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: 18472
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18472 18472.08 HHS/Centers for To Be Determined 8114 8114.08 Providing AIDS
Disease Control & Care and
Prevention Treatment
Table 3.3.01:
Continuing Activity: 18477
18477 18477.08 HHS/Centers for To Be Determined 8114 8114.08 Providing AIDS
Table 3.3.03:
Continuing Activity: 18513
18513 18513.08 HHS/Centers for To Be Determined 8114 8114.08 Providing AIDS
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Antiretroviral (ARV) Drugs
Overview & Challenges
Limited USG HIV program resources in the DRC have prohibited procurement of ARVs. This priority issue has been highlighted
for the Partnership Compact in FY 09. Currently, several USG programs are leveraging other donors' investments in ARVs to
complement USG supported HIV services. The USG is also proposing to support the MOH's efforts to strengthen the supply chain
system.
The 2007 DHS estimates that HIV prevalence in the general population of DRC is 1.3% (1.9% urban v. 0.8% rural, 1.6% among
women v. 0.9% men). The 2006 ANC Surveillance estimates the prevalence rate at 4.1% with three key findings: increasing
numbers of infected women; the epidemic is spreading to rural areas (Lodja and Karawa have the highest rates of prevalence
among pregnant women); and the majority of new cases are among people under 24 years of age. The provincial capitals of
Kasai Oriental, Katanga and Kinshasa reveal prevalence rates of 24.5%, 23.3%, and 18.4%, respectively, among commercial sex
workers. Differences in DHS and ANC estimates are typical due to the different sample populations. The studies reveal
concentrated epidemics in pockets throughout the country. The need for increased surveillance of hidden, high-risk populations
remains; improved surveillance would facilitate resource targeting and effective responses to the epidemic. UNAIDS EPP
Spectrum-derived estimates, based on existing surveillance data from the past five years (prior to DHS results), suggest 1.2
million Congolese are infected with HIV. The same study project over 42,000 vertical mother-to-child infections will occur in 2008,
and that 250,000 Congolese will be eligible for ART by 2010. Access to treatment remains a significant challenge, although
improvements can be shown over the past three years. In 2006, approximately 8.6% (17,561) of those eligible for ART were
enrolled in ARV treatment and in 2007; that number increased to 10.9% (20,856 people). PNLS has reported that 19,483 people
were receiving ART as of June 2008. However, approximately 92,726 people were waiting to access treatment.
Current generic treatment regimens are registered and imported, mainly from India. However, Pharmakina, a national
pharmaceutical company based in Bukavu, began local production of generic ARVs (including fixed dose combination) in June
2005. The MOH authorized the distribution of these drugs which are now being used in several provinces at a cost of
approximately $22/patient/month. These ARVs are distributed by private providers as well as several FBOs (Caritas Goma in
North-Kivu, Caritas Boma in Bas-Congo, Caritas Butembo in North-Kivu). No major donor is currently procuring Pharmakina
ARVs. Concomitantly, the WHO is working with the GDRC to determine if Pharmakina meets international General Manufacturing
Practice (GMP) standards. The recommendations from that assessment are now being implemented by Pharmakina with support
from GTZ.
Leveraging and Coordination
The GDRC set an ambitious goal of enrolling 92,726 Congolese on ART by the end of 2008 and 100,000 by the end of 2009.
Achievement of these national targets relies primarily on the Global Fund which provides 80% of the ARVs to HIV positive patients
in the DRC and MAP's free ARV programs. In the past few years funding and coordination bottlenecks at both the Global Fund
and MAP have hindered full-scale rollout of treatment programs. Throughout 2007, the USG supported technical assistance to the
Global Fund CCM to address these issues.
Communication and coordination within the CCM and the national program has improved as a result of the TA, and DRC has
successfully secured $71M of Round 3-Phase 2 funds for HIV. These funds have been received by the UNDP, disbursements to
implementers have been made, and programs are resuming national scale-up. Additionally, the GDRC has received approval and
signed the agreement for $70M from Round 7 using UNDP as the principal recipient.
Furthermore, the Round 7 and 8 proposals were prepared with efficiency and coordination never before experienced in the DRC.
The proposals were submitted to Geneva early - a positive indicator of successful collaboration. The Round 8 DRC HIV proposal
to the Global Fund has been approved for $262,911,091 for five years to the DRC.
In response to ongoing delays in implementation resulting from mismanaged contracts, the World Bank/MAP has reassessed its
approach to HIV services in the DRC. In order to assure expediency and accountability in delivering services, MAP has opted to
realign the remaining $67M of the $102M HIV grant to work in health zones that already have well-established World Bank
supported health programs through 2010. MAP and Global Fund have signed an MOU to avoid duplication of services in the same
health zones. The USG's primary concern with MAP's new approach is that the rollout will prioritize existing World Bank health
program areas as opposed to high risk zones and MARPs. Overall, the USG's engagement with both the Global Fund and MAP
during the last year has produced positive results. The USG will continue to actively coordinate with the national program to
improve effective scale-up of ARV supported by the Global Fund and MAP programs.
The USG also is working with the Clinton Foundation's new program in DRC, focused on pediatric treatment and care. The
Clinton Foundation is working in Kinshasa, Lubumbashi, Kisangani, Mbuji-Mayi, Bukavu, Matadi, Kananga and Goma with a goal
of enrolling 2,000 children in ART and related HIV care programs. They provide first-line and second- line HIV pediatric drugs and
second- line for adults. Additionally, the WHO secures ARV stock for 15,000 patients in case a stock-out of ARV occurs in DRC.
This system has been tested twice and has performed well both times. Yet, the WHO has expressed the need to have other
donors support the buffer stock initiative.
FY09 Support
No FY09 will be allocated to support ARV procurement.
Please see the care and treatment program area contexts for more information on how the USG is leveraging efforts to improve
access, quality and the scale of ARV services in the DRC.
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $397,134
Laboratory Infrastructure
Overview
At present, HIV laboratories in the DRC are in extremely poor condition. Other challenges which need to be addressed include:
(1) weak coordination by the National AIDS Control Program (NACP), (2) absence of standardized protocols including demand-
based procurement guidelines, (3) ad-hoc fee structuring, and (4) gaps in quality control procedures. Global Fund supported an
ARV assessment in September 2006 which identified laboratory service fees as a barrier to treatment. Of the 80 sites evaluated,
only 36% provided consultation, lab and ARVs without charge. The same evaluation will be repeated in earlier 2009 and will
include new sites supported through the Global Fund Phase 2 Round 3.
The rollout of Global Fund and World Bank/MAP programs provide an excellent opportunity for nationwide improvements based
on the National HIV Lab Plan recently developed by the PNLS. Thus far, Global Fund has equipped five laboratories with CD4
machines and plans to expand support to all 11 provincial labs with the Phase 2 Round 7 funds. MAP is supposed to fill gaps by
providing missing equipment. Challenges remain for a consistent supply of equipment and reagents for biochemistry and
hematology for disease monitoring. The USG supports the PNLS- led HIV Laboratory Task Force and advocates for donor
collaboration to standardize laboratory equipment and procedures nationally.
Current USG Support
The USG promotes quality laboratory services to ensure effective diagnosis and treatment, safe blood services, and accurate
epidemiologic surveillance. The USG supports HIV laboratory quality improvements by providing TA for the development of
national lab policy, norms, procedures and standards. The USG also provides TA for the development of a laboratory quality
assurance program at the national, provincial and district hospitals as well as local clinics. However, the USG focuses support in
four cities (Kinshasa, Lubumbashi, Matadi and Bukavu) prioritized in the five-year strategy. The USG also supports an HIV
laboratory training site at the KSPH that conducts pre-service and in-service training in HIV laboratory techniques/procedures for
students enrolled at the Laboratory Technician Institute, KSHP and the University of Kinshasa Medical School. With FY08 funds,
the rehabilitation of two KSPH HIV training laboratories was completed. Additionally, technical trainings were initiated to improve
competency in diagnosis and monitoring through the use of CD4 FACS count, DNA PCR machines, HIV rapid tests, and
microscopes.
The USG is also training four military laboratory technicians to strengthen capacity in the areas of rapid testing, data
management, confidentiality, and medical waste disposal. This training will be followed up with quarterly supervisory visits and
refresher training as needed.
Results of a USG field survey assessment conducted by the KSPH for laboratory equipment needs were completed early in 2007.
This survey identified specific laboratory needs including equipment required to implement essential HIV services. Provincial
Laboratories needing equipment were prioritized following the USG geographic zones as defined in the Five-Year HIV Strategy
and input from collaborative partners such as the Clinton Foundation's Pediatric AIDS Initiative. As a result, the USG has is
provided through KSPH key HIV laboratory equipment for provincial hospitals including Jason Sendwe Provincial Hospital in
Lubumbashi and Kalembe Lembe Pediatric Hospital in Kinshasa. With FY08 funds, two additional provincial hospital laboratories
are being equipped for diagnosis and disease monitoring in Matadi and Bukavu. The HIV quality control/quality assurance plan
was finalized in FY06. Currently, the USG is implementing a proficiency test using dried tube samples at 80 sites where HIV rapid
testing occurs.
USG FY09 Support
With FY09 funds, additional resources will concentrate on quality assurance in provincial hospitals and key laboratory sites. This
work will include revising the training curricula and subsequent training of provincial laboratory technicians. Funds will continue to
be used to fill critical gaps in equipment purchases and reagents that are necessary for related laboratory testing. These efforts
will promote the validation of new laboratory techniques. The USG will support in-service and pre-service training of HIV
laboratory technicians based on standardized procedures. The USG will continue to strengthen laboratory capacity at health
facilities based on patient care needs, cost, effectiveness and efficiency.
FY 09 funds will continue to support laboratory services in the new integrated HIV bilateral program (mechanism TBD). This
support will include the provision of equipment and reagents, training of laboratory technicians, and establishing quality assurance
and supervision systems (especially in Lubumbashi). *
Program Area Downstream Targets:
12.1 Number of laboratories with capacity to perform 1) HIV tests and 2) CD4 tests and/or lymphocyte tests: 7
12.2 Number of individuals trained in the provision of laboratory-related activities: 510
12.3 Number of tests performed at USG-supported laboratories during the reporting period: 202,400
HIV testing: 91,000; TB diagnostics: 15,200; Syphilis testing: 42,200 and HIV disease monitoring: 54,000
Table 3.3.16:
Continuing Activity: 18369
18369 11859.08 HHS/Centers for To Be Determined 8114 8114.08 Providing AIDS
11859 11859.07 HHS/Centers for University of North 5908 5908.07 UTAP $183,630
Disease Control & Carolina
Prevention
Table 3.3.17:
