PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
A World Food Program study of HIV-affected, WFP-supported households in Cote d'Ivoire in April 2008
showed that most were food-insecure; that for 80%, more than 50% of their expenditures were for food;
that 27% of people on ARV treatment were malnourished (adults, BMI <18.5%); and that 78% of
households hosted orphans. Nutrition support is an important aspect of comprehensive treatment, palliative
care, and OVC services. The WFP has developed nutrition-related activities for HIV/AIDS-related care and
treatment, particularly nutritional support for HIV-positive pregnant women in the framework of prevention of
mother-to-child transmission (PMTCT), adherence to ARV treatment for PLWHA, and food security support
for OVC households, including enabling OVC to receive education. The objectives of nutritional support by
WFP programs are to:
- Improve adherence to prophylaxis, especially to prevent vertical HIV transmission from mother to child
- Assure the nutritional health of pregnant women, PLWHA, and OVCs
- Reduce the risk of low birth weight of infants
- Improve nutrition education, particularly regarding the feeding of infants born to HIV-positive mothers, in
order to reduce the risk of transmission
- Contribute to food security for the households of HIV-positive individuals
- Contribute to food security and support to OVC households
With its own funding, the WFP is providing 5,842 PLWHA and their households (29,210 beneficiaries in
total) with food rations in 2008, contributing to their treatment adherence and overall health. Of those
assisted, 72% are women, and 67% are on ART. In addition to the food rations, the patients are benefiting
from specialized medical and psychosocial care from WFP partners.
WFP was awarded PEPFAR funding in FY08 (in the ART Services program area) to strengthen nutritional
support for HIV-affected people in collaboration with the National Nutrition Program (PNN) and PEPFAR
partners IYCN/PATH and FANTA, but funding has been delayed while a USAID mechanism is being
finalized. It is expected that FY08 funding will be available in late 2008 and will allow planned activities to
begin.
As WFP's strategy in Cote d'Ivoire has moved away from broad humanitarian aid to more targeted food aid
and food-insecurity activities in post-crisis Cote d'Ivoire, the USG partnership is intended to build on the
WFP's strengths - including donated food, expertise in nutrition education, and a strong but regionally
limited distribution system - for both short- and longer-term objectives: to provide immediate nutritional
support to those in urgent need and to help construct a national, sustainable system of nutritional support
with clearly defined priorities and criteria.
Activities planned with FY08 funding, under the coordination of the PNN, include an assessment of food
insecurity and nutritional needs of PLWHA and OVC; elaboration of entry and exit criteria for nutritional
support for PLWHA and OVC; design of a distribution system (building on the WFP's system in the North
and West) that can serve high-priority PLWHA and OVC throughout the country; distribution of 5,666 tons of
food commodities to at least 4,400 HIV-affected households (23,400 beneficiaries), 1,000 pregnant women
at PMTCT sites (5,000 beneficiaries), and 3,000 OVC households (15,000 beneficiaries); promotion of good
nutrition practices, including demonstrations and other support for at least 40 HIV care and treatment sites,
10 PMTCT sites, and 25 OVC program sites; training for PNN staff in results-based management; and
training of health care workers and community counselors in nutrition for HIV-exposed infants, PLWHA, and
OVC.
FY09 funding will allow the WFP to continue and expand these efforts into 2010. In addition to carrying on
FY08-funded activities and contributing food worth at least $3 million, the WFP will continue to work to
strengthen local partners' capacity to provide nutrition education as a way to enhance the effectiveness of
HIV/AIDS care and treatment. The WFP will work with partners such as FANTA and IYCN/PATH to provide
technical assistance to the PNN and to facility- and community-based OVC and palliative care providers to
develop and implement nutrition activities. Technical assistance will also support development and rollout of
national policies, training materials, and tools for nutrition for persons living with or affected by HIV/AIDS. All
activities will be under the leadership of the PNN and will seek to maximize synergies with other partners,
including UNICEF, the Ministry of Health, and the Ministry of the Fight Against AIDS. The WFP's emphasis
on building capacity for the national program and local implementers will contribute to establishing a
sustainable national nutrition-support program for people affected by HIV.
In all, approximately 6,080 PLWHA households (30,400 beneficiaries) will receive direct food and nutrition
support by September 2009, and at least 200 people will be trained. Specific activities will include:
1. Building capacity in nutrition education by training PNN staff and implementing partners on all aspects of
the relationship between nutrition and HIV/AIDS. Regional health workers and community health workers
will be trained in treatment and care for HIV patients, OVC, and caregivers. This activity will be carried out
with PNN partners.
2. In consultation with the PNN, helping to implement exit and entry criteria for nutritional care and support
for PLWHA and OVC, including working with PEPFAR and partners to develop Food by Prescription
activities.
3. Helping to establish a distribution system (building on the WFP's system in the North and West) that can
serve high-priority PLWHA and OVC throughout the country.
4. Strengthening the effectiveness of WFP food-aid interventions through a strong nutrition-education
component during food distributions and through regular program activities, leading to a more sustained
impact.
5. Working with the PNN and partners to create and disseminate policies and guidelines on nutrition and
HIV/AIDS.
6. Activities to increase food security in households affected by HIV/AIDS, including home and community
gardening, in partnership with the FAO, that could lead to income generation activities.
7. Collecting and analyzing data on nutrition and food security in relation to households affected by
Activity Narrative: WFP will implement a monitoring and evaluation plan to provide timely, accurate reports to national
authorities and the USG strategic information team. To help build a unified national M&E system, WFP will
participate in quarterly SI meetings and will implement decisions taken during these meetings.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $45,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $64,575
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $30,000
Education
Water
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $1,470,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Background
Côte d'Ivoire's adult HIV prevalence is estimated at 3.9% (UNAIDS 2008). The HIV epidemic in Cote d'Ivoire is marked by
important gender differences (6.4% of women vs. 2.9% of men) and low access to and uptake of PMTCT and counseling and
testing (CT) services. Only 11% of women and 8% of men report ever having had an HIV test, and only 7% of women access
PMTCT services during antenatal care (AIDS Indicator Survey, 2005). It is estimated that 52,000 children are living with HIV
(UNAIDS 2008). In 2006 it was estimated that about 24,000 children were in need of antiretroviral therapy (ART) (UNAIDS 2006).
In 2007, routine CT of children attending the pediatric ward at the University Teaching Hospital of Treichville showed that 32%
were infected with HIV. The pilot phase of an early infant diagnosis (EID) program showed a 14.6% HIV prevalence among HIV-
exposed children in PMTCT settings.
Within the context of a country moving toward stability but limited by poorly equipped and critically understaffed health and social
services, the USG program is working to build a continuum of comprehensive HIV/AIDS prevention, care, and treatment services.
Care and support services are delivered at 240 health facilities (September 2008), as well as through community- and home-
based caregivers, mobile services, and organizations targeting high-risk populations, such as teachers, the uniformed services,
and sex workers. Between October 2007 and June 2008, about 3,800 children received care and support with direct USG support
(7% coverage).
While Cote d'Ivoire continues to make rapid progress in scaling up HIV treatment services, access to ART for children is still
lacking. In September 2008, only 2,107 children were receiving ART with direct USG support at 160 sites (8% coverage). The
USG team projects direct support to 255 sites serving 4,800 children on ART by September 2009.
PEPFAR-supported care and treatment services are provided by EGPAF, ACONDA, and ICAP Columbia University, with a new
partner to be added in FY09. With collaboration from the National HIV/AIDS Care and Treatment Program (PNPEC), the USG has
adopted a regional approach to improve program monitoring and quality of services: Services in Ministry of Health (MOH) facilities
in the mideastern part of the country are assigned to EGPAF, those in the far west to ACONDA, and those in between to ICAP.
Abidjan and surrounding areas are supported by both EGPAF and ACONDA. Facilities in the lower-prevalence and conflict-
affected North and West receive support through the Global Fund, although implementation of services has been weak.
FY06-08 Response
Pediatric Care and Support
The national palliative-care policy (finalized in FY06 with USG support) defines minimum standards of care for clinic, community,
and home settings, and an implementation plan outlines training and supervision approaches. These guidelines incorporate
guidance on cotrimoxazole prophylaxis (recommended for HIV-infected children with CD4 <25%; children at stages 2, 3, and 4 of
the WHO classification; and HIV-exposed infants after 6 weeks of age); most programs also support treatment for OIs, malaria,
and STIs; basic pain management; screening for TB; and psychosocial support. Some programs are working to incorporate
provision of insecticide-treated nets (ITNs), nutritional assessment and supplementation, HIV testing for family members; and
interventions to improve hygiene and water safety.
In FY07-FY08, PEPFAR continued to support the PNPEC in developing a comprehensive care and support program and
integrating it within the continuum of care as defined by the national standards. Guidelines for community-based care and national
policy documents on nutrition for PLWHA (including for HIV-exposed and -infected children) were developed, followed by training
of providers. The PNPEC has finalized a policy on the use of lay counselors in support of prevention, care, and treatment services
in health centers and the community. Despite important accomplishments, the number of children receiving quality care is a small
proportion of those in need, and linkages with other services and with community-based programs are poorly defined in some
regions.
Pediatric Treatment
As of June 2008, the PNPEC listed 177 accredited ART sites, of which 143 were receiving direct PEPFAR support. (By
September 2008, PEPFAR was supporting 160 sites.) The functionality of Global Fund-supported sites has been incomplete due
to a lack of biological monitoring and ongoing support, resulting in an increase of the patient load of fully functional PEPFAR-
supported sites in some regions.
The basic HIV clinical treatment package provided by USG partners includes ARV therapy, cotrimoxazole prophylaxis, biological
monitoring, and limited OI prevention and care, with links to community-based care and support. Improved data management and
use include longitudinal follow-up and ARV-resistance evaluations. The PNPEC recently revised the national guidelines on ART
and on basic laboratory monitoring tests for ART patients, including a shift from a D4T-containing regimen to an AZT-containing
regimen as the preferred first-line regimen for all patients infected with HIV-1. It was also recommended that children undergo two
viral-load tests per year. In August 2008, the MOH discontinued its ARV cost-recovery system, making ART free for all adult
patients. ART was already free for children, but this decision should increase the number of adults on treatment, facilitating
identification of more HIV-exposed or HIV-infected children eligible for care and treatment services.
The USG is providing continued technical and financial assistance to train trainers in service delivery, to support TOT for ART
providers, and to develop treatment performance standards. PEPFAR partners are continuing to promote better support and
referral systems, better interpersonal communication for more effective care and treatment, and mass-media campaigns to
promote CT, raise awareness of available HIV/AIDS services and reduce stigma and discrimination.
A number of implementing FBO/NGO/CBOs are being funded through a performance-based competitive sub-granting process in
an effort to begin to address barriers such as lack of motivation of personnel and human-resource deficits, especially in the North.
The USG supports the implementation of a network model with linked services at the regional and district levels. District pilot
models are used to develop and evaluate a comprehensive approach featuring a continuum of care with community mobilization
and follow-up.
Priorities for FY09
USG strategies in FY09 will focus on evidence-based interventions, training and supervision for care providers, and strengthening
of support and links through trained, full-time counselors at all sites. Key goals in FY09 include:
1. Increased geographic and population coverage. USG partners will continue rapid expansion of services with a goal of
supporting i) 15,200 non-ART-eligible children with HIV (8% of all patients) at 490 care and support sites (excluding TB), and ii)
4,800 children (8%) on ART at 255 sites, including sites in all 19 regions of the country down to the district general hospital level
and in some cases to the community health center level. A new partner will focus on the center-north of the country.
2. Systematic provision of cotrimoxazole as the most important evidence-based means of decreasing morbidity and mortality,
delaying disease progression, and improving quality of life. ITNs will be provided to HIV-exposed, infected or affected children in
regions not covered by the Global Fund Malaria Project. Clean-water kits (container and chemical) will be provided to households
with HIV-exposed, infected or affected children in regions with low water quality.
3. Improved linkages between facility- and community-based services and between pediatric care and other services. All PEPFAR
-supported ART, PMTCT, and HIV/TB service providers will be funded to engage counselors at all sites who will provide a
comprehensive package of HIV prevention interventions for all clients and effective support, follow-up (including provision of
medications where feasible), and referrals to community-based care and support services for HIV-positive clients. All PEPFAR
partners providing community- and home-based care and support will be funded to cross-train their community counselors to
provide OVC care services. For maximum effectiveness, partners will be encouraged to engage PLWHA in these positions.
4. Improved reach and quality of pediatric care and support services. In FY09, PEPFAR-supported programs will reach an
estimated 20,000 children with care and support. Quality improvements will include efforts to strengthen training and supervision
for facility- and community-based care providers; to promote systematic screening for TB; to improve nutritional assessment and
support, especially infant feeding counseling based on AFASS criteria; to diagnose and treat opportunistic infections, to reduce
loss-to-follow-up before initiation of ART; and to pursue opportunities for wraparound services with other donors/partners, such as
provision of heavily subsidized ITNs through the Global Fund, clean-water commodities through the private sector, and nutritional
support in partnership with the World Food Program.
5. Ensure that supportive policies and practices for HIV-related pediatric care and support are in place. Several partners will
continue to work with the PNPEC and stakeholders to implement supportive policies related to the scale-up of EID; to the rollout of
the new national HIV whole-blood finger-prick rapid-testing algorithm for children over 12 months; and to a redefinition of the role
of non-medical health professionals and lay persons in performing HIV tests and prescribing or supporting certain medications.
The issue of caregiver burnout will be addressed in topical meetings and through technical assistance to partners.
6. Improved ART performance with increased uptake of pediatric treatment and reduced loss to follow-up among children
receiving care and treatment. Building on FY08 activities, USG partners will focus on providing high-quality care to children on
ART with greater access to services, uninterrupted availability of commodities, and systematic accreditation and site openings. A
key objective will be to improve coordination, planning, supervision, and training at site and district levels. Promotion of pediatric
treatment will be a sustained focus, with continued expansion of early infant and pediatric diagnostic capacity. HIV-infected
children will be identified through DNA PCR for infants ages 6 weeks to 12 months and through serology for children over 12
months. Links to community- and home-based care, and OVC services will be strengthened, along with expansion of routine,
provider-initiated CT in health facilities and outreach to families. Efforts to improve ART adherence will focus on counseling - both
facility- and community-based - that also addresses issues of stigma. To ensure quality, PEPFAR partners will assist in the
development and implementation of performance standards for all clinic-based services. National care and treatment guidelines
will be updated, and clinicians will receive refresher training via regular supervision and continuing medical education. Training,
supportive supervision, career progression, and expanded peer and community services will be used to address human-capacity
barriers and improve the quality of care. Basic program evaluations (BPE) and public health evaluations (PHE) will be conducted
to assess the quality of the ART program and the efficacy of evidence-based interventions to reduce early mortally of children on
ART.
7. Gender sensitivity as a component of quality pediatric care and treatment. The feminization of the epidemic requires greater
gender awareness in all aspects of care and prevention, including disclosure of HIV status, since a disproportionate number of
HIV-infected women are in sero-discordant relationships. Strategies will include reaching more girls in the provision of care and
treatment services, positive-prevention interventions for young girls infected with HIV, and stigma-reduction campaigns with an
expanded role for peer support and peer advocacy.
8. Ensuring availability of drugs and commodities. Most HIV-related drugs and consumables will be centrally procured through the
Partnership for Supply Chain Management (SCMS), which will also continue providing technical and management support to the
Public Health Pharmacy (PSP).
Pending OGAC approval, PEPFAR CI will strengthen its evidence base in care and treatment through three public health
evaluations (PHEs) assessing 1) the effectiveness of EGPAF's care and treatment program, 2) interventions to reduce early
mortality among patients initiating ART (an inter-country PHE), and 3) care and treatment of patients with HIV-2 infection. The last
will serve to create a research platform for further studies, and its findings will have regional implications and provide data for
WHO guidelines on HIV-2 infection.
EGPAF, ACONDA, ICAP, and the new partner will link with three main Ivorian partners supporting community services (ANADER,
ANS-CI, and RIP+). Care International will continue to support local organizations providing care in the North and West, and PSI
will continue a program focused on care for the uniformed services. The Ministry of Education will continue a program focusing on
teachers, and FHI will continue programs targeting sex workers while providing technical support to the PNPEC.
Hope Worldwide CI will twin with the African Palliative Care Association to support continued advocacy for an opioids policy and
implementation of care standards. FANTA will continue to assist the PNPEC and the National Nutrition Program to strengthen
nutrition policy and support.
Cote d'Ivoire's Round 8 application was not successful. After the Round 2 HIV project ends in March 2009, it is expected that the
GF will continue to provide ARVs and lab commodities to support its current patients. The USG team is represented on the CCM
and in regular consultation with the GF principal recipient, and is prepared to help address potential programmatic implications of
a GF service-delivery gap as well as to join MSH in providing TA for an expected GF Round 9 application.
When possible, the USG provides complementary programming with other donors and partners, such as the Global Fund for ARV
procurement and the WFP for food aid for PLWHA. The USG continues to promote sustainability by transferring technical,
financial, programmatic, and M&E skills from international organizations to local CBOs, NGOs, FBOs, and ministries.
Table 3.3.10:
care, and OVC services. WFP has developed nutrition-related activities for HIV/AIDS-related care and
With its own funding, WFP is currently providing 3,000 OVC households (15,000 beneficiaries) with food
rations, which are helping to maintain the nutritional status of OVC households and to allow the children to
obtain an education.
The WFP was awarded PEPFAR funding in FY08 (in the ART Services program area) to strengthen
nutritional support for HIV-affected people in collaboration with the National Nutrition Program (PNN) and
PEPFAR partners IYCN/PATH and FANTA, but funding has been delayed while a USAID mechanism is
being finalized. It is expected that FY08 funding will be available in late 2008 and will allow planned
activities to begin.
WFP's strengths - including donated food, expertise in nutrition education, and a strong distribution system
- for both short- and longer-term objectives: to provide immediate nutritional support to those in urgent need
and to help construct a national, sustainable system of nutritional support with clearly defined priorities and
criteria.
FY09 funding will allow the WFP to continue and expand these efforts. In addition to carrying on FY08-
funded activities and contributing food worth at least $3 million, WFP will continue to work to strengthen
local partners' capacity to provide nutrition education as a way to enhance the effectiveness of HIV/AIDS
care and treatment. The WFP will work with partners such as FANTA and IYCN/PATH to provide technical
assistance to the PNN and to facility- and community-based OVC and palliative care providers to develop
and implement nutrition activities. Technical assistance will also support development and rollout of national
policies, training materials, and tools for nutrition for persons living with or affected by HIV/AIDS. All
In all, at least 3,900 OVC households (19,500 beneficiaries) will receive direct food and nutrition support in
2009, and at least 200 people will be trained. Specific activities will include:
for PLWHA and OVC, including working with PEPFAR and partners to develop and implement Food by
Prescription activities.
Estimated amount of funding that is planned for Human Capacity Development $30,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $43,050
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $6,841,478
While the use of new formulas for estimating overall adult HIV prevalence in Cote d'Ivoire lowered the estimate from 4.7% to 3.9%
(UNAIDS 2008), the 2005 national AIDS Indicator Survey (AIS) remains an important source of information for rational targeting of
prevention, care, and treatment efforts. Within a generalized epidemic, HIV testing services cover only 8% of Cote d'Ivoire's
population, with large underserved regions in the North and West. Only 11% of women and 8% of men reported ever having had
an HIV test with receipt of their results.
As the key entry point to life-sustaining HIV care and treatment and an effective tool for primary and secondary prevention, HIV
counseling and testing (CT) remains significantly underused. Accelerated expansion and efficient targeting of quality CT services
are national and PEPFAR priorities and critical components of the scale-up of HIV/AIDS prevention, care, and treatment.
To reach FY09 treatment targets, aggressive expansion of routine provider-initiated CT in all clinical settings (including TB and
STI treatment sites and antenatal clinics) is needed to identify a larger proportion of persons living with advanced HIV disease and
eligible for antiretroviral therapy (ART). Community-based fixed and mobile CT services are designed to complement routine
health facility-based CT services and to emphasize both prevention and care opportunities by providing accessible CT to target
groups such as youth, couples, men, and high-risk or vulnerable subpopulations.
FY07-FY08 Response
In FY07 and FY08, significant progress was made in extending routine provider-initiated CT in clinical settings, including sites
offering TB, PMTCT, and inpatient and outpatient services (respiratory, general medicine, pediatrics, obstetrics and gynecology,
dermatology/STI). With leadership from the national HIV and TB programs, the national CT policy was adapted to integrate recent
WHO guidelines for CT, including routine testing of all patients coming to health-care settings. Training materials and job aids
were adapted, and training of trainers was conducted to allow on-site coaching of clinical-care providers. Training tools for
community counselors are being completed in preparation for CT by non-medical personnel.
As of September 2008, all of the 240 clinics supported by PEPFAR were working to integrate routine provider-initiated CT, and
uptake continues to improve steadily from low initial rates, at times reaching 100% of patients registered in clinical settings. With
PEPFAR support, the national TB program is providing leadership for implementation of routine CT at all of its 96 integrated TB
facilities as part of a comprehensive approach to integrated HIV/TB services, including community support, with plans for further
expansion and decentralization of services. The overall CT target for FY08 is to provide counseling and testing services for
331,000 people.
In preparation for scaling up CT services, PEPFAR has supported the development and validation, through the CDC/Retro-CI
laboratory, of a simplified whole-blood finger-prick testing algorithm. This new algorithm uses Determine as the initial test, Bioline
as the confirmatory test (which can discriminate between HIV-1 and HIV-2 or dual infection), and STAT Pack as the tie-breaker
assay. After validation by the Ministry of Health, this is now the official HIV testing algorithm for the country and is in the process
of being scaled up nationally. The MOH has taken an official decision to allow non-laboratory technician health care personnel
(including nurses, midwives, and social workers) to perform HIV testing under the supervision of a laboratory technician. The next
step will be to allow lay counselors to perform the tests.
Meanwhile, a steady expansion of services is being achieved through:
• Adaptation of training tools, job aids, and TOT for innovative strategies such as routine testing and couples counseling.
• Routine integrated CT at health facilities and community-based CT services at 24 sites that provide specialized and "friendly"
services for families, men, and couples.
• Mobilization of HIV-positive clients to encourage their families, including children, to be tested
• Use of six mobile CT units in rural areas, in the North, and in cities in order to reach high-risk and underserved populations such
as sex workers and the uniformed services.
• Scale-up of early infant diagnosis in PMTCT clinics, with linkages to nutrition, immunization, and OVC gateways.
Community-based models have been successful by leveraging and combining resources from multiple sources, such as a building
and support staff from the local mayor or general council, HIV tests and professional staff from the national government, funds for
equipment and renovations from an external donor, and technical assistance to assure training, supervision, quality assurance,
and monitoring and evaluation. To date, six mayors and 11 general councils have participated in establishing 24 sites that tested
38,500 people throughout the country during the first half of FY08. CT services were also extended to remote underserved rural
areas by ANADER, a rural development agency.
A twinning partnership between three Ivorian organizations (a CT site in Port Bouet, a PLWHA organization, and a family
planning/social-marketing NGO) and the NGO Liverpool VCT of Kenya is working to strengthen the quality and sustainability of
CT services through South-South capacity building.
FY09 Priorities
With FY09 funding, PEPFAR partners will work to improve service quality and increase client uptake, with a target of testing
400,000 people at 444 health facilities and 44 community-based and mobile sites. The target represents strategic decisions
designed to lay the groundwork for a CT scale-up in FY09, taking into account limited funding for HIV testing, growing but limited
capacity to provide needed care and treatment, and unexploited opportunities for cost-effective testing at health facilities.
Continued improvement of CT services in FY09 will emphasize:
• Full implementation of routine provider-initiated CT at all health facilities (including TB, antenatal, STI, and ART settings).
• Scale-up of a simplified HIV rapid-test algorithm using whole-blood finger-prick methods and accompanied by intensive training
for professional and lay personnel.
• Targeting of about 70% of CT efforts at health facilities, where clients are more likely to be HIV-infected, and 30% on existing
community-based sites, including outreach to underserved areas (rural and northern zones) and higher-risk groups (sex workers,
soldiers, discordant couples), in line with the country's growing capacity to provide care and treatment and within the framework of
the official discontinuation of ART cost recovery.
• A comprehensive district-based approach to testing that includes HIV prevention behavior-change communication, promotion of
couples testing, referral to ART and palliative care, and effective links with community-based care and OVC services.
• Strengthening of community and PLWHA involvement, including harmonization of community-based tools and effective links with
PLWHA groups to ensure care and support.
• Reinforcement of community-based CT services through promotion (using peer educators, local languages, mass media, etc.)
and training.
• Expansion of a National HIV Testing Day led by NPI awardee RIP+ (Network of PLWHA Organizations) and the Ministry of the
Fight Against AIDS.
• Development of post-test counseling approaches focusing on prevention messages for HIV-negative people.
• Strengthening of the national referral system for treatment, care, and support.
• Strengthening and expansion of CT among children, including early infant diagnosis and routine serology testing for children
older than 12 months.
• Participation in a multi-country public health evaluation to assess effective interventions to provide routine and provider-initiating
counseling and testing.
Because human resources remain a major barrier to scaling up, initiatives will continue with targeted recruitment of staff for
underserved areas and training and support for both health-professional CT providers and non-health-professional counselors.
Pending OGAC approval, PEPFAR Cote d'Ivoire is also planning to strengthen its evidence base for decision-making through an
inter-country public health evaluation of three models of CT in outpatient departments to determine the most effective model for
increasing testing uptake, identifying HIV infection early, and ensuring linkages to care and treatment services.
The USG continues to promote sustainability by building the capacity of indigenous organizations to implement programs and
raise funds. The USG is transferring technical, financial, programmatic, and M&E skills from international organizations to local
CBOs, NGOs, and FBOs as well as local governments and ministries to manage and be accountable for implementing activities
and achieving intended results. Coordination of CT activities, including supervision and quality assurance, through the national CT
technical working group and other forums is improving.
Table 3.3.14:
