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.
A new TBD partner will support the Ivorian Ministry of Health to expand access to comprehensive HIV/AIDS
care and treatment while building the capacity of national structures and contributing to sustainable service
delivery within the health sector in Côte d'Ivoire, with a primary focus of activities in three northern regions
of the country: Vallée du Bandama, Zanzan, and Les Savanes
ART services will be initiated at health facilities where there is at least one medical doctor, according to the
national guidelines. PMTCT services will be offered at antenatal clinics and CT at all health facilities. In
FY09, the partner will provide support to five facilities delivering CT, PMTCT, palliative care and ART
services. In COP09, at the five partner-supported sites, 1000 pregnant women will be tested for HIV and
receive their results, and an estimated 40 HIV-infected pregnant women will receive a complete course of
ARV prophylaxis. All pregnant women testing HIV positive will receive CD4 testing and those who are
eligible for HAART will initiate their treatment during pregnancy.
The partner will support sites to provide family-centered PMTCT services, using antenatal care (ANC) and
other maternal and child health (MCH) services as a key entry point. The partner's capacity-building
approach, focusing on district- and facility-level systems strengthening and provider training and mentoring,
will help ensure long-term sustainability.
Interventions will include:
• Conducting initial assessments and developing work plans in collaboration with Ministry of Health and
District authorities to establish and/or improve PMTCT Services according to national guidelines. This will
include developing a plan for reorienting services to ensure that the PMTCT cascade is effectively
implemented (e.g. ensuring CD4 testing the same day as HIV test results, coordinating ANC visits with care
and treatment visits for pregnant women initiated on ART , etc).
• Providing training and on-site clinical mentoring for 15 nurses, midwives, social workers, counselors, and
medical doctors on PMTCT and conducting on-site mentoring for initiation and implementation of services.
• Supporting sites to provide quality group and individual pre- and post-test counseling to maximize testing
consent, receipt of results, and enrollment in and adherence to the PMTCT program. A routine opt-out
testing approach will be adopted.
• Providing counseling and testing to pregnant women presenting to the facility for the first time during labor.
• Supporting sites to develop systems to ensure that HIV-infected pregnant women are promptly assessed
for ART eligibility, receive routine CD4 cell count testing, and are provided with the clinical and social
services appropriate to their disease stage, including ART when indicated.
• Supporting health care sites to provide enhanced counseling on disclosure, couples counseling,
prevention, family planning, nutrition, infant feeding, and adherence. In line with a family-centered care
model, women will be strongly encouraged and supported to bring their children, their partners and other
family members to the facility for testing.
• Developing systems for linking PMTCT, care, and ART services to ensure that all pregnant women testing
HIV-positive are enrolled in HIV care and treatment and receive ongoing care after delivery.
• Supporting facilities to establish systems for identifying and tracking women lost to follow-up and
supporting adherence to ARV prophylaxis and ART, including linkages to PLWHA organizations and
community-based support programs.
• Supporting sites to establish/strengthen links with community-based organizations to ensure adherence to
the prescribed prophylactic regimen, nutritional support, and other services; at each PMTCT site, at least
one community-counselor will be identified, trained and will be involved in follow up of pregnant women; the
partner will introduce a community resource mapping tool and support sites to develop formal agreements
and referral systems with relevant organizations.
• Ensuring effective HIV exposed-infant follow-up, including initiating 90% of all exposed infants on
cotrimoxazole, growth monitoring, and early infant diagnosis using DNA PCR. Supporting sites to enroll
HIV-positive infants into care and treatment services. Sites will also create linkages with community based
OVC services for all exposed and infected children.
• Collaborating with districts to support the initiation of PMTCT services and ongoing supervision and quality
improvement.
• Supporting sites to implement patient record-keeping systems and databases and to summarize and
analyze data for routine reporting, using national tools. A data quality assurance system will be
implemented, and partner technical advisers will assist PMTCT sites to analyze data regularly to assess
program quality. This will include the introduction of registers that will allow sites to track mother/infant pairs
throughout the PMTCT cascade of services. The partner will meet regularly with MOH officials at the
national and district levels to provide feedback on PMTCT-related M&E tools and approaches to help
improve the national system of data collection and reporting.
• Collaborating with SCMS and the Public Health Pharmacy (PSP) to ensure effective forecasting of needed
medications and test kits and to ensure timely delivery and management of pharmaceutical drug and related
commodities stocks.
At all PMTCT, ART, and CT sites, the partner will contract with local organizations to provide counselors
dedicated to support for a comprehensive package of HIV prevention interventions for all clients and
effective referrals for PLWHA and their children.
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
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. The partner will ensure that community-based
services capable of meeting these needs are identified, and the partner will be responsible for monitoring
and reporting on referrals according to a nationally standardized referral system.
Activity Narrative: The partner will continue its collaboration with nutritional partners (National Program of Nutrition, PATH) to
improve nutritional services for exposed infants, according to national guidelines. All HIV positive pregnant
women, before delivery, will receive individual counseling regarding infant feeding, according to national
and international (WHO) guidelines.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
services. By September 2009, the five facilities will have enrolled 1,000 HIV-infected adults into care and
support services.
The partner will also provide subgrant funding and technical assistance to a variety of subpartners, including
private clinics, faith based clinics, and local associations of PLWHA to provide additional support for HIV
care and treatment services.
Adult care and support services for HIV-positive adults will be provided by a multidisciplinary team of
providers, and will focus on caring for the whole family, and will be strongly integrated with CT (included
routine provider-initiated CT), PMTCT, and ARV services, as well as identification of orphans and
vulnerable children (OVC) with referral to appropriate services.
The partner will develop and implement a capacity-building approach focusing on district and facility-level
systems strengthening and provider training and mentoring to ensure long-term sustainability.
In FY09, adult care and support interventions will include:
• The partner will work with health districts and individual facilities to identify staff needs, including materials
and training. This may also include the direct hiring of staff assigned to data entry at the site level.
• Providing the necessary clinical training, resources, and tools needed to provide quality adult care and
support services will help motivate staff and increase retention.
• Train in collaboration with PNPEC at least 20 doctors, nurses, social workers, counselors, and outreach
workers to deliver palliative care.
• The partner will conduct intensive on-site mentoring during the initiation of services and regular follow-up
training and mentoring thereafter.
• Support sites to identify HIV-positive patients by strengthening HIV counseling and testing interventions,
including traditional VCT and routine opt-out CT (see Counseling and Testing section). The partner will also
support sites to publicize the availability of adult care and support services in the communities they serve.
• Support sites to develop patient-flow algorithms, patient-appointment systems, and protocols related to
care and support based on national guidelines.
• Support the formation and functioning of Multidisciplinary Team Meetings to discuss complicated cases,
including those failing treatment, and to better coordinate individual patient care.
• Promote OI prophylaxis and treatment in accordance with MOH/National HIV/AIDS Care and Treatment
Program (PNPEC) guidelines. Similarly, routine TB screening will be promoted for HIV infected adults and
children.
• Ensure strong linkages between palliative care services and other services within the facility, such as
inpatient wards, the outpatient department, VCT, PMTCT, TB, under-5 clinic, and family planning. HIV
testing will be routinely offered to all patients in these services, and those testing HIV-positive will be
immediately enrolled in the care and treatment program and initiated on ART if eligible. HIV Program
Management Committees, including key staff representing various departments, will be established and will
meet regularly to coordinate services and cross-referrals.
• Enhance adherence and psychosocial-support activities at sites, including the implementation of support
groups and the use of peer educators. The partner will work with RIP+ (the national network of PLWHA
organizations) and local PLWHA organizations to implement successful peer-education programs to raise
awareness about HIV testing and the availability of care and ARV treatment services, to provide information
and emotional support to palliative care patients, and to conduct home visits to patients who have become
lost to follow-up.
• Work closely with SCMS and the Public Health Pharmacy (PSP) to ensure effective forecasting of needed
medications and test kits and to ensure timely delivery and management of pharmaceutical stocks.
• Work with health districts to support the initiation of palliative care services at sites and to provide ongoing
supervision and quality-improvement monitoring.
• Support sites to implement patient record-keeping systems and databases and to summarize and analyze
data for routine reporting, using national tools. A data quality assurance system will be implemented, and
partner technical advisers will assist sites to analyze data regularly to assess program quality. The partner
will meet regularly with the MOH to provide feedback on palliative care-related M&E tools and approaches
to help
improve the national system of data collection, reporting, and analysis.
• Support sites to provide HIV prevention counseling for HIV-positive individuals (Prevention for Positives)
enrolled in care and treatment programs.
• Enhance counseling of HIV-infected individuals to promote secondary prevention, enhance adherence to
care and treatment, provide psychosocial support, link patients to community resources, and identify
household members in need of testing, treatment, and care, including children in need of OVC services.
partner will also ensure that patients have access to nutritional assessment and counseling.
• Support sites to establish and strengthen links with community-based organizations to ensure community
based patient support for home-based care, OVC services, adherence support, nutritional support, and
other services. The partner will introduce a community resource mapping tool and support sites to develop
formal agreements and referral systems with relevant organizations.
The partner will contract with local NGOs in the districts they support to hire and train peer counselors who
will be placed at all sites and charged with ensuring effective referrals between services at the facility (i.e.
from VCT to care), providing psychological peer-support, counseling clients about HIV prevention and
adherence, and conducting home visits.
Activity Narrative: 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, the partner will ensure that community-based
services capable of meeting these needs are identified, and partner will be responsible for monitoring and
reporting on
referrals according to a nationally standardized referral system.
The partner will report to the USG strategic information team quarterly program results and program data
requested on an ad hoc basis. To participate in the building and strengthening of a single national M&E
system, the partner will participate in quarterly PEPFAR SI meetings and will implement decisions made
during these meetings.
Gender
* Increasing gender equity in HIV/AIDS programs
* Malaria (PMI)
* TB
Table 3.3.08:
services. The partner will newly initiate 500 adults on ART and will have at least 400 patients actively on
ART by September 2009.
The partner will also provide subgrant funding and technical assistance to several subpartners: private
clinics, faith based clinics for implementing HIV care services.
The partner will contract with local NGOs working on HIV/AIDS and PLWHA associations. To improve
outcomes for care and treatment through improved adherence and reduced rates of loss to follow-up, the
partner will collaborate with local associations of PLWHA, involving them in patient care and treatment at
health facilities and in the community. ART services for HIV-positive individuals will be provided by
multidisciplinary teams of providers who will focus on caring for the whole family with referral for orphans
and vulnerable children (OVC).to appropriate services
In FY09, the partner will initiate support of health facilities 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 multidisciplinary team of providers. The partner will emphasize the involvement of PLWHA
in programs through peer-support interventions and strong linkages to community resources. The partner's
capacity-building approach, focusing on district- and facility-level systems strengthening and provider
training and mentoring, will help ensure long-term sustainability.
Key activities and approaches will include:
• Support to sites in recruiting and retaining staff for ARV service provision. The partner will work with both
district officials and individual health facility staff to identify staff needs and find solutions within the Ministry
of Health system for augmenting staff. Provision of appropriate training, resources, and clinical tools will
help motivate staff to provide quality ART services and increase staff retention.
• Clinical training for 20 doctors to provide ART according to the recently revised national care and
treatment guidelines.
• Ensuring intensive onsite mentoring to the multi disciplinary team during the initiation of services, and
periodic follow-up training and mentoring thereafter.
• Support to sites in identifying HIV-positive patients by strengthening CT interventions, including routine
provider initiated opt-out CT. The partner will support sites to publicize the availability of ART services in the
communities they serve.
• Support to sites in developing 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.).
• Development of protocols and systems for clinical staging of HIV patients and establishing eligibility for
ART according to national guidelines and WHO clinical staging, when appropriate.
• Support for the creation and management of multidisciplinary team meetings to discuss complicated cases
and
coordinate individual patient care.
• Helping sites to provide effective support to patients prior to ARV initiation, such as counseling about
HIV status disclosure, side effects and adherence to treatment.
• Supporting sites to develop patient-tracking systems that will help to identify patients who have not
returned for pharmacy refill or other appointments. Protocols for patient home visits will be developed. The
partner will develop a program to train PLWHA as peer educators/counselors to support patients enrolled in
ART services and track patients who miss appointments or who become lost to follow-up. Peer educators
will be
supervised by social workers or other staff.
• Ensuring 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 in these services. HIV
program management committees, including key staff representing various departments, will meet regularly
to coordinate services and cross-referrals.
• Supporting 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.
The partner will introduce a community resource mapping tool and support sites to develop formal
agreements and referral systems with relevant organizations.
• Ensuring availability of lab services for biological (hematology and biochemistry) and immunological (CD4)
patient monitoring of patients receiving HIV care and treatment services. The partner will upgrade all district
hospital labs so they can provide immunological and biological monitoring for the entire district, either by
direct laboratory support on site or referral of specimens via an effective and efficient specimen referral
system. The new treatment partner will support each district to develop an effective sample transportation
system to ensure that patients at all ART sites within the region receive immunological and biological
laboratory results in a timely manner.
• Working with SCMS and the Public Health Pharmacy (PSP) to support treatment site pharmacies to
establish systems for ARV quantification, stock management, and patient appointment tracking 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.
Activity Narrative: • Providing 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
analyze data for routine reporting using national tools. A data quality-assurance system will be
implemented, and partner technical advisers will assist sites to analyze data regularly to assess program
quality. The partner 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. The partner will continue
to work with URC on piloting quality improvement approaches.
At all ART, PMTCT, and CT sites, the partner 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. The partner will
engage enough counselors (funded in part through AB, Condoms and Other Prevention, OVC, and adult
care and support funds) to allow every site to provide this prevention and referral package to all clients.
All clients who test HIV-positive will be offered information about and referrals to specific services
appropriate to their needs. The partner will ensure that community-based services capable of meeting these
needs are identified, and the partner will be responsible for monitoring and reporting on referrals according
to a nationally standardized referral system.
Table 3.3.09:
services.
In FY09, the partner will support a total of five sites providing care and treatment services, three of which
will provide pediatric care services and by September 2009, they will have enrolled 100 HIV-infected
children into care and support services.
Pediatric care services will include growth monitoring, immunization services, nutritional counseling, and
systematic cotrimoxazole prescription for exposed infants. Care and support services for HIV-positive
children will be provided by a multidisciplinary team of providers, will focus on caring for the whole family,
and will be strongly integrated with routine provider-initiated CT for the children of each enrolled HIV-
positive woman, and all exposed children.
The partner's capacity-building approach, focusing on district and facility-level systems strengthening, and
provider training and mentoring for providing pediatric care, will ensure long-term sustainability.
The partner will provide financial, programmatic, technical and overall capacity building support to
subpartners who will receive subgrant funding and technical assistance.
In FY09, care and support interventions concerning children will include:
• The partner will work with districts and facilities to identify staff needs, including materials and training.
• Providing the necessary training, resources, and tools needed for staff to provide quality care and support.
Services for children will help motivate staff and increase retention.
• Training in collaboration with PNPEC at least 20 doctors, nurses, social workers, counselors, and outreach
• The partner will conduct intensive on-site mentoring during the initiation of services and periodic follow-up
• Supporting sites to identify HIV-positive children by strengthening HIV counseling and testing
interventions,
including routine provider-initiated CT for children of each enrolled HIV positive woman and symptomatic
children, and offering early diagnosis for all exposed children.
• Supporting sites to develop patient-flow algorithms, patient-appointment systems, and protocols related to
palliative care (e.g. CD4 schedule for pre-ARV patients, OI prophylaxis and treatment, etc).
• Supporting the formation and functioning of Multidisciplinary Team Meetings to discuss complicated cases,
including those failing treatment, and to coordinate individual pediatric care.
• Promotion of OI prophylaxis and treatment in accordance with MOH/National HIV/AIDS Care and
Treatment
Program (PNPEC) guidelines. Similarly, TB screening will be promoted for HIV infected children.
The partner will support renovation of district level general hospital structures to create space for additional
HIV/AIDS services. The new treatment partner will:
• Ensure strong linkages between growth monitoring services, immunization services and nutritional
services where routine HIV testing will be offered to all children, and those testing HIV-positive will be
immediately enrolled in the care and treatment program and initiated on ART if eligible.
• Enhance adherence and psychosocial-support activities at sites for mothers and their children and support
routine home visits to active patients and those who are lost to follow-up.
• Work closely with SCMS and the Public Health Pharmacy (PSP) to ensure effective forecasting of
Pediatric medications and test kits to ensure timely delivery and stock management.
• Work with health districts to support the initiation of palliative care services at the site level and provide
ongoing
• Support sites to implement record-keeping systems and databases and to summarize and analyze
the partner technical advisers will assist sites to analyze data regularly to assess program quality. The
partner will meet regularly with the MOH to provide feedback on palliative care-related M&E tools and
approaches to help improve the national system of data collection and reporting.
• Support sites to provide HIV prevention counseling for HIV-positive individuals enrolled in care and
treatment programs.
The partner will also ensure that patients have access to nutritional assessment and counseling.
• Support care and treatment sites to establish and strengthen links with community-based organizations to
ensure community based patient support for home-based care, OVC services, adherence support,
nutritional support, and other services. At all sites, the partner will contract with local organizations to
support counselors dedicated to providing a comprehensive package of HIV prevention services.
Table 3.3.10:
In FY09, the partner will support this package of services at five facilities, three of which will provide
pediatric treatment services and by September 2009, they will have initiated 38 HIV-infected children on
ART.
The partner will continue to adapt and utilize evidence-based systems, tools, and procedures to achieve this
goal. 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.
A partner technical adviser will work closely with sites to provide focused training and clinical mentoring for
pediatric care and treatment. Interventions will include:
• Assessment of lab services for pediatric diagnostics and development of plans for capacity-building. This
will include assuring the availability of early infant diagnosis by dried blood spot DNA PCR via specimen
referral to the regional or national reference laboratory level as appropriate.
• Establishment or strengthening HIV testing at entry points to pediatric services (inpatient wards, family-
centered
care programs, CT programs, adult ART clinics, under-5 clinics).
• Strengthening referral mechanisms between ART clinics and entry points to pediatric services.
• Assessment of staff capacity for pediatric ART according to national guidelines and provide targeted
supplementary training.
• Strengthening of care services (including staging, cotrimoxazole prophylaxis, nutrition and growth
monitoring,
parental counseling, social and adherence support) for all HIV-exposed and HIV-infected children.
• Assessment of feasibility of co-located services and/or coordinated appointment scheduling for HIV-
infected
women and their children.
• Working closely with SCMS and PSP to ensure an uninterrupted supply of pediatric ARV and OI drugs.
• Establishing pediatric and family support groups.
• Establishing or strengthening links to community-based services for infants and children, including
nutritional
support and OVC services.
Table 3.3.11:
delivery within the health sector in Côte d'Ivoire, with a primary focus of activities in three northern regions:
Vallée du Bandama, Zanzan, and Les Savanes.
ART services will be initiated at health facilities where there is at least one medical doctor, according to
national guidelines. PMTCT services will be offered at antenatal clinics and CT at all health facilities. Wirth
FY09 funding, the new partner will provide support to five facilities delivering CT, PMTCT, TB/HIV, care and
support, and ART services.
In FY09, the partner will support this package of services at five facilities delivering care and treatment
services, 3 of which will be TB diagnosis and care clinics (CDT). By September 2009, the partner will
counsel and test more than 90% of TB patients for HIV and screen for TB more than 90% of HIV+ patients
who attend HIV care/treatment sites.
At all five sites, the partner will ensure that intensified TB case finding is consistently done among all the
patients enrolled in HIV care and treatment at enrollment and follow up visits, and that those who screen
positive by symptoms are properly managed, including provision of or referral for smear microscopy, chest x
-ray, molecular diagnosis and TB culture as appropriate and according to national guidelines using
appropriate tools.
In addition, the partner will ensure—either directly or in coordination with other implementing partners
(PEPFAR and GF)—that at least 80% of all TB suspects, either at the on-site TB clinic or at referring TB
treatment facilities (CAT and all CDTs in the covered area) are tested for HIV and that those testing positive
are referred for enrollment in care and treatment.
Proven TB/HIV integration approaches and tools, such as a simple TB screening tool developed in by ICAP-
CU and adapted for Côte d'Ivoire, will be implemented. The partner will also focus on promoting and
supporting processes that minimize nosocomial transmission of TB and that protect health care workers
from TB infection. The partner's capacity building approach, focusing on district and facility-level systems
strengthening, and provider training and mentoring, will ensure long term sustainability.
A TB/HIV adviser on the partner's staff will work closely with the PNLT, the regional CAT, and the treatment
teams from individual sites to provide focused training and clinical mentoring for integrated TB/HIV
interventions.
• Ensuring that minor renovations are completed taking into account fundamental infection control principles
that are appropriate for resource-limited settings to prevent transmission of TB.
• Support for laboratories to conduct appropriate diagnostics for TB in the context of HIV co-infected
patients, ensuring that all the three TB diagnostic sites have functional microscopes and staff who are
competent
in smear microscopy.
• Provide intensive training and on-site mentoring on integrated TB/HIV activities with a focus on routine
testing for all TB patients, routine TB screening among all patients enrolled in HIV care and treatment,
linkages and cross referrals between programs, and adherence and follow-up for co infected patients.
• Sites will be supported to introduce and continue using a standardized TB screening questionnaire for
intensified TB case finding in HIV-infected patients and to providing routine TB screening, prevention, care,
and referrals for all patients enrolled in care and treatment.
• Sites will be supported to implement routine HIV counseling and testing (moving toward an opt out
approach), prevention education, and referral for HIV care, if needed, for all TB patients. Staff at the TB
clinics will be trained in PITC using the training material developed by CDC/ WHO, which has already been
adapted for and translated into French.
• Implement systematic, preventive cotrimoxazole therapy for all (100%) HIV co-infected TB patients at TB
clinics.
• For all children under 5 and all infected children, a screening algorithm will be adapted to include history of
tuberculosis related symptoms, clinical indicators suggestive of tuberculosis, and history of TB contacts
within and outside the household. The use of TST testing will be explored to establish the feasibility and
efficacy to determine latent TB status in this population.
• In addition to direct evaluation of TB risks in children, the routine TB screening questionnaire mentioned
above will be administered to the adult caregivers of all children testing HIV positive. Most children are
exposed to TB through adult caregivers within the household and in child care settings. Adults with a
positive screening questionnaire will be referred for further evaluation. All pediatric household members will
be screened for HIV as well as TB.
• Ensure adherence with both TB and HIV treatment in order to achieve optimal patient outcomes.
The partner will work with care and treatment sites to develop innovative approaches to adherence support
such as DOTs or using peer educators to conduct patient follow up. The partner will also work closely with
NGOs and CBOs to ensure community based support for TB and HIV patients.
• Ensure the implementation of data collection instruments developed by the national TB program (PNLT) to
monitor and evaluate HIV/TB screening, diagnosis, and treatment activities at all sites supported by the
partner.
• Ensure that linkages between HIV and TB clinics are established and strengthened at all partner
supported sites.
The multidisciplinary care teams in each facility will include representation from the TB service. Mechanisms
to facilitate referral will be introduced, supportive supervision will be provided, and activities will be closely
assisted and monitored by partner technical experts.
Table 3.3.12:
of the country: Vallée du Bandama, Zanzan, and Les Savanes. As part of a full range of HIV care,
treatment, and prevention services, the partner will support the development of strong mechanisms and
services targeting OVC and their families.
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 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, the
partner will ensure that community-based services capable of meeting these needs are identified, and the
partner will be responsible for monitoring and reporting on referrals according to a nationally standardized
referral system. Health workers will be trained in pediatric HIV/AIDS management and care and will be
encouraged to facilitate access to OCV services in the partner assisted regions. The partner will promote
uptake of early infant diagnosis and provision of cotrimoxazole prophylaxis. All community leaders will be
sensitized and encouraged to facilitate access to OVC services
Funding to support staffing and training of these counselors, as well as training of physicians and nurses to
refer clients to the counselors, and adaptation and reproduction of job aids and prevention materials will be
apportioned among different program areas (OVC, Adult Care and Support, Adult Treatment, PMTCT, CT,
and Pediatric Care).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 for persons living with HIV. The program's effort will reflect the funding
proportions noted above.
Table 3.3.13:
services. All five facilities will provide CT services, and by September 2009, the partner will counsel and test
1,500 individuals.
Limited access to HIV counseling and testing remains a critical impediment to the identification of HIV
individuals and to ensuring their early access to HIV prevention, care, and ART, if eligible. The partner will
ensure that counseling and testing are available at sites through regularly scheduled CT days, availability of
trained counselors, and the establishment of routine, opt-out testing at all its supported facilities.
CT will become part of the continuum of HIV care for patients at each of these sites. The partner's capacity
building approach, focusing on district- and facility-level systems strengthening, and provider training and
mentoring, will help ensure long-term sustainability. Interventions will include:
• Support for the operations of CT services at 15 designated facilities. As validated at the national level, a
new rapid-test algorithm will be introduced to improve turn-around time for test results and limit dependence
on laboratory staff, thus making point-of-service counseling and testing easier.
• Support for facilities to expand counseling and testing access and improve quality and linkages to care
and ART services.
• Provide training and on-site mentoring to at least 25 nurses, social workers, and counselors on CT.
• Provide on-site mentoring to nurses, social workers, and counselors on the new whole blood finger-prick
rapid test algorithm for CT
Focus will be on strengthening providers' counseling skills, including those related to HIV prevention and
couples
counseling.
• Promotion of the use of routine opt-out models in clinical settings such as ANC, TB, and STI clinics, and
for adult and pediatric inpatient and outpatient settings to facilitate diagnosis and referral for enrollment and
entry into treatment programs. The partner will support sites to develop standard operating procedures
related to routine testing within the facility and will train appropriate staff.
• Development of tools, instruments, and databases to track HIV counseling and testing activities, including
Linkages to HIV care and treatment.
• Support CT services in all the prisons and in the school infirmaries (SSSU) of the three supported regions
• Support for facilities to establish strong linkages with PLWHA organizations, OVC services, faith-based
groups and community-based NGOs to reduce stigma surrounding HIV testing, promote HIV counseling
and testing, and ensure that those who test HIV-positive are offered the opportunity to access care and
treatment services.
• Work with health districts to support the initiation of CT services and ongoing supervision and quality
• Work with SCMS and the central Public Health Pharmacy (PSP) to ensure effective forecasting of test kits
and to ensure timely delivery and management of stock.
At all sites, the partner 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. The
partner
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. 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.
All clients who test HIV-negative will be referred (on an opt-out basis) to a counselor for behavior-change
based
OVC care and palliative care services tailored to their needs. With assistance from the National OVC
Table 3.3.14:
of the country: Vallée du Bandama, Zanzan, and Les Savanes.
FY09, the partner will provide support to five facilities delivering CT, PMTCT, TB/HIV, care and support, and
ART services.
The overarching goal of the M&E component of the partner program implementation is to develop and
conduct high-quality, timely, and sustainable monitoring and evaluation of the partner supported activities
for program evaluation and improvement. This is a collaborative effort, with local, national, and international
partners to routinely collect, analyze, and disseminate data to assess program quality, as well as program
impact within and across sites and countries. The partner will implement the nationally approved monitoring
and evaluation system and tools, including the harmonized patient monitoring tools. The partner will
participate in PEPFAR or national committees to review and revise M&E tools.
In FY09, the partner will support routine data collection, management, use, and transmission at the site
level. More specifically, partner will implement the following activities:
A- Partner Country Team Activities
Partner strategic information officers in collaboration with the national counterparts and other PEPFAR
partners will:
1) Implement SIGVIH on the partner assisted sites providing treatment and continue other adopted country
data collection tools (paper and electronic) in the M&E strategy.
2) Provide ongoing technical support and training to data clerks at the site level.
3) Train the multidisciplinary care teams on how to use program data to assess the quality of care at their
site.
4) Provide semi-annual and annual program results, and ad hoc data sets as requested by the PEPFAR
USG team.
5) Participate in quarterly SI meetings organized by the USG strategic information branch.
6) Implement decisions agreed upon during these meetings.
7) Any publications submitted to peer-review journals using data collected with USG funding support will
collaborate on these submissions with the USG in country team.
B- Site Activities
1) Hire, orient, and continually train and supervise data clerks at each new site.
2) Provide SI related materials to each site including but not limited to (computer hardware, computer
software, printer, registers and forms, internet connection)
3) The partner field staff will attend specific workshops, conferences, or classes that improve their technical
capacity.
4) Support the SI capacity development of all personnel within the health facilities supported by the partner.
C- Strengthening National Strategic Information Activities
1) Personnel at district sites will be trained and responsible for ensuring data recording and transfer,
electronic recording and processing, and report editing by the district teams. partner will provide strong
support to the district teams to enable them to supervise this effort. The district teams will prepare monthly
reports that include information related to all aspects (quantitative and qualitative) of the partner's program.
Reports will be sent to the regional level of the MOH and to the PNPEC at the national level to incorporate
into national data-collection efforts.
2) Develop and execute a data quality improvement plan with technical assistance from external contractors
and in close collaboration with the CDC-RETROCI SI team and district data managers.
4) Collaborate with the DIPE, PNPEC (the national data monitoring and care and treatment programs) and
other partners to use unique patient identifiers as a way of tracking patients through time and space.
5) Feed commodities data into the national data-collection system for drug and supply-chain management.
The patient-management system being used at all sites will be interfaced with the Partnership for Supply
Chain Management Systems system which will be monitoring all care and treatment commodities data for
PEPFAR programs in Cote d'Ivoire in FY09.
6) Participate in ongoing national efforts to maintain and improve a harmonized national longitudinal HIV
positive patient monitoring system.
To help ensure greater sustainability, the hiring of staff will be conducted in close collaboration with the
MOH and other government decentralized entities (including district government officials).
Table 3.3.17:
