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.
N/A
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $10,600
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
Estimated amount of funding that is planned for Human Capacity Development $8,400
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $585,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The Swaziland HIV Estimates and Projections (2007) estimate that there are approximately 188,000 people living with HIV/AIDS
(PLWHA) in 2008. Of these, approximately 15,000 are children. The Swaziland Demographic and Health Survey (SDHS) 2007
reports the HIV prevalence in children to be 5.1% in the 2-4 year age group, 4.2% in the 5-9 year age group, and 2.6% in the 10-
14 year age group. Recent estimates also suggest that 4,745 children are in need of ART in 2008.
Despite strong government commitment to the delivery of HIV/AIDS services and extremely impressive achievements to date, the
country still faces severe ART as well as other care and treatment service-delivery challenges. Specifically for children, access to
HIV testing as an entry point to HIV/AIDS-related care and treatment remains an issue. While the roll-out of DNA-PCR for early
infant diagnosis is underway, HIV testing of the slightly older children remains particularly problematic (see HVCT). Thus far,
HIV/AIDS care and treatment services for children have been largely limited to young infants within the context of the gradually
expanding PMTCT+ program. In addition, there is one private health care provider, Baylor College, who specifically provides
pediatric HIV/AIDS care and treatment services for a wider age range of children. The Swaziland National AIDS Program (SNAP)
estimates that, thus far, approximately 2,500 children have been started on ART. However, approximately one third of those have
been lost to follow-up within the first 12 months of treatment, owing to highly centralized services, ineffective adherence support
and poor patient monitoring. It is estimated that 1,700 children remain on ART to date. The inadequate referral from PMTCT+ to
mainstream HIV/AIDS care and treatment services appears to also contribute to treatment interruptions and loss to follow-up. The
SNAP and its stakeholders are working tirelessly to tackle these issues, with a clear goal of implementing a more decentralized,
integrated and comprehensive HIV/AIDS-related care and treatment package, including for children, while dramatically increasing
the quality of service delivery in the existing services. Efforts include the appointment of a dedicated Pediatric Care and Treatment
Coordinator in SNAP.
Over the past few years, several USG partners have been key members of the PMTCT Technical Working Group (TWG), the
National Care & Treatment TWG and the National Palliative Care TWG and participated in the development of policy, technical
guidelines, training curricula, etc. for HIV/AIDS-related care and treatment services. Most of these documents contain materials
that specifically apply to children. Besides the National Guidelines for Anti-retroviral Treatment for Adults and Adolescents, a
dedicated guideline for pediatric ART exists. PEPFAR has provided considerable support towards the roll-out of the ART program,
primarily in the context of PMTCT+, including the implementation of pediatric HIV testing for Early Infant Diagnosis and Early
Infant Treatment and other pediatric HIV/AIDS-related care services. USG partners have been involved in training and mentoring
of key PMTCT and ART program personnel and in actual on-site implementation support to address issues of service quality and
care and treatment adherence. In addition, PEPFAR partners have played a crucial role in planning with SNAP to re-position ‘pre-
ART' and to develop a ‘Comprehensive HIV/AIDS Care Package', with a slightly adapted version for children, that is currently
being implemented.
PEPFAR has also supported the community-based and home-based extension of service-delivery, through its support to several
community-based NGOs and FBOs. PEPFAR has recently assisted the SNAP with an assessment of the current linkages and
referrals within HIV/AIDS services. This assessment was part of a multi-step process defined by the National Linkages and
Referrals TWG to develop an evidence-based and much-improved referral system to address the country's fragmented continuum
of care. It is also important to note that, besides direct support to care and treatment service delivery, USG has also provided
considerable technical support to improve the availability and quality of HIV/AIDS-related diagnostics and to address issues
around ARV and other OI management drugs availability and consistent drug supplies.
Swaziland has been designated as a FY08 Compact Country, and care and treatment, including for children, is one of the five key
areas for much increased PEPFAR involvement. The PEPFAR pediatric care and treatment support will be in line with the
National Strategic Framework (NSF) for 2009-2013 that is currently under development.
In FY09, USG and its partners will step up their support for the SNAP plans for scale-up and quality improvement of HIV/AIDS
related care and treatment services for children. Support will be centered on the further roll-out of Early Infant Diagnosis and
increased access to Early Infant Treatment through the implementation of a more decentralized, more integrated, and
comprehensive HIV/AIDS care and treatment package.
1) USG Partners will continue to work closely with the MOHSW and other stakeholders, including WHO, Clinton Foundation, and
Baylor College, through the TWGs and/or other stakeholder consultations, on the development of policies and technical guidelines
in support of a comprehensive pre ART, ART, and end-of-life care package for children. Critical policy issues to be addressed
include, but are not limited to, guardian consent for child services, HIV testing of children (see HVCT), decentralization of services,
linkages and referrals, and task shifting.
2) The ‘Comprehensive Care Package' for infants and children that is currently being developed by SNAP, with technical
assistance from ICAP and EGPAF, includes:
•Provider-Initiated HIV Testing and Counseling / Early Infant Diagnosis (see HVCT)
•Baseline assessment
•Growth monitoring
•Neuro-developmental monitoring
•Lab & clinical monitoring (see HLAB)
•TB screening (see HVTB)
•Provision of prophylaxis with CMX, INH, Fluconazole
•Managing common symptoms
•Diagnosis and treatment of OIs
•Diagnosis and treatment of malnutrition
•ART / Early Infant Treatment
•Adherence to care & treatment for child / mother / family
•Psychosocial support for child / mother / family
•Early Infant Feeding / Nutrition support
•Hygiene, water and sanitation support
•End-of-life care and support
3) USG partners will continue their implementation support to the existing PMTCT+ services and ART-centers. The emphasis of
their support will be on strengthening quality of services and improving outcomes. Support to facilities will include the
improvement of various systems including: patient flow, service scheduling, appointment systems, document of patient
information, referrals etc. Special attention will be given to the development of a system for adequate referrals from PMTCT+ to
mainstream HIV/AIDS care and treatment services. Finally, new interventions will be designed and implemented to address client
retention and treatment adherence, such as monitoring of missed appointments and different approaches to defaulter tracing.
4) In the context of USG support for the SNAP's decentralization of general HIV/AIDS care and treatment services and the roll-out
of the "Comprehensive Care Package" to the primary health care level (see HBHC), special attention will be given to inclusion of
facilities and services for children beyond PMTCT.
5) PEPFAR will also build upon the already existing community-based health care structures to further support the continuum of
care concept and to increase the involvement of client families (see HBHC). USG implementing partners will identify links with
community-based child support groups and OVC associations and encourage adequate referral of orphans and vulnerable
children for HIV testing and/or care and treatment. They will also support infant follow-up services by capitalizing on already
existing infant programs in the community.
6) USG partners will continue to support the MOHSW by further developing training curricula and providing in-service training to
key personnel in the PMTCT and ART programs on all aspects of pediatric HIV/AIDS-related care and treatment. Special attention
will be given to improving the skills of health workers in pediatric counseling through training and mentorship to improve provider
confidence to handle special pediatric issues on consent, disclosure, and adherence, and psychosocial support activities designed
to support the specific needs of HIV-infected adolescents or orphans and vulnerable children. USG partners will collaborate to
explore efficiencies and ways to coordinate different aspects of training in order to minimize the burden on health personnel and
their availability for service delivery. In addition, USG will work with tertiary training institutions for health care workers to
incorporate pediatric HIV/AIDS-related care and treatment in their training curricula. Working with nursing schools will be the
starting point, but this may eventually expand to other health cadre training institutions (see OHSS).
7) USG partners will support and facilitate the introduction of fixed-dose drug combinations for pediatric ART, and introduce
pharmacovigilance measures to ensure the safe and effective use of these ARVs and other medicines used in pediatric HIV/AIDS
patients. The training of healthcare workers and on site technical assistance in the identification and reporting of HIV/AIDS
medication-related adverse effects in pediatric patients is critical to improving healthcare outcomes in this vulnerable population.
8) USG partners will continue to assist MOHSW with program guidance for adequate referral mechanisms for post-test support,
care, and treatment services for HIV-infected children. (see HVSI, HVCT, OHSS). This work, under the Referrals Working Group,
will build on the outcome of the ‘referral assessment' that was just recently completed and on previous efforts at establishing
‘referral directories', in order to improve the continuum of care.
9) Through MSH, the USG has developed an ART patient management information system, RxSolution, currently used at the
existing ART sites. Besides providing routine site-level data and periodic reports, it allows for better patient management,
including the possibility to identify defaulting patients. MSH will ensure that infrastructure, training and mentoring for RxSolution
will follow the decentralization of services. The system will be able to also generate child specific data and reports that could be
used to make informed care and treatment service improvements, addressing issues of standards of care specifically for children.
Products/outputs:
•National Guidelines for ART for children
•National Guidelines for Community-based Care and Support
•Comprehensive HIV/AIDS Care Package for children
•Modular training curricula for pediatric HIV/AIDS-related care and treatment
•Referral Directories for pediatric HIV/AIDS-related care and treatment services
•Quality assurance plans with supervisor guidelines
•Quality assessment tools
The Compact provides PEPFAR with a significant opportunity to decentralize and extend care and treatment services for children.
Refurbishment of facilities, task shifting, recruitment and training of significant numbers of staff in both the public and private
sector are heavily dependent on compact funding. With pre-Compact funding levels, PEPFAR will continue to support services at
the existing ART sites, including major hospitals and health facilities in urban areas. Implementation of the national plan to
broaden access to high quality care and treatment services for children is in large part dependent upon the availability of compact-
level PEPFAR technical and material support.
Table 3.3.10:
Estimated amount of funding that is planned for Human Capacity Development $4,200
Estimated amount of funding that is planned for Human Capacity Development $9,333
Table 3.3.11:
