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
N/A
New/Continuing Activity: Continuing Activity
Continuing Activity: 21113
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21113 21113.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $50,000
Disease Control & of Public Health SCHOOL OF
Prevention PUBLIC
HEALTH COAG
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $35,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Continuing Activity: 21115
21115 21115.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $50,000
Estimated amount of funding that is planned for Human Capacity Development $23,800
Table 3.3.03:
Continuing Activity: 21114
21114 21114.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $19,115
Estimated amount of funding that is planned for Human Capacity Development $19,115
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Total Planned Funding for Program Budget Code: $1,166,715
Program Area Narrative:
Adult Care and Support
Overview
The 2007 Demographic and Health Survey (DHS) estimates that the prevalence of Human Immunodeficiency Virus (HIV) in the
general population of Democratic Republic of the Congo (DRC) is 1.3%: 1.9% urban v. 0.8% rural and 1.6% among women v.
0.9% men. The 2006 Ante-natal Clinic 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 differences in DHS and
ANC estimates are typical due to different sample populations. The need for increased surveillance of hidden, high-risk
populations remains; improved surveillance would facilitate resource targeting and effective responses to the epidemic.
In 2007, the PNLS reported that 31,491 Opportunistic Infection (OI) cases were treated at 166 sites, 25,168 People Living With
HIV and AIDS (PLWHA) received cotrimoxazole (CTX) prophylaxis and only 28% of PLWHA enrolled in ART received at least one
palliative care service. Overall, the coverage and quality of care in DRC is inadequate. The United States Government (USG) is a
major donor for care services both in clinical and community-based settings and provides leadership in supporting care to victims
of sexual violence, including HIV-services.
Challenges
Throughout the DRC, poorly paid health care workers often demand unofficial payments and are frequently unable to provide
basic care services. Cost and poor outcomes deter clients from seeking care. Preventive measures including vaccination,
hygiene, sanitation, and public infrastructure have been neglected for years resulting in recurrent epidemics of communicable
diseases, such as measles, typhoid fever, and cholera. Other challenges to HIV care include disclosure, stigma, and adequate
supplies of both OI and ARV medications. Additionally, the limited number of care and treatment facilities, compounded by poor
supply chain systems makes access to services and treatment a major issue. The lack of food and nutritional support for patients
is a further complication.
Leveraging and Coordination
As of June 2008, the Global Fund is providing support to 204 clinics nationwide for prophylaxis and treatment of OIs. The
Government of the Democratic Republic of the Congo (GDRC), relying primarily on the Global Fund and Multi-Country AIDS
Program's (MAP) free ARV programs, set an ambitious goal of reaching 100,000 patients by the end of 2009. However, in the
past few years at both the Global Fund and MAP, funding and coordination bottlenecks have hindered full-scale rollout of
treatment programs and reaching these targets is unlikely.
Throughout 2007, the USG supported technical assistance (TA) to the Global Fund Country Coordinating Mechanism (CCM) to
address these issues. As a result of the Technical Assistance (TA), DRC has successfully secured $71M of Round 3 - Phase 2
funds for HIV and it is expected that resulting disbursements to implementing partners will occur without delay and programs will
resume with national scale-up. Furthermore, the Round 7 proposals were submitted to Geneva early - a positive indicator of
collaboration. Round 7 ($71M) and Round 8 ($262,911,091) were both approved.
The Global Fund experienced delays in program implementation due to the mismanagement of contracts. This led the DRC's
World Bank MAP to reassess their approach to implementing HIV programs. MAP has opted to realign their HIV programs to
work in health zones with already well-established World Bank supported health programs. New, legitimate contracts have been
signed, and working in areas with an established World Bank presence should facilitate efficient implementation of care programs.
The USG's primary concern with MAP's new approach is that the location of existing World Bank health programs is the key
determinant rather than epidemiological evidence. The USG will remain vigilant in working with the national program to assure
that the Global Fund and MAP programs are able to implement their ARV programs at scale.
International donors have historically supported Community-based Organizations (CBOs) and Faith-based Organizations (FBOs)
to implement Home-based Care (HBC) programs. However, there is a lack of national data to show the coverage and impact of
these programs.
In order to prepare for ARV scale-up, technical and financial investments in health facility rehabilitation, laboratory equipment, and
development of health commodity distribution systems are underway by multiple bilateral and multilateral health development
partners. As partners roll out HIV services and chronic disease treatment models, it will be necessary to integrate HIV services
into the existing health care delivery system. An integrated approach should strengthen the overall health system while ensuring
a comprehensive continuum of care approach provided at both facility and community levels: early diagnosis, confidential
counseling, treatment of tuberculosis (TB)/HIV co-infection, access to OI and ARV treatments, home based care, reduction in HIV-
related stigma, as well as the involvement of the entire family. In the DRC, the USG agencies have spearheaded the development
of effective health care delivery systems that provide integrated quality care.
Current USG Support
At the national level, the USG strategy promotes the integration of care and support into the framework of the Family Centered
Continuum of HIV Services model. To this end, priorities will include the development of home-based care guidelines,
standardized training, a standardized package of services, and the provision of home-based care kits.
In clinical settings, the USG supports provision of access to the following package of services: psycho-social assessments during
each clinic visit; individual, couples and family counseling; home visits; support groups; and disclosure support. Implementing
partners are responsible for the development, training, implementation and evaluation of support activities. Clinic staff and
participating local community-based groups will conduct the assessments and activities.
At the community level, the USG supports the provision of basic care and support to PLWHA in Lubumbashi, Matadi, and Bukavu.
The current home-based care program focuses on social care services which include food support, legal aid, support groups,
income generating activities (IGA), psychosocial support and limited clinical services such as clinical monitoring and support to
adherence on treatment through both health providers and home-based care volunteers. Community-based care programs also
provide linkages to youth friendly VCT services, specifically to serve marginalized youth and OVC. Linkages to treatment, health
and social services are provided to PLWHA and OVC though home-based care providers. These home-based care programs
include organizational capacity-building of the indigenous organizations as a key strategy to sustain community-based efforts.
Given the extremely limited resources of the USG HIV program, the USG is not engaged in ARV procurement. However, several
USG programs are leveraging other donors' investments in ARVs to complement USG services. The family-centered care
program in Kinshasa run by UNC leveraged ARVs from other donors, including the African Development Bank and Belgian
Technical Cooperation, so that recipients of USG services are directly linked into ART programs. Similar linkages exist in the
home and community-based care programs in Bukavu, Lubumbashi, and Matadi with organizations such as Médicins Sans
Frontières (MSF), so that the USG program beneficiaries are enrolled into complementary ARV programs.
The USG supports the regional ROADS II project, a five year Leader With Associates (LWA) program, to deliver prevention care
and support services at the DRC/Rwanda and the DRC/Burundi borders. ROADS II will provide care and support services to
1,000 PLWHAs in order to meet their needs through three clusters of 81 local associations including youth, low-income women,
and transporter associations. The program targets the provision of care support including psychosocial support, food support, anti-
stigma activities and support group activities to HIV positive people. This support is provided by both nurses and community
volunteers belonging to the three clusters. This program will be complementary to the Great Lakes Initiative Against AIDS (GLIA)
-World Bank and Global Fund programs which provide additional services such as ARV treatment.
USG FY09 Support
FY09 funds will continue to support care and treatment services in clinical and community based settings. Family-centered
programs will continue to provide the package of services described above. USG will continue to develop a health network of
facilities including Kalembe Lembe Pediatric Hospital and twelve Salvation Army operated clinics that will provide post-birth follow-
up care for HIV positive mothers, newborns and immediate family members. A referral service will be developed to shift stabilized
clients on ART from the hospital to Salvation Army clinics located nearer to the clients' residences. USG will provide technical
assistance to the Salvation Army clinics through training of ten additional physicians in ART (drugs, materials, and equipment are
funded by GFATM). USG supported activities at Kalembe Lembe Pediatric Hospital will be coordinated with the Clinton
Foundation to add 2,000 new cases on ART nationwide.
Efforts to support community-based palliative care programs will also continue in FY10 using FY09 funds through the new
integrated HIV bilateral program (mechanism TBD). Activities currently implemented in the cities of Bukavu, Matadi, and
Lubumbashi as well as ROADS II target sites of Bukavu and Uvira will continue and be expanded to other high prevalence
‘hotspot' areas.
Additionally, FY09 funds will support the expansion of the Lubumbashi HIV activities through this integrated bilateral program in
Kasumbalesa, Kolwezi, Kipushi and Likasi located outside of Lubumbashi at the Zambia border and along a major trucking route
which starts in South Africa and travels north through Zimbabwe and Zambia into Lubumbashi through Kasumbalesa. This
strategy will fill the programmatic gap between clinical and community-based care programs that had been identified during
implementation of the existing program. FY09 funds will sustain a more comprehensive HIV program with improved services
including prevention, CTX prophylaxis, palliative care, referral for other services, and improved monitoring and reporting systems.
The PEPFAR team will also coordinate with Global Fund activities to fill gaps in the existing package of services. This program,
articulated by the Ministry of Health (MOH), envisions comprehensive health care at the site level with linkages to strengthen the
continuum of care between health facilities and the communities that they serve. Should DRC receive increased HIV/AIDS
funding, the program will expand to other critical high prevalence, hotspot areas targeting the Most At-Risk Populations (MARPs).
Having one prime partner providing such comprehensive prevention, care and treatment services will ensure coordinated and
consistent programming limiting the possibility for a break in services, increase synergies and linkages at all program levels, and
reduce duplication of efforts.
With several other USG health and development projects ongoing in these regions, as well as other donor investments, there is
an opportunity to leverage resources to maximize the effectiveness of care services. Linkages through referrals with services such
as counseling and testing, laboratory, TB screening and treatment, OI management, PMTCT, and ARV will be strengthened to
ensure access to integrated and comprehensive support. The HIV program will also seek to strengthen the continuum of care
between health facilities and community level programming by implementing activities at both levels. Leveraging of USG funds for
family planning, nutrition, and economic growth programs will be essential to strengthening care programs. Expansion to other
hotspot regions and MARPs will be determined by regional priorities in the DRC 5-year strategy as well as the results of the DHS,
increased funding and a new Partnership Compact Program.
The USG has provided care and support to over 75,000 victims of sexual violence in conflict-ridden eastern Congo since 2002.
Sexual violence atrocities are structured around rape and sexual slavery and aim at the complete physical and psychological
destruction of women with implications for the entire society. Other USG funds will continue to be leveraged in FY09 to provide
VCT and PEP as components of comprehensive palliative care programs for survivors of sexual violence. This holistic approach
to care includes medical assistance (including fistula repair), psycho-social support, and advocacy, socio-reintegration services,
promoting judicial support and referral, and new protection laws. Women who are eligible for ART are referred to MSF and other
donor treatment centers. As care for HIV-positive victims of Gender-based Violence (GBV) is a key priority, USG HIV programs
will attempt to support and link with these programs that provide comprehensive services to a critically underserved population.
6.1 Number of service outlets providing HIV-related palliative care (including TB/HIV): 199
6.2 Number of individuals provided with HIV-related palliative care (including TB/HIV): 8,603
Male: 2,978 Female: 5,625
6.3 Number of individuals trained to provide HIV palliative care (including TB/HIV):1386
11.1 Number of service outlets providing antiretroviral therapy (FY07 said includes PMTCT sites): 27
11.2 Number of individuals newly initiating antiretroviral therapy during the reporting period (FY07 said includes PMTCT sites):
593 Male (0-14) : 0 ; Male(15+) : 220 ;Female (0-14): 0; Female (15+): 337 and pregnant female (all ages): 36
11.3Number of individuals who ever received antiretroviral therapy at the end of the reporting period: 922 Male (0-14): 0; Male
(15+) : 304; Female (0-14): 0; Female (15+): 552 and pregnant female (all ages): 66
11.4 Number of individuals receiving antiretroviral therapy at the end of the reporting period: 871; Male (0-14): 0; Male(15+): 255;
Female (0-14): 0; Female (15+): 537 and pregnant female (all ages): 79
11.5 Number of health workers trained to deliver ART services, according to national and/or international standards : 197
11.6 Number of individuals receiving ART with evidence of severe malnutrition receiving food and nutritional supplementation
during the reporting period: 30
Table 3.3.08:
Continuing Activity: 21116
21116 21116.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $15,000
Estimated amount of funding that is planned for Human Capacity Development $14,000
Table 3.3.14:
Not applicable
Continuing Activity: 18361
18361 11856.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $231,437
11856 11856.07 HHS/Centers for Kinshasa School 5978 5978.07 KINSHASA $296,134
Table 3.3.16:
Continuing Activity: 21118
21118 21118.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $214,888
Estimated amount of funding that is planned for Human Capacity Development $48,000
Estimated amount of funding that is planned for Public Health Evaluation $25,000
Table 3.3.17:
Continuing Activity: 21119
21119 21119.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $441,434
Continuing Activity: 18363
18363 11860.08 HHS/Centers for Kinshasa School 8063 5978.08 KINSHASA $73,978
11860 11860.07 HHS/Centers for Kinshasa School 5978 5978.07 KINSHASA $73,978
Estimated amount of funding that is planned for Human Capacity Development $60,000
Table 3.3.18:
