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.
None provided.
Table 3.3.07:
Integrated Service Strengthening
This is a new activity at hospital level. This activity relates to Integrated Service Strengthening at health centers.
Integrated health service strengthening builds capacity for decentralized HIV services, including chronic disease management, ART and prevention requires good coordination of clinical care with the woreda or zonal health network and appropriate back-up from zonal, regional and university hospitals. The basic network consists of a hospital, health centers, health posts, and community-based health workers. These health networks have already been selected based on MOH national plans for scale-up. Scale-up of HIV prevention, care and ART at health center level is now proceeding very rapidly with efforts to link hospitals and health centers by developing regional clinical mentoring programs. See COP07 proposal for anticipated health center WHO technical assistance.
Doctors and health officers at hospital level need to be prepared for their role with compatible training materials then supported with an ongoing learning program.
Scaling up HIV care and ART requires decentralization and the active strengthening of a woreda or district network, establishment of a consultative referral and back-referral system between community, health center and hospital, and a system of supportive supervision and clinical mentoring. This requires consistent support and understanding of the planned set of interventions and the simplified, operationalized Ethiopia-adapted IMAI guidelines and training materials used at health center level and at the several levels (hospital, health center and community). Inconsistencies in approach will cause confusion and undermine attempts to extend HIV prevention, care and ART. These new clinical teams need reinforcement of what they have just learned, not contradiction due to differences in guidelines such as when to require CD4 or other laboratory testing; frequency of follow-up; or different empirical approaches to the management of common OI or STI.
Many doctors and health officers at hospital level will need to serve as clinical mentors at health center level. In this role, they will need to reinforce what has been learned in IMAI HIV care/ART training. Later, they will need to introduce any new guideline changes or additional HIV interventions, as HIV global normative guidelines then national policies changes.
The WHO IMAI/IMCI Second Level HIV Clinical Learning Program consists of an introductory training course and materials to support ongoing learning after initial in-service training, supporting both their own progressive expertise and accommodating new updates.
WHO will (1) provide technical assistance to work with the Ethiopian and the US universities to adapt and support the IMAI/IMCI Second Level HIV Clinical Learning Program. This will be done by supporting adaptation and further development of the training program with partners in Ethiopia, training of trainers, training program for clinical mentors, technical supervision of the clinical mentoring program to assure quality development of functional woreda/zonal networks (mentors and additional hospital HIV care/ART will be provided by the university contractors or quality assurance for the training and ongoing learning program; (2) provide technical assistance with career development and retention schemes for doctors and medical officers; and (3) develop clinical training videos to support both improved initial and ongoing learning.
This learning program begins with the second level in-service course (or adapted pre-service training). This course is based on initial training with the IMAI Basic Course then covers material designed specifically for district doctors. It is designed as an initial in-service training in ART and OI. It is an interactive approach to learning that includes interactions with expert patient trainers and hospital and clinic visits. The second level course does not produce HIV expert physicians or pediatricians, but doctors and medical officers competent at handling first and second line ART, OI, and TB-HIV co-infection in adults and children, and their common complications. The course focuses on the most common conditions that require management at the district hospital.
The second level learning program is framed in the public health approach to scaling up access to high quality HIV care and treatment. There are already more than 30 organizations and 15 countries involved in the iterative development process, including the US universities working at hospitals in Ethiopia- I-TECH, JHU, Columbia University, and UCSD.
Mentoring and follow-up training are integral to the IMAI approach to doctor training. Other components of the learning program include follow-up short courses, preparation for clinical mentoring and ongoing support as a mentor, clinical case book exercises, and video case presentations. These support doctors to further develop their HIV care skills and expand their knowledge. The follow-up courses help solidify existing experience and training as well as expand knowledge around a particular topic, such as pediatric ART, or TB/HIV. This will harmonize with the national approach to training with substantial benefit for the zonal/ woreda district network and the speed and efficiency of scale-up. This will lead to wider access to higher quality HIV care which can be sustained.
Each potential mentor will undergo a week's training course including how to be an effective mentor, adult participatory education skills (communication skills, active listening, giving nonjudgmental feedback), how to review cases and care effectively. They will also be provided with a set of standardized mentoring tools, including reporting forms and log books. Mentors will be expected to participate in the two-week basic IMAI clinical course in order to become completely familiar with the clinical and operational protocols used at district hospital and health centre level. Mentors will be trained to use the standardized patient monitoring system (ART follow-up form, ART and pre-ART registers) to find and review interesting cases, and to calculate simple indicators which can easily be calculated by the clinic staff or a clinical mentor during an on-site visit in order to identify, change and improve inefficient or ineffective clinical practices.
