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:
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $1,454,989
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The National Strategic Plan for HIV and AIDS (2006-2008) and the Health Sector Response Plan for HIV and AIDS (2006-2008)
commit ‘to increase the proportion of people who have received HIV Testing and Counseling (HTC) services and know their HIV
status from 10% to 40% by the end of 2008'. In order to achieve this, the Ministry of Health and Social Welfare (MOHSW) is (1)
strengthening national capacity to provide HTC at all levels, (2) implementing fully integrated, routine, provider-initiated HTC in
preventive and clinical care services, (3) strengthening the expansion of HTC services beyond health facilities, and (4) increasing
public awareness and uptake of HTC services.
The Swaziland Demographic and Health survey (SDHS) 2007 estimates that, among the population age 15-49, 36% of women
and 17% of men reported having ever been tested and receiving HIV test results at some time: one in five women (22%) and one
in ten men (9%) were tested and received HIV test results in the 12 months preceding the survey. This is far short of the targets
mentioned above. Client-initiated HTC services have historically been provided in 42 public and private facilities throughout the
country. Some of these are free-standing and run by NGO's, while others are integrated in existing government health facility
structures. Many of them have additional outreach services. While the MOHSW Swaziland National AIDS Program (SNAP) is
working with all involved parties to further strengthen the existing client-initiated HTC services, it has also launched a bold
initiative to introduce provider-initiated HTC services at all levels of public health facilities throughout the country. This initiative is
still in its early stages, with human resource limitations being one of the main obstacles. While many health care workers have
already been trained to provide HTC, actual service delivery is mostly limited to ANC clinics (see MTCT), TB diagnostic and
treatment facilities (see HVTB) and, most recently, STI treatment centers.
Over the past few years, PEPFAR and its partners have provided significant assistance to SNAP in HTC promotion and quality
assurance and the establishment of the currently available HTC services. The PEPFAR has been instrumental in establishing the
National HTC Technical Working Group (several PEPFAR partners are part of its ‘Core Team') and in the development of the
National HTC Policy, HTC Technical Guidelines and Standard Operating Procedures (SOP's), and an HTC Training Curriculum.
For client-initiated HTC the SNAP has adopted SOP's that were developed in PEPFAR partner settings and is working with
PEPFAR partners to sustain the franchised network of ‘New Start' branded client-initiated HTC centers, with outreach facilities,
throughout the country. Equally, the SNAP has relied heavily on PEPFAR partners to establish provider-initiated HTC services at
ANC, TB and STI clinics. PEPFAR collaboration with the SNAP has included joint activities on HTC promotion, training of
counselors, supervision and quality-assurance of services, lab support and supply chain management, and efforts to standardize
data collection across HTC centers. PEPFAR has also worked with the SNAP to organize stakeholder conferences on the
importance of HIV- infected clients' access to adequate prevention, support, care and treatment services and the compilation of
regional ‘referral directories'.
In FY09, PEPFAR will continue to support client-initiated HTC services while, at the same time, taking a leading role in the
establishment of provider-initiated HTC. PEPFAR HTC support will be in line with the new National Strategic Framework for
HIV/AIDS (NSF) for 2009-2013 that is currently under development.
1) PEPFAR and its partners will continue to support dialogue at national level on policy issues that are critical for the further
expansion and national scale-up of HTC services. PEPFAR partners, in collaboration with other stakeholders, will provide
technical assistance to MOHSW and SNAP to streamline policies on integration of provider-initiated HTC in clinical services, task
shifting of HIV testing and counseling to lay cadres, blood sample collection through finger prick, and issues of HIV testing in
children.
2) PEPFAR and its partners will continue to provide extensive technical assistance in the development and/or implementation of
an adapted national HTC policy document, an HTC expansion strategy, up-to-date HTC standard operating procedures, including
adequate testing procedures and quality assurance (see HLAB), and a modular HTC training curriculum. PEPFAR partners will
facilitate, together with SNAP, the formation of an HTC forum for sharing best practices.
3) In line with the SNAP communication strategy for HTC, PSI will work to develop and disseminate communications to increase
awareness on the availability of both client initiated and provider initiated HTC services. Mass campaigns, such as a "National HIV
Testing Week" will be integrated in the overall communication strategy.
4) PEPFAR partners will provide considerable support to enhance the lab capacity to provide adequate and quality assured HIV
testing (see HLAB). ICAP and EGPAF will continue to support, in close collaboration with Clinton Foundation and Baylor College,
the rapid expansion of access to early infant diagnosis.
5) Through PSI, PEPFAR will continue to operate its client-initiated HTC sites and increase outreach programs to the general
population, through the chieftainships and community- and faith-based organizations, and to the workplace setting. In addition it
will continue to support the franchise network of ‘New Start' branded client-initiated HTC centers.
6) PEPFAR partners will actively engage in health worker training, on-the-job mentoring and supervision and assist public health
facilities in establishing high-uptake and quality-assured provider-initiated HTC services. EGPAF will continue its long-standing
support to ANC service providers (see MTCT), URC will further support TB diagnostic and treatment facilities (See HVTB), and
PSI will continue focusing its efforts on STI clinics. In addition, within the context of a decentralized, comprehensive and integrated
HIV/AIDS care and treatment package, ICAP and other PEPFAR partners will increase support for HTC and all aspects of post-
test support, prevention, care and treatment services at the primary clinic level (see HBHC, PDCS).
7) Several of the PEPFAR partners will collaborate with SNAP to provide comprehensive workplace programs to increase access
of corporate, agricultural and factory workers to HTC services. Through DOD, PEPFAR will also support the development of HTC
services for the Umbutfo Swaziland Defense Force (USDF) and some of the other uniformed services. An important aim of these
programs is to increase utilization of services by men who otherwise do not access health settings for care and treatment.
8) PEPFAR will continue to support HTC services for correctional facilities to target prisoners. Rather than providing outreach
services to prisons, PEPFAR will assist with the set up of dedicated, in-house VCTs.
9) Pact and PSI/TASC, partnering with several community-based organizations, will continue to pursue innovative approaches to
provide mobile outreach and community-based, door-to-door, and family-centered HTC services, in order to reach youth
(especially out-of-school youth), men, couples, and client family members.
10) Special consideration will be given to the integration of HTC within the context of male circumcision services (see CIRC)
11) PEPFAR will continue to assist in the development and implementation of a routine data collection, analysis and reporting
system for HTC services. PSI will continue to support and mentor SNAP's quality assurance officer who will be responsible for
monitoring and evaluation, and support for HTC sites to adhere to national standards and protocols
12) PEPFAR partners will continue to assist MOHSW with program guidance for adequate referral mechanisms for post-test
support, prevention, and care and treatment services for HIV infected clients. (see HVSI, HBHC, PDCS, 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.
13) PEPFAR will work with training institutions for health care workers to incorporate HTC 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).
Products/outputs: HTC Policy, HTC Expansion Strategy, National HTC Guidelines, HTC Referral Directory, Standard Operating
Procedures, HTC Training Curriculum, HTC Recording and Reporting System, HTC promotion campaigns, National HTC Forum
Plans to task-shift HTC to lower level cadres of health workers and expand services into rural areas are dependent on Compact
funding. With pre-compact budget levels, scale-up of provider-initiated HTC and work to improve referrals will be very limited.
HTC in the context of MC scale up is also dependent on Compact funding.
Table 3.3.14:
Table 3.3.18:
