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.
moved to tx services per program review
Sustainable ART Adherence through Self-Help Groups and Clinic-Community Linkages
This is a new activity designed to address gaps in community and facility linkage within the health network model. It links with ART Service Expansion at Health Center Level; ITECH palliative care (5767), ITECH technical support for ART scale up (5658), PMTCT/Health Centers and Communities (5586), and Care and Support Contract Palliative Care (5616).
Recognizing both the public health benefits and risks of rapid roll-out of free ART in Ethiopia, PCI conducted interviews with key stakeholders to identify barriers to ART adherence. Among the salient barriers identified were those requiring social support, such as lack of sustainable means to obtain money for food, shelter and other necessities such as transportation to ART sites; stigma and misconceptions regarding ART; and cultural and religious beliefs that lead to misconceptions about HIV and AIDS.
According to stakeholders, these challenges are due to a complete overload of the health system. In the face of growing caseloads and a severe shortage of health care providers, the traditional clinic-centered model of ART adherence support is clearly insufficient. The task of ensuring adherence will be more comprehensive and successful if shared with the community. Unfortunately, most communities and civil society organizations currently lack the capacity, as well as systematic and sustainable strategies, to address this challenge effectively.
As the first site in Ethiopia to distribute free ART, the All African Leprosy and Rehabilitation Training Center (ALERT) is an example of the clinic-community linkages to be supported by this project. ALERT practitioners discovered that over 70% of ART patients needed social support, the absence of which could undermine ART adherence. In response to patients' needs and lack of capacity to meet those needs at the clinic level, ALERT developed links with various Civil Society Organizations (CSO) in its catchment area. Over fifty local CSO joined the ALERT network, but even this extended network faces difficulties in absorbing additional beneficiaries as most CSO have limited capacity and experience in providing HIV/AIDS care and ART adherence support. Clearly, there is a need to support capacity building of the CSO partners to enable them to provide social services to more clients, but also to complement their work by involving clients in mutual support.
Presently, the clinic-community link that characterizes the ALERT model is very important as an effective health network tool replicable in other parts of the country where such support is equally needed. It is vital to enhance the clinic-community link, while simultaneously building community capacity so as to avoid the CSO overload that occurred in the ALERT network.
In response to the needs and context reflected above, this project will improve ART adherence by linking health care services and communities, and by facilitating a community self-help strategy to reinforce adherence. Key elements of this model include: (1) Identification of CSO (NGO, PLWHA Associations, Idirs, etc.) that are committed to care and support of PLWHA through home-based or other outreach activities. (2) Placement of "Linkage Coordinators" in ART sites to screen ART clients and link individuals with CSO in their kebeles. (3) Building the capacity of these CSO by providing training to outreach workers on how to support ART adherence. (4) Provision of grants to CSO to form self-help groups among interested ART clients, and training groups. (5) Training of self-help group members as peer educators, able to reach out to new ART clients as well as HIV+ individuals who are not yet on ART, as members grow stronger due to their adherence to the ART regimen. (6) Mobilize family members of PLWHA to join self help groups and to support ART adherence
The project will be implemented in Bahirdar zone, Amhara region to create an effective network model involving six ART health centers: Estie, Durbete, Dangla, Adet, Wereta and Bahirdar health centers and the Bahirdar regional referral hospital.
During the "linkage" phase, CSO with existing home-based care programs will be identified for each of the ART sites. CSO, health center and hospital personnel will be invited to
attend workshops through which participants will better understand the importance of developing and maintaining community-clinic linkages. ALERT representatives will be invited to share their experiences with networking; participants will learn about the self-help strategy for economic empowerment and psychosocial support among PLWHA; and all will contribute to the development of action plans for establishing and maintaining community-clinic links. To support these linkages, PCI will hire and train a "Linkages Coordinator" for each of the three ART sites. These will be trained PLWHA who will receive referrals from the hospital, and link the PLWHA to CSO.
During the "capacity-building" phase, assessments of strengths and needs will be conducted with the partner CSO. Training will be provided on ART and adherence issues, as well as self-help methodology.
CSO will be supported to incorporate ART-adherence counseling into their routine outreach work, and selected CSO will be provided with mini-grants to form and provide ongoing technical assistance to self-help groups, a strategy which forms part of PCI's present PEPFAR Ethiopia-funded OVC project. "Self-help groups" will consist of 15 to 20 ART clients who will meet weekly to discuss aspects of positive living, including: living with HIV and AIDS, ART adherence, prevention of further infection, proper nutrition, exercise, etc. Groups will also participate in an economic empowerment strategy, in which they will begin to save existing financial resources, however small they may be, rather than receive external material resources. This financial discipline will eventually enable the group to provide loans to its members for micro-enterprises.
Experience in Ethiopia has shown that this self-help model fosters community self-reliance and collaboration among very poor participants. The formation of self-help groups is an ideal solution to ART adherence-barriers for many reasons, including self sustainability once established; self-help groups provide a social network of self reliance, in which members develop positive attitudes and proactive solutions rather than falling into a sense of fatalism; they are excellent forums for transmission of key messages, elimination of misconceptions about ART, and adoption of new practices because of strong mutual support and positive group peer pressure.
PCI will closely monitor the implementation self help groups and its impact on ART adherence, self reliance, stigma mitigation and involvement of family members of PLWHA in adherence support.
