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
Not applicable
New/Continuing Activity: Continuing Activity
Continuing Activity: 18473
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18473 18473.08 HHS/Centers for To Be Determined 8113 8113.08 Providing AIDS
Disease Control & Care and
Prevention Treatment
Table 3.3.01:
Continuing Activity: 18479
18479 18479.08 HHS/Centers for To Be Determined 8113 8113.08 Providing AIDS
Emphasis Areas
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
Estimated amount of funding that is planned for Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
N/A
Continuing Activity: 18516
18516 18516.08 HHS/Centers for To Be Determined 8113 8113.08 Providing AIDS
Table 3.3.09:
Estimated amount of funding that is planned for Human Capacity Development $2,690
Estimated amount of funding that is planned for Food and Nutrition: Commodities $15,040
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $127,891
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
NA
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $2,070
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $873,663
Program Area Narrative:
TB/HIV
Overview
TB is one of the leading causes of death in the DRC with an estimated annual incidence of 150 per 100,000 inhabitants. The DRC
has TB case detection rate of 68% (66,099 news cases reported in 2007), and a DOTS completion rate of 81%. A TB drug
resistance surveillance conducted in Kinshasa in 2004 revealed a multi-drug resistance (MDR) rate of 2.9%. EPP Spectrum
analysis estimates that there will be 131,400 individuals in DRC co-infected with HIV and TB in 2009.
With 18 % HIV prevalence rates among adult TB patients, TB clinics are prime locales to identify PLWHA for care, support, and
treatment. The DRC's national TB program (PNT) within the MOH has a reputation as the strongest of the national health
programs while the National HIV/AIDS Program (PNLS) is still weak.
TB clinics are well prepared to take on issues of co-infection. Despite minor increases in the number of clinics providing TB
diagnosis and treatment, TB case notification declined from 2005 to 2006. If TB incidence has in fact started to decline, it is likely
that the epidemiology of HIV is a part of the explanation. While treatment outcomes for smear-positive patients are good
compared with other African countries, very few smear-negative cases are reported, suggesting problems with diagnosis.
Coordination with the National AIDS Control Program continues to be problematic, and fewer than 2% of TB patients were tested
for HIV in 2006. However, the absorptive capacity of the National TB program appears good, so it is likely that increased funding
would increase HIV testing at these clinics. (Source: WHO Report 2008)
Despite continued improvements in TB programming in the DRC over the past five years, the DRC program identifies four areas
that are still in need of significant strengthening: laboratory facilities (specifically quality control and resistance surveillance),
coordination of programs at the provincial level, supply chain and distribution of medication, and management of TB/HIV co-
infection. Through PEPFAR funds, the USG is expanding efforts to address TB/HIV co-infection, building from the strengths of the
National TB Program.
Leveraging and Coordination
The USG provides the DRC National TB Program with technical support to strengthen TB/HIV activities including case detection,
care, and treatment policies. The USG supports the steering committee for TB/HIV set up by the MOH in 2006. The committee
coordinates the National HIV/AIDS and TB Programs' efforts to improve service quality offered to HIV-positive TB patients. The
Global Fund granted the DRC $36.2M to develop a program to strengthen the DOTS strategy, social mobilization, development of
TB/HIV collaborative activities, and multi-drug resistant tuberculosis treatment. The Global Fund TB grants have been disbursed
with fewer bottlenecks than HIV funds. Linkages and referrals to Global Fund PMTCT and ARV programs will be supported to
ensure a continuum of services. The Global Fund TB Round 5 grant was adequately managed, allowing provision of
comprehensive care and treatment services in 127 of the planned 250 Health Diagnoses and Treatment Centers as of June 2008.
Global Fund Round 6 grant will continue to support the strengthening and extension of the fight against tuberculosis in the DRC.
Unfortunately the Round 8 TB proposal was not approved, thus risking a service gap in TB-HIV activities.
Current USG Support
The USG through UNC supports 14 TB clinics to assure HIV rapid testing of new TB clients and palliative care for co-infected
individuals. 5 of Kinshasa's TB clinics also provide other HIV services such as ART as a part of the Continuum of Care package.
Referral and linkages to HIV services for those stand-alone TB clinics are being developed by UNC. The USG, through CT
funding, also supports 3 HIV CT in TB clinics in Matadi, Bukavu, and Lubumbashi.
USG provides the National TB Program with technical assistance in developing training manuals for the treatment of co-infected
individuals, assuring microscopy competence to diagnose TB, and instituting laboratory quality control efforts. With non-PEPFAR
USAID TB funds, TB CAP supports TB-HIV activities in two provinces (Bas-Congo and North-Kivu). The program is a joint project
with the European Commission, and USAID TB funds provide support for the development of an Integrated HIV Care for TB
patients in 21 pilot sites: nine sites in Bas-Congo province and twelve sites in North Kivu province. Using FY08 funds (both HIV
and non-HIV funds), TB CAP has expanded its activities in two other provinces: Equateur and Kasai-Occidental. TB CAP is
supporting coordination of collaborative TB/HIV activities at national and provincial levels as well as integration of TB-HIV
activities at the health facility level in these four provinces. Targeted activities include TB-HIV task-force meetings, annual TB-HIV
meetings, joint TB-HIV supervision, implementation of PICT at TB clinic settings, TB screening among HIV patients and quality
assurance. In total, 25 TB clinics will integrate comprehensive HIV-TB care in these four provinces. Non-HIV funds from Global
health and USAID TB funds are being used to support procurement of HIV tests kits, provision of reagent for TB diagnosis and to
strengthen TB lab to detect and manage MDR TB and XDR TB cases.
UNC is conducting a pilot project to assess the feasibility and effectiveness of the integration of ARV treatment in five TB clinics in
Kinshasa.. Preliminary results show successful implementation of this strategy. Final results are expected by July next year 2009.
USG programming will continue to complement and leverage work being done in eighty health zones through USAID TBCAP:
activities will be focused on strengthening local capacity to better manage TB and TB/HIV co-infection and promote VCT for TB
patients.
USG FY09 Support
FY09 funds will be used to provide technical assistance to the PNLS and the PNT to coordinate TB/HIV activities. Through TB-
CAP, which has a history of working with the PNT, the USG will fund technical assistance to coordinate TB-HIV activities at both
the national and provincial levels. Activities include implementation of the TB-HIV strategic plan that was developed in 2007, the
development of a joint annual operational plan with joint supervision and joint annual review. This strong collaborative process will
have positive impact at the service delivery level to increase TB-case detection among HIV patients, increase HIV testing for TB
patients, and to establish a harmonized monitoring and evaluation system.
USG technical assistance will continue to support development of TB/HIV training guides for training of trainers and nurses.
Subjects covered include: TB/HIV collaborative activities and the role of the TB/HIV counselor; PICT for TB patients; management
of HIV+ TB patients; TB case identification among PLWHAs, management of OIs and referral; M&E; stigma; family approach to
counseling; counseling children; support groups for patients; community mobilization; and palliative care. Training guides will be
used by the TB program nationwide.
FY09 funds through the new integrated HIV bilateral program, to be awarded in September 2009 (mechanism TBD), will continue
to support TB/HIV activities at three TB clinics in Matadi, Bukavu, and Lubumbashi. FY09 funds will support the expansion of HIV
activities to Kasumbalesa, Kolwezi, Kipushi and Likasi; these areas are located outside Lubumbashi along a major trucking route
which starts in South Africa and travels north through Zimbabwe and Zambia into Lubumbashi . TB/HIV activities will include the
implementation of PICT in TB clinics, intensification of TB case identification among PLWHA, TB infection control including
renovation of ARV settings, administrative, environmental and personal protection, implementation of TB drug resistance
surveillance, laboratory quality assurance, and support of Monitoring and evaluation activities. A strong link to community based
activities will be established through engaging the Ligue Nationale Antituberculeuse et Antilepreuse du Congo (LNAC) in TB-HIV
related BCC activities including sensitization for HIV testing and prevention strategies among HIV positive patients. This program
will also leverage ongoing efforts by TBCAP to provide DOTS in health zones in Northern Katanga. The PEPFAR team will also
coordinate with Global Fund activities to fill gaps in the existing package of available services.
In Kinshasa, PICT for TB patients will continue in 14 health facilities; within these facilities, linkages to ARV and PMTCT are
offered through GFATM support. In addition, the USG will continue to support service models for integrating ART to TB services in
Kinshasa and Matadi by developing a health network of facilities including Kalembe Lembe Pediatric Hospital, Salvation Army
clinics and other clinics which will provide follow up care for HIV+ TB patients and their immediate family members.
Using the results from the pilot project, with USG support UNC is planning to expand ART to additional TB clinics that have
already integrated PICT activities in Kinshasa. USG is aiming to integrate PICT to all major TB clinics in Kinshasa.
Through TB-CAP, 25 health clinics in four provinces will continue to receive technical support to implement TB-HIV activities.
Activities will include PICT in TB clinics, intensification of TB case identification among PLWHA, TB infection control, drug
resistance surveillance, quality assurance, and M&E support.
Program Area Downstream Targets:
7.1 Number of service outlets providing clinical prophylaxis and/or treatment for tuberculosis (TB) to HIV-infected individuals
(diagnosed or presumed) in a palliative care setting (a subset of indicator number 6.1) : 40
7.2 Number of HIV-infected clients attending HIV care/treatment services that are receiving treatment for TB disease (a subset of
indicator number 6.2): 478 Male: 232 Female: 246
7.3 Number of individuals trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals (diagnosed or
presumed) (a subset of indicator number 6.3):30
7.4 Number of registered TB patients who received HIV counseling, testing and their test results at a USG supported TB service
outlet (a subset of indicator number 9.2): 11,696
Male: 4,975 Female: 6,721
Table 3.3.12:
Continuing Activity: 18481
18481 18481.08 HHS/Centers for To Be Determined 8113 8113.08 Providing AIDS
Estimated amount of funding that is planned for Human Capacity Development $1,200
Continuing Activity: 18530
18530 18530.08 HHS/Centers for To Be Determined 8113 8113.08 Providing AIDS
Table 3.3.13:
Continuing Activity: 18376
18376 11858.08 HHS/Centers for To Be Determined 8113 8113.08 Providing AIDS
11858 11858.07 HHS/Centers for University of North 5910 5910.07 UTAP $131,901
Disease Control & Carolina
Prevention
Table 3.3.17:
Continuing Activity: 21120
21120 21120.08 HHS/Centers for To Be Determined 8113 8113.08 Providing AIDS
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $3,882,379
Management and Staffing
BACKGROUND
The Democratic Republic of Congo (DRC) is a non-focus country with extreme needs yet with an incredibly limited budget. Due to
this extreme disparity in need versus resources, DRC's approach to staffing for results in HIV/AIDS is substantially different than
that of a PEPFAR focus country.
STAFFING FOR RESULTS
The USG team in DRC (USAID, CDC, STATE and DoD) continues to work collaboratively to assure HIV/AIDS remains a priority
to the US Mission. Prioritizing HIV/AIDS is not a simple task in a country with a fragile democracy, continued violence and armed
conflict, massive poverty, and an almost completely decimated infrastructure. Despite these challenges, all agencies working on
HIV/AIDS in DRC work collaboratively to realize the vision laid out in their 5-year PEPFAR strategy: to capitalize on the transition
from conflict to peace and democracy by assisting the Congolese efforts to mitigate the impact of the HIV/AIDS epidemic.
The USG HIV/AIDS PEPFAR in-country team meets on an as-needed basis to share information, discuss strategy, and identify
opportunities for collaboration. Across the four (4) agencies involved in PEPFAR, fewer than a dozen people work regularly on
technical and strategic planning for PEPFAR, with less than 6 people across the USG team currently dedicated full-time to
HIV/AIDS. The team believes that continuing to work as a small, cohesive unit is the most efficient way to use limited resources in
order to achieve common results.
CURRENT STAFFING PATTERN
In focus countries with substantial resources, it may be realistic to recruit staff according to the PEPFAR program areas. However,
given the extremely limited budget of the USG team and the many technical areas that USG staffs are expected to engage in with
the Government of the Democratic Republic of Congo (GDRC), other donors, and implementing partners, staff must be able to
work comprehensively across prevention, care, treatment, and other cross-cutting issues. The current staff working on PEPFAR
primarily consists of a mix of individuals with public health, clinical and public diplomacy skills, with an emphasis on hiring staff
who understand Congolese culture, government, and history. In a country where Global Fund and MAP programs are the largest
contributors to national HIV/AIDS programs, USG staff are required to work with other programs to assure their success. Because
USG programs alone cannot go to scale in DRC, working with the GDRC, Global Fund, and MAP is essential. While USG staff
regularly provides technical assistance and leadership in prevention, care and treatment to other players, USG staff also applies
skills in diplomacy, negotiation, and consensus-building.
The USG has made progress in filling key positions. The USG team initially decided not to hire a PEPFAR Coordinator last year
due to the budget reduction. Based on anticipated funding through the Compact, the team is moving forward with the hiring
process through a USAID/PSC mechanism. The closing date for the advertisement was November 1, 2008 and the team is
hopeful the position will be able to be filled within the next few months. In the meantime, through CDC, an interim coordinator was
contracted for three and a half months to provide assistance on the Mini-COP.
CDC is in the process of filling its Deputy Director position and hopes to have that person in country by early Spring 2009. They
currently have two (2) other vacancies, a Laboratory Specialist (FSN) and Administrative Assistant (FSN). A total of four (4) CDC
staff provides technical leadership to the GDRC as was well as implementing partners: one (1) FTE (Chief of Party), and three (3)
FSNs (Care/Treatment, Strategic Information/Lab and IT services) and two (2) ASPH Fellows providing M&E and HMIS technical
assistance. Previously, there were two (2) FTE positions, but the Medical Epidemiologist moved to the Chief of Party position,
thereby creating a significant void for technical assistance.
USAID has staffed its vacant positions. USAID currently has one full-time FSN dedicated to HIV/AIDS in addition to one FSN
assigned 50% to HIV/AIDS since July 2008. The HIV/AIDS and Infectious Disease (ID) technical advisor position was filled by a
Global Health Fellow in November 2008; he will dedicate 50% of his time to HIV. The new Health Officer is able to dedicate 40%
of her time to PEPFAR.
There have been no changes in the Public Diplomacy section of DOS but the new FSN positions proposed in the reprogramming
request are greatly anticipated.
FSNs are relied upon to provide technical leadership to the GDRC as well as to implementing partners. The DOD representative,
who was a local hire and a fully engaged member of the USG Team, resigned and that position is currently being recruited. This
void is also significant.
USG agencies contribute the following to achieving results in DRC:
1. Department of State: The Deputy Chief of Mission (DCM) chairs the Mission's interagency HIV/AIDS PEPFAR In-Country
Team. The Public Diplomacy Officer (Public Diplomacy section) is part of the Strategic Planning group and participates actively on
HIV/AIDS issues. Mission implementing agencies (USAID, CDC, and DOD) provide the technical expertise to manage programs,
but final decisions are made by consensus of the HIV/AIDS PEPFAR In-Country Team members. The Chief of Mission, through
the DCM, would make a final call if the best efforts of the task force did not result in a consensus position.
2. Centers for Disease Control and Prevention/ Department of Health and Human Services: CDC provides leadership in
surveillance, Monitoring and Evaluation (M&E), laboratory strengthening, training and continuum of family-based HIV care
(PMTCT, TB/HIV, Palliative Care and ART). CDC participates on a variety of task forces providing technical assistance on HIV
(surveillance, PMTCT, ARV, and laboratory support task forces), TB task force, Blood Safety task force, Global Fund (CCM, M&E,
technical assistance to UNDP/PR), and the National HIV M&E task force supported by the PNMLS. In addition, CDC provides
technical assistance on other donor supported efforts such as the World Bank, GFATM, UNAIDS, and DFID.
3. United States Agency for International Development: USAID provides leadership in behavior change communication, the
targeted social marketing and provision of condoms, and other primary prevention, home and community based care-and support
for PLWHA and OVC, HIV counseling and testing, drug forecasting and other supply chain management issues, and PMTCT in
rural health zones. USAID also focuses on linkages with other USG health and development programs, such as TB, family
planning, education, child protection, and food and nutrition. USAID provides technical assistance to the Ministry of Social Affairs
on OVC issues in collaboration with UNICEF. USAID is second vice-president of the CCM.
4. Department of Defense: DOD provides training to military physicians in the prevention, care and treatment of HIV/AIDS patients
within the military community. It establishes a mechanism for surveillance, education and prevention of HIV through the
strengthening of labs, VCT services and PMTCT within the eleven military regional hospitals. DOD fosters reputable leadership
and improved civil-military relations in the course of field operations, through professional military education seminars and
courses.
HOW THE USG TEAM PLANS TO IMPLEMENT STAFFING FOR RESULTS IN FY09
The USG team will continue to meet regularly as a cohesive unit to continue to plan strategically, troubleshoot, share information,
and collaborate. New staffing proposals will be discussed at the Strategic Planning group meetings to assure that new positions
are designed to contribute to the overall USG team's efforts. Some additional steps the team will consider taking in FY09 include:
(1) hosting quarterly all USG partner meetings to discuss technical priorities, share successes and challenges, and identify
opportunities for partnerships; (2) conduct interagency site visits when possible so that agencies benefit from learning about each
other's programs and implementing partners benefit from technical expertise of all USG staff; and (3) sharing annual progress
reports across agencies to identify successes and focus on challenges in achieving results. With USAID and CDC co-located as
the main implementing agencies of HIV/AIDS funds, collaboration and joint-meetings will continue to be a regular occurrence.
NEW POSITIONS
Based on the potential of Partnership Compact funds, the following positions were proposed by the Interagency Team:
USAID - HIV Prevention Program Specialist, HIV/Health Advisor, HIV Program Assistant, Financial Analyst, and Contracting
Specialist (Regional); State - PEPFAR Coordinator and PEPFAR Administrative Management Specialist; CDC - M&E Specialist,
Surveillance Specialist, Prevention, Care and Treatment Program Specialist, Data Specialist and Financial Analyst.
During these staffing for results exercises, it was also agreed that additional technical areas were in need of high-level positions.
CDC put in a request for two (2) additional direct hire positions to fill the Medical Epidemiologist position as well as a Senior
Laboratory Program Advisor. The two new FTEs were approved by CDC Headquarters and the NSDD-38 process has begun.
These positions cannot be filled under the current CDC budget and must wait additional funding under the Compact budget.
However, these positions still need to be discussed and agreed upon by the PEPFAR Country Team.
The budget for this program area exceed 10% of the budgetary requirement due to 2 main reasons including the relocation of
CDC Office and the proposed staff increase based on the potential of Partnership Compact Funds.
Table 3.3.19:
