in programs through
peer-support interventions and strong linkages to community resources. ACONDA's capacity-building
approach, focusing on district- and facility-level systems strengthening and provider training and mentoring,
will help ensure sustainability. Key activities and approaches will include:
• Support sites to recruit and retain staff for ARV service provision. ACONDA will work with districts and
facilities to identify staff needs and find creative solutions for augmenting staff. Providing the training,
resources, and tools needed for staff to provide quality ART services will help also motivate staff and
increase retention.
• Train 120 doctors, nurses, social workers, counselors, and outreach workers to provide ART, intensive on-
site mentoring during the initiation of services, and periodic follow-up training and mentoring thereafter.
• Support sites to identify HIV-positive patients by strengthening CT interventions, including routine provider-
initiated CT. ACONDA will support sites to publicize the availability of ART services in the communities they
serve.
• Support sites to develop patient-flow algorithms, patient-appointment systems, and protocols related to the
initiation of ART (e.g. number of pre- and post-ARV initiation appointments, standard ARV prescriptions,
etc.).
• Develop protocols and systems for clinical staging of HIV patients and establishing eligibility for ART using
national guidelines and clinical staging, when appropriate.
• Support the formation and functioning of multidisciplinary team meetings to discuss complicated cases and
coordinate individual patient care.
• Help sites to provide effective support to patients prior to ARV initiation, such as counseling about
disclosure, adherence, and peer support.
• Support sites to develop patient-tracking systems that will help to identify patients who have not returned
for pharmacy or other appointments. Protocols for patient home visits will be developed. ACONDA will
develop a program to train PLWHA as peer educators/counselors to support and track patients enrolled in
ART. Peer educators will be supervised by social workers or other staff.
• Ensure strong linkages within the facility and with community-based services. Referral mechanisms will be
developed between ART services and other services (inpatient and outpatient departments, CT, PMTCT,
TB, under-5 clinic, family planning). HIV testing will be routinely offered to all patients. HIV program
management committees will meet regularly to coordinate services and cross-referrals.
• Support sites to establish/strengthen links with community-based organizations to ensure patient support
for home-based care, OVC services, adherence support, nutritional support, and other services. ACONDA
will introduce a community resource mapping tool and support sites to develop formal agreements and
referral systems with relevant organizations.
• Ensure availability of lab services for CD4 testing and to monitor drug toxicity. ACONDA plans to upgrade
all district hospital labs so they can provide CD4 testing for the entire district. ACONDA will support each
district to develop an effective sample transportation system to ensure that patients at the health center
receive CD4 results in a timely manner. Labs at all levels will have enhanced biochemistry and hematology
capacity.
• Work with SCMS and the Public Health Pharmacy (PSP) to support site pharmacies to establish systems
for ARV quantification, stock management, and patient appointments and to train pharmacists in counseling
patients about ART, including side effects and adherence. All ARV, OI drugs, and other commodities will be
procured by SCMS and distributed to sites via the PSP.
• Provide regular, supportive supervision, clinical updates, and refresher training to multidisciplinary care
teams and ART program managers, including the integration of M&E data into program planning and
improvement.
• Support sites to implement patient record-keeping systems and databases and to summarize and analyze
data for routine reporting using national tools. A data QA system will be implemented, and ACONDA
technical advisers will assist sites to analyze data regularly to assess program quality. ACONDA will meet
regularly with the MOH to provide feedback on ART-related M&E tools and approaches to help improve the
national system of data collection and reporting. ACONDA will report to the USG SI team quarterly program
results and ad hoc requested program data. To build and strengthen a single national M&E system,
ACONDA will participate in quarterly SI meetings and will implement decisions taken during these meetings.
At all ART, PMTCT, and CT sites, ACONDA will provide - either through direct hire or by contracting with
individuals or local organizations - counselors dedicated to providing a comprehensive package of HIV
prevention interventions for all clients and effective referrals for PLWHA and their children. ACONDA will
engage enough counselors (funded in part through AB, Condoms and Other Prevention, OVC, and
palliative care funds) to allow every site to provide this prevention and referral package to all clients.
All clients who test HIV-negative will be referred (on an opt-out basis) to a counselor for BCC interventions
focusing on ABC methods of risk reduction, as well as partner testing and STI prevention and care. HIV-
positive clients will be referred (on an opt-out basis) to a counselor for individual counseling that will include
Activity Narrative: ABC prevention interventions (including disclosure, partner and family testing, and STI prevention and care)
and referral to community-based OVC and palliative care services to address family and individual care
needs. Where possible, family-planning services will be provided through wraparound programming by non-
PEPFAR funded partners, and condoms will be provided free of charge.
All HIV-positive clients will be offered information about and referrals to specific community-based OVC
care and palliative care services tailored to their needs. ACONDA will ensure that community-based
Pediatric ARV Services
ACONDA will ensure that at least 10% of HIV care and treatment patients enrolled at its 90 sites are infants
and children (at least 2,000 patients on ART by March 2009). Pediatric support will focus on increasing
availability of infant HIV diagnostics, enhancing pediatric case finding and referral, ensuring comprehensive
care and treatment services for HIV-exposed infants and for HIV-infected infants and children, and
increasing access to pediatric ART. Emphasis will be placed on full involvement of families. An ACONDA
pediatric adviser will work closely with sites to provide focused training and clinical mentoring for pediatric
care and treatment. Interventions will include:
• Assess lab services for pediatric diagnostics and design capacity-building plans. This will include assuring
the availability of dried blood spot diagnosis by DNA PCR via specimen referral to the regional or national
reference laboratory level.
• Establish or strengthen HIV testing at entry points to pediatric services (inpatient wards, family-centered
care programs, CT programs, adult ART clinics, under-5 clinics).
• Strengthen referral mechanisms between ART clinic and entry points to pediatric services.
• Assess staff capacity for pediatric ART and provide targeted supplementary training.
• Strengthen care services (including staging, cotrimoxazole prophylaxis, nutrition and growth monitoring,
parental counseling, social and adherence support) for all HIV-exposed and HIV-infected children.
• Assess feasibility of co-located services and/or coordinated appointment scheduling for HIV-infected
women and their children.
• Work closely with SCMS and PSP to ensure a seamless supply of pediatric ARV and OI drug formularies.
• Establish pediatric and family support groups.
• Establish or strengthen links to community-based services for infants and children, including nutritonal
support and OVC services.
comprehensive, family-based care services in support of the Ministry of Health (MOH) PMTCT and HIV
treatment programs. ACONDA defines a holistic approach to care and seeks to provide a complete and
integrated package of quality services that includes prevention (CT, PMTCT, secondary sexual prevention);
adult, child, and family care (with provision of ART, OI prevention and treatment, and promotion of "positive
The main objective of ACONDA's M&E strategy is to use all relevant tools and procedures to ensure that
patients can be effectively managed within the comprehensive-care system. ACONDA has been using a
data-management system at all of its sites for the past three years. The system, based on a 10-year history
of providing services and doing research in Cote d'Ivoire, was designed to optimize the capability of sites to
follow patients closely. ACONDA assigns one focal point to each of the district hospitals where it works, who
in turn trains others and provides regular supportive supervision to keep checks on the data that is
recorded. In FY07, ACONDA trained 36 data clerks (called AMDs), three focal points, and three nurses who
specialize in epidemiology (called CSEs). Through its data-management system, ACONDA monitors patient
tracking information as well as information that is needed by the EP, the National HIV/AIDS Care and
Treatment Program (PNPEC), the MOH, and ACONDA partner ISPED.
This data-management system will be made available to all the health centers at which ACONDA will add
HIV/AIDS activities in FY08. In many cases, this will require ACONDA to provide computers, other
equipment, and training that will allow the new sites to use the system. In addition to rolling this system out
to new sites, ACONDA will strengthen monitoring activities at its 74 continuing ART sites by providing
refresher training and monthly supervision. In all, ACONDA's FY08 activities will train 330 people in
strategic information and provide 90 local organizations with technical assistance for strategic-information
activities. ACONDA will also implement the following activities:
ACONDA Headquarters Activities
In collaboration with national counterparts, the USG team, and other EP partners, ACONDA SI officers will:
1) Adapt the country's data-collection tools (paper and electronic)
2) Provide ongoing technical support and training to AMD/CSE/focal points
3) Train multidisciplinary care teams on how to use program data to assess the quality of care at their sites
4) Provide semi-annual program results, annual program results, and ad hoc data sets as requested by the
USG team
5) Participate in quarterly SI meetings organized by the USG strategic information branch and implement
decisions taken during these meetings
6) Organize a quarterly workshop with the ACONDA M&E team and field staff to talk about practical issues
in the field and appropriate solutions
7) Organize an annual meeting to review M&E activities at all sites
8) Attend specific workshops, conferences, or classes that bolster staff members' technical capacity
9) In collaboration the USG team, submit articles for publication in peer-reviewed journals.
Site-Level Activities
1) A team made up of AMDs, CSEs, and focal points, who serve on district health teams, will be trained to
better manage data. The training, provided by the ACONDA M&E team, will consist of a five-day session
followed by a 10-day practicum
2) ACONDA will provide SI-related material to each site, including computer hardware and software,
printers, registers and forms, and Internet connectivity
3) The ACONDA field staff will attend specific workshops, conferences, or classes that bolster their
technical capacity
4) ACONDA will support the SI capacity development of all personnel at health facilities hosting ACONDA
sites.
Strengthening National SI Activities
To strengthen the national SI system, ACONDA will:
1) Design or adapt additional management tools to improve follow-up of patients, based on each district's
data-management needs. These tools include forms and registers that allow comprehensive collection of
information on morbidity, ART treatment follow-up, laboratory investigations, and drug-supply management;
2) Train and support district teams that will be responsible for ensuring and supervising data recording, data
transfer to the district-team location, electronic recording and processing, and reports editing. District teams
will prepare monthly reports covering all aspects (quantitative and qualitative) of ACONDA's program.
Reports will be sent to the regional level and to the PNPEC, to feed into national data-collection efforts;
3) Set up a network between ACONDA and the district teams;
4) Develop and execute a data-quality improvement plan with technical assistance from external contractors
and in close collaboration with the RETRO-CI SI team and district data managers;
5) Work with the DIPE, the PNPEC, and other partners toward the use of unique patient identifiers as a way
of following patients through time and space;
6) Feed into national data-collection systems for drug and supply-chain management. The patient-
management system that is currently used at ACONDA-supported sites will be interfaced with the system
that the Partnership for Supply Chain Management Systems will be sharing with all care and treatment
programs in Cote d'Ivoire in FY08;
7) Participate in ongoing national efforts to maintain and improve a harmonized national longitudinal HIV-
positive patient-monitoring system.
Activities Supporting the National Electronic Patient-Monitoring System
To support the use of ACONDA's PMMS software at the national level, ACONDA will assist the national
program to develop additional measures as necessary, with technical support from ISPED/Bordeaux. The
current technical support of University of Bordeaux (ISPED) consists in analysing data to follow-up major
program outcomes and potential pitfalls are essential. The ISPED computer network specialist supervised
ACONDA data managers to enhance their routine analytical capacities. ISPED developed a quarterly report
Activity Narrative: system on the quality of the data. ISPED work closely, in partnership with ACONDA, with all national and
international partners to improve and adapt the electronic software and the M&E procedures for a
decentralized national use. In FY08, ACONDA/ISPED will:
1) Assist electronic patient-monitoring system stakeholders (ACONDA, EGPAF, ICAP-CU, DIPE, and CARE
International) to harmonize and install a central-level data-management system;
2) Ensure the technical governance and maintenance of the electronic patient-monitoring system;
3) Continue the follow-up training of local data managers to develop local statistical capacities to analyze
program outcomes.
4) Continue to control the quality of collected data through direct supervision and through cross-matching of
data by an experienced data-management team. Site-level data will be analyzed in order to monitor the
progress of individual sites, and will be summarized in monthly reports;
5) In collaboration with the USG team, submit articles for publication in peer-reviewed journals.
To promote sustainability, the hiring of staff will be done in close collaboration with the MOH and
decentralized government entities (mayors, general counsels).
